Healthcare Reimbursement Updates

MP News

Part B Cap Exception Extended. Transition to Value-Based Service Model Continues.

Some of our rehabilitation therapy revenue is paid by the Medicare Part B program under a fee schedule. Congress has established annual caps that limit the amounts that can be paid (including deductible and coinsurance amounts) for rehabilitation therapy services rendered to any Medicare beneficiary under Medicare Part B. The Deficit Reduction Act of 2005 (DRA) added Sec. 1833(g)(5) of the Social Security Act and directed the Centers for Medicare and Medicaid Services to develop a process that allows exceptions for Medicare beneficiaries to therapy caps when continued therapy is deemed medically necessary.

healthcare-news-part-b-cap-ext-300x300Annual limitations on per beneficiary incurred expenses for outpatient therapy services under Medicare Part B are commonly referred to as “therapy caps.” All beneficiaries began a new cap year on January 1, 2015, since the therapy caps are determined on a calendar year basis. For physical therapy (PT) and speech-language pathology services (SLP) combined, the limit on incurred expenses is $1,940 in 2015. For occupational therapy (OT) services, the limit is $1,940 in 2015. Deductible and coinsurance amounts paid by the beneficiary for therapy services count toward the amount applied to the limit.

An “exceptions process” to the therapy caps was expected to expire on March 31, 2015; however, the U.S. House of Representatives and Senate each voted to extend the Cap Exceptions process through December 31, 2017. For claims exceeding the $1940 therapy caps, therapy service providers and suppliers may request an exception when one is appropriate. When using the Cap Exceptions process to continue treatment beyond the $1940, the provider is attesting that the services are reasonable and necessary and that there is documentation of medical necessity in the beneficiary’s medical record. The passage of this bill repeals the sustainable growth rate (SGR) and moves toward payment systems based on quality, but does not end the Medicare outpatient therapy cap.

Instead of a full repeal, the therapy cap exceptions process will extend until December 31, 2017. The vote on the SGR ends payment system that would have resulted in 21% reductions in Medicare Part B Fee Screen. One of the most significant features of the bill is that it sets the stage for a transition to value-based health care services, and away from the fee-for-service model. The Centers for Medicare and Medicaid Services (CMS) has submitted the CARE (Continuity Assessment/Record Evaluation) Item Set as the Functional Outcome Measure for Proposed SNF, LTACH and IRF in the Final Rule. For the SNF, it has been built into the MDS for Data Collection. By partnering with Optima Health Care Solutions, the maker of our therapy software Rehab Optima, we are one step ahead of the curve. Optima HCS has built the CARE Tool into our documentation system and was also approved as a national repository for the data because the CARE Item Set is geared toward mobility and self-care, we have also incorporated NOMS (National Outcome Measurement System) as the functional outcome measurement tool for our SLP Services. Optima HCS has also made this tool available in our documentation system. We are beginning the transition to requiring these tools as a part of our Evaluation and Discharge Process. The tools are standardized through the therapist certification in their use. These standardized measures incorporated into the evaluation and discharge process of our patients, further support the efficacy of our services and helping to position us for the ongoing changes expected in healthcare. Ensign Therapy is staying ahead of the curve!

DORs: You’re Not Alone

MP Celebrate

I want to give a big shout-out to all the DORs to remind you that you are not alone out there. Every DOR in every Ensign facility shares your struggles and wants to celebrate your successes. We do our best to be strong leaders for our teams, but we also need to remember to lean on each other when times are tough. support

What makes a strong leader? The dictionary defines a leader as one who inspires and guides others. He or she must possess certain qualities such as honesty, confidence, a good sense of humor, a positive attitude, good communication skills and intuition for reading people.

As a leader, you set the mood every day when you enter the office. Staff members feed off of the energy you exude; whether it is positive or negative is entirely up to you. Remember to take a moment before you walk through that door to put on your game face for the day. You get what you give.

You are probably the first one in the door in the morning and the last to leave at night. You try to lead by example, but not everyone realizes the time and effort it takes to stay on top of productivity, census, compliance audit updates, case mix, clinically appropriate RUGs, staffing challenges, continuing education and great outcomes in patient care. You are always on call. If you are truly honest, I bet you have worked on your computer while on vacation! (I know I am guilty.)

You work your hotlist daily and spend time analyzing reports to make sure everything is done on time. You hold your therapists accountable for their treatment minutes, paperwork, productivity and outcomes while never forgetting to provide each and every one of them with respect and encouragement, for a job well-done. One of the things I enjoy the most with my team is setting team goals together and then celebrating together as each goal is met. The importance of celebration can’t be overstated!

Remember, your therapy team is a group of highly educated professionals who can help you in your daily tasks if you delegate appropriately. Allow them to be creative in their treatment approaches, provide monthly continuing education, explore their career interests, and find new ways to assist them in advancing patient care to new levels in your facility. Ask their opinion on goals for the department in the coming year. Have them discuss the group strengths and areas for improvement. These educated people are a strong resource for all DORs when you are feeling stuck. Set your goals as a team, and your team will shine.

By Donna Black, DOR, The Courtyard Rehabilitation and Healthcare, Victoria, TX

 

Celebrate Better Hearing and Speech Month!!

MP Celebrate

For over 75 years, May has been designated as Better Hearing and Speech Month — a time to raise public awareness, knowledge, and understanding of the various forms of communication impairments to include those of hearing, speech, language, and voice. Communication impairments often affect the most vulnerable in our society — the young, the aged, and the disabled.

Helen Keller once noted that of all her impairments, she was perhaps troubled most by her lack of speech and hearing. She elaborated that while blindness separated her from things, her lack of speech and hearing separated her from people — the human connection of communication.

For a fun way to share some common speech disorders – click here for a video with our favorite Looney Tunes characters!

https://youtu.be/UASW6zSuXaE?list=PL6GgE3NLyHD6WlIsVXhi-rThjkF25f8E0

For more information on Better Hearing and Speech Month: http://www.asha.org/bhsm/

Littleton Celebrates OT Month!

MP Celebrate

Littleton Rehab’s OT team once again promoted OT Month in their facility to educate residents, staff and families. They not only hung a large informational and colorful board in the hallway, but each of the Littleton staff was given a small gift with a message about occupational therapy. The message was written by AOTA president Ginny Stoffel: “Occupational therapy addresses real, down to earth, everyday life issues. We are true to our profession when our practice results in helping people reengage in everyday life activities that hold meaning, purpose and value for them.”

What is Occupational Therapy? Spread the word!OT Month 1

Occupational therapy is the only profession that helps people across the lifespan to do the things they want and need to do through the therapeutic use of daily activities (occupations). Occupational therapy practitioners enable people of all ages to live life to its fullest by helping them promote health, and prevent-or live better with-injury, illness, or disability. Common occupational therapy interventions include helping children with disabilities to participate fully in school and social situations, helping people recovering from injury to regain skills, and providing supports for older adults experiencing physical and cognitive changes. Occupational therapy services typically include an individualized evaluation, during which the client/family and occupational therapist determine the person’s goals, customized intervention to improve the person’s ability to perform daily activities and reach the goals, and an outcomes evaluation to ensure that the goals are being met and/or make changes to the intervention plan. Occupational therapy practitioners have a holistic perspective, in which the focus is on adapting the environment and/or task to fit the person, and the person is an integral part of the therapy team. It is an evidence-based practice deeply rooted in science. Learn more at:http://www.aota.org/Conference-Events/OTMonth/what-is-OT.aspx#sthash.of9qsny6.dpuf

Working With Cognitively Impaired Patients

MP Learn

Memory loss and brain aging due to dementia and alzheimer's disease as a medical icon of a group of color changing autumn fall trees shaped as a human head losing leaves as intelligence function on a white background.

Cognitively impaired patients are described as those whose skills and abilities they had before their accident or medical problem are now either absent or have some defect that compromises their ability to function. Cognitive impairments can be caused by head trauma, neurological conditions, Dementia, anoxia, encephalopathy, etc.

Diagnostic Coding

When selecting the medical and treatment codes for this population, select the codes that best describe the change in medical condition that warrants intervention from each discipline. Avoid using the admitting diagnosis if it does not support intervention for cognitive impairments (i.e. using a hip fracture diagnosis would not be appropriate for SLP intervention).

Evaluation Considerations

Both OT and SLP scope of practice allows for assessment of cognitive/ cognitive-linguistic impairments. It is important for each discipline to differentiate how the assessment and scores will tie into their specific discipline for intervention. It is also important to use standardized assessments to further support the need for skilled intervention especially in clinical cases where the change is cognitive function is noted after a medical procedure or surgery that is not of neurological nature. Remember: Describing how the medical history impacts current functional status helps determine the circumstances that led to the need for skilled intervention.

OT Cognitive Assessments include interviewing the client / caregivers, cognitive screening, performance based assessments, environmental assessments, and specific cognitive measures, which taken together identify and describe:

  • The impact of cognitive deficits on everyday activities, social interactions, and routines. OTs assess the cognitive demands of functional activities, and design intervention plans that enhance performance through remediation or adaptation.
  • The relationship between cognitive processes and performance of daily life occupations, roles and contextual factors
  • Information processing functions carried out by the brain that include: attention, memory, executive functions, comprehension and formation of speech, calculation ability, visual perception, and praxis skills

SLP Cognitive-Linguistic Assessments are conducted to identify and describe:

  • Underlying strengths and weaknesses related to cognition, language, and social/behavioral factors (see Signs and Symptoms) that affect communication performance
  • Effects of cognitive-communication impairments on the individual’s activities and participation in ideal settings, everyday contexts, and employment settings;
  • Contextual factors that serve as barriers to or facilitators of successful communication and participation for individuals with cognitive-communication impairment;
  • The impact on quality of life for the individual and the impact on his or her family/caregivers
  • Review and include relevant case history, including medical status, education, occupation, and socioeconomic, cultural, and linguistic background
  • Assessment identifies the specific deficits along with preserved abilities and areas of relative strength in order to maximize functional independence and safety, and to address the deficits that diminish the efficiency and effectiveness of communication.

Physical Therapy will need to assess how cognitive functioning impacts their ability to participate in skilled services and what modifications / adaptations will be required for maximum progress.

Establishing Goals

Goals need to tie back to the deficits noted on evaluation and PLOF. Goals may be focused on improving safety during functional tasks and structuring care to allow the patient to perform at their best functional ability consistently during activities.

Skilled Intervention Considerations

For this patient population interventions need to be tailored to the unique needs of the individual (avoid too many electronic documentation “builds”). If the patient is instructed in tasks, include documentation that cognitive ability to learn is present. Ensure skilled interventions provided tie back to the goals identified at evaluation. The skills and techniques that can be taught to this population will not only improve the quality of their functional abilities but also improve their quality of life.

Skilled Documentation Considerations

Use terminology that reflects the clinician’s technical knowledge. Be sure to indicate the rationale (how the service relates to functional goal), type, and complexity of activity. Report objective data showing progress toward goal including: accuracy of task performance, speed of response/response latency, frequency/number of responses or occurrences, number/type of cues, and level of independence in task completion, physiological variations in the activity.

Specify feedback provided to patient/caregiver about performance (i.e. trained spouse to present two-step instructions in the home and to provide feedback to this clinician on patient’s performance). Explain the clinical decision making that resulted in modifications to treatment activities or the POC. Explain how modifications resulted in a functional change and evaluate patient’s/caregiver’s response to training.

Progress Reports

Be sure to capture patient progress and/or need for continued skilled intervention at each progress reporting period. This can be done by breaking down goals and reporting accuracy of task performance, speed of response/response latency, frequency/number of responses or occurrences, number/type of cues, level of independence in task completion, and physiological variations in the activity.

If no progress is noted, then explain why progress is expected to occur with continued treatment by listing any barriers to progress: Co morbidities, medical complexities, cognition helps justify continued services and/or explaining the “flat lines” when the goal status is the same progress report to progress report. This may also be an indication to modify the goals to better capture the patients’ functional status.

Justification Statement

This justification statement is the opportunity to further describe the need for continuation of skilled intervention. Simply stating “continue per plan” does not meet this criteria. Justification statements need to address: what skills were demonstrated/ achieved during the progress note reporting period; what deficits remain; and what is the clinician going to do about it. Strong justification statements at progress reporting periods are critical to supporting skilled intervention.

At Discharge

The discharge summary is the last documentation opportunity to support the skilled services provided. Use this opportunity to recap the patient’s status from evaluation to discharge. Summarize any programs established (i.e. functional maintenance); caregiver training; and patient’s current functioning status. Also consider providing a description of any complicating factors that impacted progress; emphasizing the skilled services and the treatment methods provided; and concluding with a brief statement of how skilled intervention has improved the patient’s function and/or quality of life.

In Summary

The need for skilled intervention must make sense; support medical necessity and tie back to the goals. It is important to ask what could happen if skilled rehabilitation services were not initiated, such as safety risks and possible further decline.

Medicare will only pay if it is clear that a therapist must provide the care that allows the patient to make progress. If the treatment seems routine or repetitive, Medicare will assume restorative could provide the treatment or the patient could spontaneously recover on their own.

By Tamala Sammons, Therapy Resource

Steps to Assessing Pain in Patients With Dementia

MP Learn

Pain scale-useAs part of the Abilities Care Approach to Dementia, the SLPs in Northern Pioneers are working to create a specialty program to better assess pain in people with dementia. The Northern Pioneers’ facilities are triggering high in the Quality Measures of pain management for long- and short-stay residents. Recently, the cluster SLPs held a skills workshop on the use of a standardized test to support this work: the FLCI, or Functional Linguistic Communication Inventory. Park View Post Acute’s Director of Rehabilitation, Jennifer Raymond, is leading this pilot program.

Overview of the Communication of Pain (COP) Assessment

The SLP program is designed as an adjunct to Abilities Care for residents with cognitive and/or communication deficits who cannot utilize the “Tell me your level of pain on a 1-10 scale” system. Referrals occur through pain committee, behavior and psychotropic committee, Abilities Care programming and Quality Measures. The program uses FLCI standardized testing to establish a patient’s communicative ability and strengths. The therapist works with the resident to establish the most effective pain scale tool that utilizes remaining abilities: reading words; ability to point; auditory comprehension at the word, phrase or sentence level; visual scanning/tracking; and verbalization. A variety of scales are available, organized in a “toolkit” and sent out by Therapy Resource Tamala Sammons. Once a successful method/scale is identified, training is completed with the charge nurse and CNAs. Nursing Care plans an individualized pain communication system, which is then used by all staff with that resident.

Research shows that negative and difficult behaviors in persons with dementia are often expressions of unmet needs that they are unable to communicate. Pain is a primary trigger for negative behavior. The pilot program is a great way for therapy to support the facility in reaching its quality-of-care goals for all residents.

By Jennifer Raymond, DOR, Park View Post Acute Care, Santa Rosa, CA

Use of Meaningful Activities to Redirect Negative Behaviors

MP Share

What if there were something besides a medication that could assist with redirecting negative behaviors? What else can we offer, after looking at basic needs — cold, hungry, in pain, needing to use the bathroom — when behaviors persist? What if we could tap into a resident’s past and provide meanConceptual image about losing your mind or thoughts.ingful activities to engage the resident and redirect their behaviors?

For Ron, that is exactly what he needed. At first glance, many said Ron was not able to attend to any task. He wandered around throughout the day, pacing the halls and knocking on the tables — a behavior the other residents and staff found annoying as he invaded personal space, knocking on the tables regardless of what was going on. Staff might be able to redirect him momentarily, but within seconds, he was back knocking away.

When we first picked up Ron for OT, there was skepticism — he won’t be able to do anything, he can’t pay attention, he doesn’t even talk. As an OT, I knew that all was not hopeless. I knew there was a way to tap into his past and engage him in meaningful activities. With a little research to find out his past interests, hobbies and jobs, and an assessment of his current cognitive level, we were able to identify activities he enjoyed and tailor them to his current cognitive level. Before we knew it, Ron was smiling and attending to tasks for over 15 minutes at a time. Who knew he could write and answer questions on paper, read a book, sit and do math worksheets or play a game of cards?

With a little staff education and a few supplies, when Ron starts knocking on the table while another resident is eating, he can be easily redirected to a meaningful activity he enjoys and can engage in — ultimately, improving his quality of life and that of those around him.

By Jeanelle Kintner, OT/R, San Marcos Rehabilitation and Healthcare, San Marcos, TX

Understanding Patients as Persons Using the Abilities Care Approach

MP Share

Northbrook 2Helen is a long-term care resident at Northbrook Healthcare Center. Initially when she was admitted, staff was having difficulty caring for Helen because of her cognition, and she was sometimes combative and anxious. When we started implementing the Abilities Care Approach to Dementia, she was one of the initial six residents enrolled in the program. Occupational Therapy identified her Allen Cognitive Level, and with the support of Social Services, we obtained her Life History Profile during an interview with Helen’s daughter, enabling us to better understand her habits, preferences and long-term memories.

By integrating what we knew from her Allen Cognitive Level and the individualized information we obtained from her life profile, we were able to train staff on how to communicate and support Helen to avoid her becoming agitated during care. Puzzles and flower arrangements were identified during the family interview as areas of past interest and skill. The therapist also identified that due to her cognitive challenges and her personality profile, large group settings were difficult for Helen, and that she had a higher quality of engagement in activities if she was by herself.

One day, Helen’s behavior had escalated, and staff wondered what happened. We thought she might be experiencing a change of condition. Upon further observation, we identified that Helen had a change in her routine related to her roommate discharging from the facility. Helen was finding it difficult to cope with this change. Having identified the situation, staff was able to use information from the Life History Profile to calm Helen and help her feel safe, preventing a potential episode of further agitation.

This situation illustrates how important it is that we not only identify the physical and cognitive functioning of our patients, but also understand them as people — what makes them happy and what makes them sad. Understanding the emotional and social component during our interventions can help us effectively approach an individual, thereby helping us to be effective clinicians. We deal with different emotions every day, whether it is happiness due to a goal being met, or sadness due to temporary loss of function or pain. These emotions are expressed by our patients, ourselves and our coworkers. Being equipped with the understanding of not only our patients’ needs, but also our own needs makes us better clinicians and much better people.

Included with this article are pictures of Helen (wearing the yellow jacket) completing her puzzles at the nurse’s station during her period of agitation. Staff was able to decrease the agitation by providing meaningful activities (adapted to meet her Best Ability to Function) that reminded Helen of the person she has always been. By engaging in a familiar task at which she could be successful, Helen gained the confidence to socialize and even got some other residents and staff to help her with the puzzles.

By JB Chua, DOR, Northbrook Healthcare Center, Willits, CA

Modified Cooking Group

MP Share

The purpose of a modified cooking group is to facilitate participation in a meaningful occupation for individuals with disabilities.

Family preparing lunch together at home

Population

  • Individuals with cognitive or physical disabilities and diagnoses such as fractures, ORIF, TKR, THR, laminectomy, CVA, Parkinson’s disease, Alzheimer’s disease and dementia
  • A modified cooking group is more appropriate for individuals who want to return to living independently

​Relevance to Therapy

  • Occupational therapists specialize in assessing for deficits in occupational performance and facilitating participation in occupations through restoration, compensation or adaptation.
  • Cooking and meal preparation is categorized under Instrumental Activities of Daily Living.
  • Cooking or meal preparation is a prerequisite for living independently with no assistance from family members, friends or caregivers.

Standardized tests can be used to evaluate cooking performance and skills related to cooking:

  • Rabideau Kitchen Evaluation – Revised
  • Kitchen Task Assessment
  • Executive Function Performance Test
  • Performance metrics include: strength, endurance, ambulation distance, gait quality, transfers, static and dynamic sitting and standing balance, gross and fine motor coordination, safety awareness, memory, sequencing skills, problem solving skills, etc.

A modified cooking program will enable therapists to:

  • Assess the patient’s ability to participate in cooking
  • Educate and train the patient in necessary skills to improve performance
  • Modify the environment or task and/or train the patient in utilizing adaptive equipment/devices to facilitate successful participation in cooking
  • Design and implement therapy exercises/activities to target specific skills required to participate in cooking
  • Recommend programs or assistance as part of discharge planning

Methods

Occupational therapists will train and educate clients in:

  • Writing down steps and checklists
  • Using energy conservation strategies
  • Using compensatory techniques
  • Delegating tasks to assistants
  • Modifying the environment for ease of access to necessary tools, supplies and working space
  • Using adaptive equipment/devices such as built-up eating and cooking utensils, long handled equipment, pan handle holder, tray mounted on a wheelchair, four wheel walker or front wheel walker, and kitchen trolley
  • Using technological devices such as analog or digital timers with sound or visual reminders, electronic can openers, digital thermometer with sound indication, cooking equipment with presets that automatically adjust for speed, time and temperature

By Ann Marie Hulse, DOR, Lemon Grove Care and Rehabilitation Center, Lemon Grove, CA

Willow Bend Wins the Flag!

MP Celebrate

Rehab_Week_2013_038 (640x480)For the first time ever, Willow Bend Nursing and Rehabilitation Center has won the most elite 2014 Ensign flag award! We are so honored and blessed to work here.

Willow Bend Nursing and Rehabilitation is a 162-bed skilled nursing facility in the heart of Mesquite, Texas. Willow Bend has been voted the best rehab in Mesquite for two years in a row. We pride ourselves on improving year after year in almost every significant measurement.

We have overcome many major hurdles, such as: 1) A brand-new skilled nursing facility opened up in between our number one referring hospital and us, and 2) We have taken on rising costs, such as hiring an additional case manager, increasing our MDS nurses from two to three and strengthening the number of employees involved in the admissions process. Despite these challenges, we have been able to increase our EBITDAR Margin. We have implemented many new programs this year to increase our employee and resident satisfaction, and we truly continue to grow as a staff. We are always striving to meet the needs of our community to remain the best SNF in our community.

Our leadership team is phenomenal! We have all directly impacted the course and future of our building and its programs:

Allen Mall, Director of Nursing: Allen became Willow Bend’s DON in 2013 and has led our facility to extraordinary clinical results. With Allen’s excellent leadership, we were able to improve our staff’s skills and education to enable us to complete our January 2015 Survey with only one low-level nursing tag. Allen has channeled his passion for nursing and the Ensign way to drive our team to strive for the excellence of an Ensign flag facility.

Allen has challenged every employee to be the very best they could be. Under his leadership, Willow Bend has been able to create a hard-working and dedicated team that truly cares for each other and our residents. Allen has helped to create a desire in employees that no matter how difficult the journey may be, we should strive to not only be one of the best within Ensign, but also the best in our community. Allen’s passion is infectious, and Willow Bend is truly blessed to have him as our DON. We are sure in the years to come that he will help our facility continually shine as a proud part of the Ensign Group.

Linda Herndon, Director of Marketing: Willow Bend is blessed to have Linda Herndon as the Director of Marketing since 2008. Willow Bend has been in the Mesquite area for over 50 years, and it did not have a good reputation. This is where Linda’s difficult job of transforming Willow Bend began. The community was not receptive because of Willow Bend’s past reputation, so Linda started developing relationships with physicians in the community. It took time to gain their confidence and give us a chance to show the level of care of which Willow Bend is capable.

The reputation began to develop and vastly improved as a result of Linda’s relationships and the great team that worked together to prove we provide quality, loving care. We all shared our peaks and valleys together, which proved to our residents, families and referral sources that the care we provided is of the highest standards. We gradually grew our skilled census from an average of less than seven residents to an average of 60 skilled residents.

Three years ago, we opened a state-of-the-art rehab unit known as The Lodge at Willow Bend, which has private rooms, private baths, and an atmosphere that encourages residents to relax and enjoy their rehab stay. Voted the best rehab in Mesquite two years in a row, we are the preferred provider for numerous physicians, churches, case managers and insurance companies. From day one, our administrator and Linda always had the vision that we would be the best in Mesquite. Our leadership team is one-of-a-kind, and we all work together as a family unit. We have all stood by each other through the ups and downs, showing what it takes to build a successful team.

Anna Boone, Director of Therapy Programs: Anna brings 22 years of experience to the Willow Bend family. Anna is a member of the Ensign Leadership Council. As a member of this elite group, she is able to help pave the path along which Ensign Therapy is moving. She is also the chairperson for the Ensign CEU committee, which focuses on the education of our therapists.

Anna leads our Rehab team to excellence in clinical, customer service and financial outcomes. Willow Bend consistently rates in the top 3 percent on the weekly trend report. Our Rehab department is unsurpassed in delivering quality patient care. Being a therapist at Willow Bend means a commitment to excellence and a devotion to continuing education, which allows us to provide the highest level of innovation to our treatment approaches.

Through our continuum-of-care approach, our therapy department follows patients from their discharge from the hospital, through their skilled stay, continuing to home health and finally outpatient services. Our unique pet therapy program puts a smile on everyone’s face. Our goal as a rehab department is to keep our residents as independent as possible for as long as possible. We own it, believe it and live it. We are blessed to have the opportunity to make a difference in people’s lives every day.

Diane Shilt, Case Manager: Willow Bend was able to create a new Case Manager position distinctly designed to grow our HMO census. Diane has been able to work with our Director of Marketing and Admissions team to grow and build relationships with Case Managers at the insurance carrier level as well as the hospital referral level. Diane has extended the networking system to increase referrals by educating and reminding fellow case managers about the unique skilled services that Willow Bend can offer.

Diane has impacted the reputation that Willow Bend has with most of the major HMO insurance carriers to be positive and support their needs. Humana has designated Willow Bend as being a Star Provider of SNF services. Before Diane was the Nurse Case Manager at Willow Bend, the average HMO census was 20 beds, and since then, the HMO census has averaged as much as 36 beds in the first year that this position was created.

Most recently, Diane has taken on the Case Manager role for all of our VA contract residents. She has ensured that Willow Bend has kept within the VA guidelines and helped obtain long-term contracts to obtain continued census. Diane has been able to impact the appeals process on a local level by researching denials on HMO carriers that need to have medical necessity in order to pay correctly. Diane has impacted the outcome studies with HMO reporting for Willow Bend and promoted the managed care guidelines of service for our facility that are necessary to ensure that we are competitive as healthcare providers in today’s market.

Yolanda Reason, MDS Coordinator: Yolanda has been able to work persistently with Willow Bend’s two other MDS nurses, Ashley Jackson and Nicole Campbell, to ensure that we capture the services rendered to our residents. Their exceptional leadership is thorough, educating our floor staff on proper documentation.

Ongoing education is necessary in efforts to capture our services provided. Yolanda recently completed a staff in-service to educate and reinforce accuracy when documenting ADL care. During our daily standup meeting, the IDT receives daily reminders about the importance of timely completion of their section(s) of the MDS. Accuracy of the MDS process is evident in our routine compliance visits. Our MDS team has worked diligently to manage as many as 62 skilled residents and 147 residents overall. Our MDS team continues to play a vital role in the financial success of Willow Bend.

Mindy Rhodes, Business Office Manager: Mindy has been Willow Bend’s Business Office Manager since March 2013. She has worked diligently with her fellow business office team members, Sheryl Porter and Rebekah Martin, to completely turn our business office around at Willow Bend for the better.

We have the highest volume of HMOs in Texas. Often, more than half of all Texas Keystone HMOs are in Willow Bend at any given time. It takes longer to collect money from HMOs than it does from other payers, such as Medicare or Medicaid. We have put systems in place to stay on top of our HMO companies to ensure follow-up happens in a timely manner so that payments can be made promptly to Willow Bend. In 2013, our percentage collected was 97 percent, and in 2014, our percentage collected was 98 percent. As a team, we have dropped our bad debt percentage from 1.89 percent in 2013 to 1.51 percent in 2014. We also had an average DSO in 2013 of 47.84. In 2014, we were able to drop this percentage to an average of 42.65; this number, when adjusted for the percentage of HMOs, represents one of the best in Keystone in the Dallas area. We strive to help our family members and residents understand everything regarding the financial portion of their stay and make the financial process as easy as possible.

Sharon Wheeler, Director of Admissions: Sharon has been with Willow Bend since March 2012. We were able to see her great potential the moment she walked through our doors, and she has gradually moved from Customer Relations Specialist and Accounts Payable to one of our most successful directors of admissions.

Willow Bend has utilized Sharon’s background and marketing and her love for organization to make our admissions process as smooth and comfortable as possible for residents, family members and employees. Sharon ensures that our up to 75 admissions a month are able to call Willow Bend their home away from home, as pain-free as possible. Sharon is aware that entering a skilled nursing facility can be scary and unnerving for many residents and families. Her excellent communication skills have helped make sure that our residents are comfortable from admit to discharge. That’s saying a lot, as we had over 750 admissions in 2014.

Waylon Howard, Director of Operations: Willow Bend is blessed to have a unique Director of Operations. Waylon began as our Director of Maintenance in 2012. Since then, he has met the facility need in several areas of administration. Waylon has morphed his Director of Maintenance position into our exceptional Director of Operations.

In addition to his Maintenance Department and Life Safety/Building Safety training duties, Waylon ensures that we are in compliance with all of our Ensign U trainings, and he facilitates our Daily PPS meetings, Weekly Skilled Medicare and Part B meetings, and Triple Check meetings. Waylon is called on daily to be our Mr. Fix-It and operates as the information source for all operation needs. Waylon is a true team player and willing to do whatever is needed for Willow Bend to be successful day in and day out.

Kevin Niccum, Executive Director: Willow Bend has been privileged to have Kevin Niccum as our Administrator since 2008. Not only has he helped our facility improve financially, but he also has instilled the idea of teamwork into our department heads and leads by example for all employees.

In 2014, Willow Bend department heads finished reading as a team The Five Dysfunctions of a Team. CAPLICO has been taught many times to our leadership team and staff, and we are excited to begin studying leadership principles. Kevin has helped ensure that Willow Bend has improved year after year in almost every significant measurement. Without Kevin’s excellent leadership, the clinical and financial outcomes could not have been achieved in 2014.

Other details of note at Willow Bend include the following:

  • We were at over 100 percent of our BHAG Goal at the end of December 2014.
  • Our facility completed our most recent Annual State survey on Jan. 9, 2015, with some of our best results yet. We have an expectation of two low-level tags.
  • We love our residents. It shows by the fact that almost all of our bread is baked fresh daily by our kitchen staff, and our vegetables are fresh, not canned or frozen.
  • We love our employees, too! Promoting culture is a way of life at Willow Bend. We hear “Benders Unite” from Kevin frequently, reminding us that we are all part of one big family working together toward the same outcomes.
  • One of the ways in which Willow Bend has addressed culture is in rewarding the staff who goes above and beyond their duties when it comes to resident or staff needs. We use a system called the WOW program to recognize our staff’s unrelenting hard work and dedication. WOW stands for Witnessed Outstanding Work, and we have cards readily available around the building so that staff, residents and families can help acknowledge the visible hard work in our building. When a staff member receives a WOW card, he or she is then invited to an employee recognition lunch where the cards are read, and the employees are thanked and congratulated and presented with a WOW card to be placed with their name badge so that everyone in the facility knows they were recognized.
  • We have expressed culture through staff and resident talent shows, using staff to assist in the decorating of common areas to create a feeling that is more like home for both the staff and residents. During our monthly all-staff meeting, we present culture in the form of in-service or games, such as the one you will find attached. Correct answers are rewarded immediately to the answering team in the form of a gift or candy to generate excitement.
  • We have a wall full of Moments of Truth, and we have an annual more prestigious award called the Pineapple Award that recognizes those who constantly show moments of truth in their everyday actions.

Here are some things we have done to promote our culture:

  • We have created neighborhoods and communities within our facility where our residents live in “households” rather than living in certain “wings” or “floors,” organized around a nurse’s station. No one is called a “patient”; rather, they are called residents.
  • Residents can wake up and go to sleep on their own schedule.
  • You’ll see our staff knock on doors before entering a resident’s room.
  • Residents have decorated their own rooms with selected belongings from home.
  • You’ll find therapy dogs coming through the home for our residents to pet, birds chirping in clean cages, aquariums in the lobby and plants placed throughout the facility.
  • Our residents order from menus.
  • We have gathering places scattered throughout the facility so residents can read, visit with each other, watch television, play games or just sit and enjoy the ambience.
  • We believe that relationships among our staff, residents and families must be continually nurtured and are vital to quality care.