...benchmarks, strategies and ideas for improving
your agency
A service of Fazzi Associates, Inc.
November 13, 2007
Best Practice Strategies
PPS Therapy Prediction
Question: The revised
PPS model scheduled to begin on January 1, 2008 requires the admitting
clinician to identify the number of therapy visits needed in the episode.
What is the best approach to projecting the number of therapy visits?
Answer: This is an important question and one
we are being asked more as agencies prepare for OASIS item M0826, Therapy
Need, to replace item M0825. Beginning with all Medicare payment episodes
on or after January 1, 2008, therapy need will require the total number
of therapy visits provided by PT, OT, and ST for the home health payment
episode. The new OASIS item, M0826, is as follows:
(M0826) Therapy Need: In the home health plan of care for the
Medicare payment episode for which this assessment will define
a case mix group, what is the indicated need for therapy visits
(total of reasonable and necessary physical, occupational, and
speech-language pathology visits combined)? (Enter zero [“000”]
if no therapy indicated.)
(_ _ _) Number of therapy visits indicated (total of physical,
occupational and speech - language pathology combined)
NA – Not Applicable: No case mix group defined by this assessment.
Ideally, an interdisciplinary
case management discussion will occur after the initial assessment to
identify the appropriate level of care. This discussion and goal setting
would then serve as the basis for ongoing care and interventions. Otherwise,
if the agency’s visit history is valid, consider using the agency’s
past practices per diagnosis as a general guideline when a case conference
can not occur timely.
Keep in mind that it
is the individual’s functional status that ultimately determines the
level of therapy care required and not the diagnosis alone. Other than
typical orthopedic patients, reasonable and necessary visits can be
determined best by assessing how the diagnosis has impacted the patient’s
functional status combined with appropriate expectations for care.
Consider the following
best practice recommendations to help ensure the estimated therapy visits
are on target and the level of care provided correlates with the goal
for home care service:
1.
Refer
to the OASIS functional assessment in developing
the plan of care. What does it tell you about
the patient’s needs and how the PT, OT or ST
could improve the functional status?
2.
Develop
an individualized plan of care and ongoing interventions
based on reasonable and necessary services.
3.
Utilize
standards of care for all clinicians in each
discipline.
4.
Conduct
interdisciplinary case management meetings early
in the episode and then weekly.
5.
Gain
a proficient working knowledge of the home health
PPS refinement. There are many helpful conferences
and teletrainings available now for clinicians
and managers. Information about Fazzi’s upcoming
PPS training series can be accessed
here.
According to Cindy Krafft
MS PT, Senior Consultant for Fazzi Associates, too often the interventions
and visit notes do not sufficiently defend the need for the therapy
services provided to the patient. Now, reasonable and necessary language
is included in the OASIS item description and serves as an important
reminder to home health providers about this requirement. Accurate assessments
and interventions will occur if the clinician is focused on the patient’s
current functional status, prior deficits, response to treatment, and
patient/caregiver goals.
If you would like an
individualized assessment of your therapy services or are looking for
insights into building the interdisciplinary team your agency needs,
please contact Gina Mazza at gmazza@fazzi.com.
