Time management is essential in every workplace, and healthcare is no different. In healthcare, good time management is imperative to ensure efficient delivery of care, maintain patient safety, and prevent burnout among healthcare professionals.

We are pulled in so many directions during the course of our day, and trying different strategies will help improve the flow of our day. Look at what is stealing your time. Perhaps you didn’t know “time stealers” creep up during your workday unannounced and undetected. Reflect on your workday today and the next work task you do. Be consciously aware if a “time stealer” has wiggled into your day, and consider some of these time management strategies specifically tailored to the healthcare sector:

1. Prioritize Tasks: Healthcare professionals often have numerous tasks competing for their attention. Prioritize tasks based on urgency, importance, and patient needs. Use tools like to-do lists or task management apps to keep track of priorities. A to-do list utilizing the Eisenhower Matrix can significantly improve your to-do list.

2. Set Realistic Goals and Be Prepared: Establish achievable goals for each day or shift. If you are able, break down larger tasks into smaller, manageable steps. Setting realistic goals helps prevent feeling overwhelmed and increases productivity. Plan ahead and make sure you have everything you need to work efficiently.

3. Use Time Blocking: Allocate specific blocks of time for different types of tasks or activities. For example, designate time for patient care, documentation writing that could not be accomplished at the time the service was being provided, and administrative duties. Avoid multitasking during these dedicated time blocks to maintain focus and efficiency.

4. Minimize Interruptions: Minimize interruptions and distractions to maintain focus and productivity. It is okay to set boundaries for non-urgent communications, such as phone calls and emails, but schedule specific times to address them. Utilize tools like “Do Not Disturb” features on electronic devices when necessary.

5. Streamline Documentation: Documentation is a critical aspect of healthcare, but it can be time-consuming. Don’t wait until the end of the day to complete all or most of your documentation; you will lose the detail of each encounter with patients, taking longer to complete your documentation because you have to think back to each particular encounter. Waiting until the end of the day may increase the chance of medical record errors. Utilize point of service documentation when it is safe to do so. If point of service documentation is not safe, complete the documentation immediately following the service delivery. It is best practice to ensure you have a dedicated workspace or area to minimize distractions and improve focus. A dedicated workspace will help set boundaries.

6. Delegate Tasks Appropriately: Delegate tasks to other members of the healthcare team when appropriate. Assign tasks based on each team member’s expertise and workload capacity. Delegating non-clinical tasks, such as administrative duties, allows healthcare professionals to focus on patient care.

7. Workflow Optimization: Analyze and optimize workflows to eliminate inefficiencies and streamline processes. This may involve reorganizing tasks, adjusting staffing levels, or adopting new protocols to improve the overall flow of work.

8. Practice Effective Communication: Clear and concise communication is essential for efficient healthcare delivery. Use standardized protocols and tools for communication among healthcare team members. Ensure that information is communicated effectively to prevent misunderstandings, reduce errors, and improve productivity.

9. Take Breaks and Rest: Healthcare professionals often work long hours, leading to fatigue and decreased productivity. Encourage regular breaks and adequate rest periods to prevent burnout and maintain focus. Short breaks can help recharge and improve overall efficiency.

10. Continuous Quality Improvement: Regularly reflect on time management practices and identify opportunities for improvement. Assess what strategies are working well and what needs adjusting. Be open to feedback from colleagues and be willing to adapt to changing circumstances.

Implementing effective time management strategies in healthcare can lead to improved patient outcomes, increased job satisfaction, and better overall efficiency in healthcare delivery and organizational performance.

What is my name? I bet the folks sitting in the waiting room at my doctor’s office can tell you my name, my date of birth, my telephone number and address, and my insurance coverage, among other things. When the receptionist called my name, I stood at the counter and she proceeded to ask me for my date of birth, my telephone number, my address, confirmed physician of record, my insurance coverage, and the reason for my visit.

Was she guilty of “monkey business?”

Wait! What?!… What is “monkey business” you ask? It’s illegal or dishonest behavior. It can also include mischief, pranks, shenanigans, or the like. But for the purposes of this blog, “monkey business” is illegal behavior.

The U.S. Department of Health and Human Services (HSS) issued the Privacy Rule outlining the use and disclosure of an individual’s health information by health care providers and other covered entities. The Privacy Rule also provides standards for an individual’s privacy rights.

The Privacy Rule applies to all Protected Health Information (PHI) and Personally Identifiable Information (PII) in all forms including electronic, written, oral, and any other mode of communications. Privacy coverage of oral or verbalized PHI or PII ensures that the information is protected when discussed or read aloud from a computer screen or paper document. As health care providers, we must provide the highest level of protection of the privileged information we encounter.

What is PII?

PII is information that, when used alone or with other relevant information, can identify an individual. Below are some HIPAA personally identifiable information identifiers. This is not an all-inclusive list:

Protecting PHI and PII

The first step in protecting this information is to be aware of who is able to hear discussions. Know your surroundings and who can hear what you are saying. Ensure you are discussing information that is on a need-to-know basis with co-workers. Avoid gossiping or talking with co-workers about patients. Your co-worker may not need to know the information you are sharing, and when gossiping or talking, you risk sharing information that violates the Privacy Rule.

Your workspace or workstation is a haven of PHI and PII. Protect that area with highest regard. Avoid using your work device (laptop, tablet, etc.) for personal use. Personal online banking, social media, and non-work-related websites open you up for HIPAA breaches, not to mention those darn scammers! Work devices are for work-related activities only and not your personal use.

Close or lock your screen on your laptop or tablet when walking away from it. Shred or destroy PHI; do not throw documents in the trash. Check printers, fax machines, and copier machines often to retrieve documents. Do not leave hard copies of PHI on your desk/workstation. Lock up laptops and tablets and any PHI documents before leaving for the day.

NEVER text patient names or initials using your personal cell phone. Text messages are not secure. Gmail, Hotmail, Yahoo, AOL, and other email domains are not secure either, so avoid sending PHI and PII utilizing personal email addresses.

Let’s revisit my question from the beginning of this post: Was the receptionist guilty of “monkey business?” If you said, “yes”, you are correct! Why? Because she verbally shared not only my PHI, but she also shared, for the entire waiting room to hear, my PII.

Avoid “monkey business” during your workday. Our patients count on us to keep their information private and secure!

The Calendar 2024 Year Physician Fee Schedule Final Rule introduced three new Caregiver Training Services (CTS) CPT codes that became available for Physical Therapists, Physical Therapist Assistants, Occupational Therapists, Occupational Therapy Assistants, and Speech Language Pathologists to use on January 1, 2024. These new service codes allow for therapists/assistants to bill for caregiver training, without the patient present, for targeted patient populations. Currently, skilled caregiver training provided by therapists and assistants is billable only with the patient present.

This new regulation is an acknowledgement by The Centers for Medicare and Medicaid Services (CMS) that often times, with certain clinical patient scenarios, we may encounter situations where providing caregiver training without the patient present would improve the outcomes of the patient’s therapy plan of care. This is definitely a win for our physical, occupational, and speech therapy professions!   

Definition of a Caregiver

In the final rule, CMS has defined the caregiver, as it relates to CTS,  as “an adult family member or other individual who has a significant relationship with, and who provides a broad range of assistance to, an individual with a chronic or other health condition, disability, or functional limitation AND a family member, friend, or neighbor who provides unpaid assistance to a person with a chronic illness or disability condition”. 

These codes are not approved for telehealth. 

CPT 97550 is the initial 30 minutes of caregiver training in strategies and techniques to facilitate the patient’s function performance in the home or community. These activities include Activities of Daily Living (ADLs), Instrumental Activities of Daily Living (IADLs), transfers, mobility, communication, swallowing, feeding, problem solving, and safety practices. This service is provided without the patient present and must be face-to-face.

CPT 97551 is billed for any additional 15 minutes of caregiver training. This is an add-on code to 97550, meaning that we cannot bill 97551 separately without first billing 97550 (the initial 30 minutes of the training). CPT 97551 must be used in conjunction with CPT 97550 if caregiver training extends beyond the first 30 minutes.

CPT 97552 is the group caregiving training code. This code is used when providing caregiver training to multiple sets of caregivers, representing more than one (1) patient. Group is based on the number of patients represented, not the number of caregivers. At this time, there is no limit on the number of caregivers that can be in the group.

• 1 patient with 3 caregivers- not group.
• 2 patients each with 1 caregiver- group.

Billing

These codes are different than what we are used to with the CMS 8-minute rule. These codes pay using the AMA “Rule of Eights,” also known as “Mid-Point Rule”.

Rule of Eights – The AMA Rule of Eights follows the same principles as the CMS 8-Minute Rule. However, with the AMA Rule of Eights, it is calculated per service. The AMA Rule of Eights still counts units in 15-minute increments, but instead of combining time from multiple units, the rule is applied separately to each specific timed service; no remainder of minutes allowed. In other words, a unit of time is attained when the midpoint is passed.

These codes are “Sometimes Therapy Codes” and therefore, MPPR does not apply. However, when an assistant (OTA, PTA) bills these codes, they are subject to the assistant payment differential.

The physician fee schedule has not yet been updated to include these codes, so we are not sure yet what they will pay. We anticipate CMS will release soon. In addition, further clarification from CMS is needed as to whether or not the minutes billed from these codes can be included on the MDS.

Caregiver Training Services (CTS) Documentation Requirements:

Medical record documentation:

• Must include CTS codes (97550, 97551, 97552) on the PT, OT, ST plan of care.
• Must document patient consent: patient or their legal representative’s consent is required to be documented for caregiver training without the patient present.
• Must support “why” training should be completed without the patient present.
• Must document the need for each occurrence (in the Treatment Encounter Note) of CTS provided.
• Must describe the specific training that was provided to the caregiver(s).
• Must describe how the caregiver responded to the training.
• Must describe how the training impacts the patient’s goals.
• For group, document number of participants and details of the group training. Group is determined by the number patients represented in the group, not the number of caregivers in the group. Remember: caregivers are attending training on behalf of the patient.

As a compliance officer, I am often asked if point of service documentation is ethical or not. As therapists and assistants, our state practice acts outline our responsibilities to ensure documentation of therapy services is appropriate, justifies the course of treatment of the patient, and accurately documented in the medical record.

For example, the Ohio Board of Physical Therapy  states, “Appropriate documentation is integral to all facets of physical therapy care.”

The Florida Board of Occupational Therapy states, “Failure to keep written medical records, justifying the course of treatment of the patient, including but not limited to patient history, examination results and test results” is a violation of the practice of occupational therapy.

The Massachusetts board of Speech Language Pathology states that “Grounds for Imposition of Disciplinary Sanctions” for “failing to establish and maintain an adequate, confidential, legible, secure, and accurate written case record for each patient…”.

From a Federal level, the Medicare Benefit Policy Manual Chapter 8 and Chapter 15 discuss the requirements for nursing and therapy documentation. In the Medicare Program Integrity Manual Chapter 3 Section 3.3.2.5A states, “All services provided to beneficiaries are expected to be documented in the medical record at the time they are rendered.” This section is referring to amendments, corrections, and delayed entries in the medical record. This section of the manual also states, “Occasionally, certain entries related to services provided are not properly documented. In this event, the documentation will need to be amended, corrected, or entered after rendering the service.”

Medicare expects documentation in the medical record to be accurate, timely, and an accurate reflection of the services provided to justify why a skilled nurse and/or therapist is required to treat the patient’s condition. My question to you is this: if you provide treatment to eight patients and wait until the end of the day to document each patient, how accurate and detailed do you think your documentation will be? Will you remember the details from the treatment provided to your first patient of the day versus your last? Is there a chance for medical errors being documented?

Human error is the main reason Medical Errors occur. Perhaps those errors are because we are pulled in so many directions during the course of our workday, provider burnout, or maybe it’s something as simple as documenting timely?

I believe it is a combination of multiple reasons. But if you can control one of the contributing factors, wouldn’t you want to for your patients’ wellbeing?

A scenario to consider: Perhaps your first patient of the day has new precautions, and because you waited until the end of the day to document, you forgot to document those precautions. The therapist or nurse who is assigned to the patient the next day is not aware of those precautions and, therefore, didn’t follow them. This, in turn, resulted in a patient injury, or maybe even death in some extreme cases.

Benefits of Point of Service Documentation

• Improves detail of the entry because the information is still fresh in your mind.
• Provides an opportunity for the therapist to educate the resident and reinforce the tasks, activities, exercises, etc., while ensuring all the important data is captured accurately.
• Improves patient involvement in their care. Provides a collaborative process with the patient engaged in what you’re writing, discussing, and documenting.
• When the therapist/assistant includes the patient in the documentation process, therapists/assistants can better integrate patient feedback & their response to treatment.
• Provides an opportunity for patient education & training by the therapist/assistant.
• Promotes resident safety and quality of care.
• Improves continuity of care; Improves communication between disciplines.
• Decreases errors. If you document point of service immediately following the session, you will significantly decrease the likelihood of forgetting important information, decrease the likelihood of documenting the wrong information, and improve recall of the session.
• Improves quality of documentation. Delayed documentation lacks the specific details necessary to support the therapy services provided.
• Clear and concise therapy documentation ensures residents receive the right care at the right time.
• Assists in ensuring timely & accurate payment.
• Ensures meeting state practice act documentation requirements.
• Decreases risk of lawsuits.

One extremely important point to mention, and this one is extremely important: patient safety always comes first! If it is not safe to document at the time the services is provided, don’t! Your clinical and professional decision-making is imperative to identify whether or not point of service documentation is safe to do.

Not every patient will be appropriate for you to document at the time of service is provided, and that is okay. Be open and recognize that with some patients, it is safe to document at the time of service; with other patients, it may not be. In that case, complete the documentation immediately following the conclusion of your treatment with the patient, and prior to working with your next patient.

Thinking back to the question, “Is point of service documentation ethical?” Considering everything discussed above, my question back is you is this: “When appropriate, is it ethical not to?”

I’m not sure most people understand how important each role plays in a healthcare setting. My most recent experience is a journey my uncle experienced beginning the middle of September.

While visiting my parents and my uncle on Sunday, my dad said my uncle wasn’t doing very well. He slid off the bed twice the day before, and my dad had to pick him up off the floor. Even though my uncle is what some people will consider “feeble,” he was completely independent with all activities of daily living, showering, preparing food, driving, managing his checkbook, and paying bills online. He was even a community ambulator without an assistive device.

This particular day, and the events that followed, were concerning to me.

When I went into my uncle’s room, he was attempting to get out of bed and was barely sitting on the edge. He complained of left leg pain. He was unable to stand or sit, and he was barely verbalizing anything. We lifted him back into bed, and I took his blood pressure, 220/197. We called the paramedics, and they reported that my uncle was in atrial fibrillation. Atrial fibrillation is something new for him.

After 8 hours of assessments by multiple healthcare personnel in the emergency department, he was admitted. He was clearly hallucinating and confused. The next day, I arrived at the hospital looking for the results from the Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiography (MRA) that they attempted to do the night before.

Unfortunately, my uncle was confused and combative and was not participatory in any Magnetic Resonance studies. Therapy was not in to see him at all on Monday, and the nurse reported that they would start tomorrow.

The Real Diagnosis

Jumping ahead to Day 3 of his hospital stay, the nurse came in to care for my uncle. I asked the nurse if they received the results yet from the MRI and MRA because we had not heard anything. The nurse informed me that they did have the results from the MRI, which confirmed that he had a stroke in the right cerebellum area of his brain. The nurse also said that my uncle coughed when taking his medications, so speech therapy was going to come in and do a bedside swallow exam.

On hospital admission Day 4, to my surprise, my uncle was sitting up in bed more alert and oriented. I asked him if he knew where he was, and he did know the name of the hospital. I also asked him if he knew why he was in the hospital, and he said for therapy. I then explained to my uncle that the MRI that was done confirmed that he had a stroke. I asked him if he had any questions, and he said no.

The neurologist walked in and asked me if I knew the results of the MRI. I told him yes, and he proceeded to tell me the extent of his stroke, and they were determining the cause. He said that the atrial fibrillation most likely caused the stroke, but they were waiting for the MRA results.

Later that same day, the cardiologist visited and informed me and my uncle that there is no evidence of atrial fibrillation. He said that my uncle has been in normal sinus rhythm with no evidence of atrial fibrillation since he came into the emergency department. The heart monitor continues to confirm no atrial fibrillation. The cardiologist said that he feels atrial fibrillation was a misdiagnosis. The plan was that they would continue to keep him on the heart monitor 30 days post hospital discharge, to see if perhaps he was going in and out of atrial fibrillation.

Physical therapy (PT) and occupational therapy (OT) continued to see my uncle in the hospital for the remaining days, and the planned discharge to a skilled nursing facility (SNF) was set for Saturday. My mom and I toured two five-star facilities listed in our area on the Medicare Care Compare website. I also reviewed the most recent nursing home survey results. The SNF of our choice would not accept him as a patient. Our second choice did accept him, and he was admitted.

The Care Conference

During his stay at the SNF, I found it very odd that the PT and OT interventions were not what I would expect to see for a stroke patient. I started to question my mom to see if anyone from therapy met with her. There had been no communication with her, and she was there at the SNF for 8 to 10 hours daily.

I asked her to speak to the social worker to see when they were planning on having the care plan meeting. The care conference took place on Friday, six days after his SNF admission. During the care conference, we learned that therapy was planning on discharging my uncle home on Tuesday, just 10 days following his admission to the SNF. The social worker explained that my uncle’s insurance company will not pay past Tuesday. I asked what insurance they are billing under, and they proceeded to tell me the Medicare regulations for therapy coverage in a SNF.

Now, you may be laughing at this because I am a Corporate Compliance Officer certified in healthcare compliance. Nonetheless, I listened to her explain the regulations and then I said he has Medicare, so it’s not the insurance company that is cutting him, it’s the facility. I then stated and asked the question, ”You’re telling me that his condition no longer requires the skills of a nurse or therapist after Tuesday, right?” And they said “yes.”

The Director of Rehab provided my uncle, my mom, and I, a thorough update on his progress. I asked if OT had trained him on safe and effective showering and I was informed “no.” I also asked if my uncle received any cognitive retraining, and I was informed that his diagnosis didn’t support cognitive retraining. I then asked, since my uncle is returning home in a few days, wouldn’t it be a good idea for him to be trained how to take a shower safely and effectively? The Director of Rehab informed me that she will ask the Occupational Therapist if they could work on a shower before he returns home. I then explained to the social worker and their Director of Rehab that my uncle had a stroke, and I would expect more therapy involvement to work on his underlying impairments that are still present. The Director of Rehab informed me that his primary diagnosis is not a stroke, but a heart condition. I explained to her that the Atrial Fibrillation diagnosis was not accurate, and that the neurologist confirmed the MRI revealed a right cerebellar stroke. She disagreed with me and said that the information in the record is a heart condition.

Highly annoyed, I could not wait for my uncle to be discharged home. After the care conference, I asked my mom if she was planning on obtaining my uncle’s medical records from the hospital. She said she already did! I was happy to hear that for sure. My uncle was discharged home, with a Home Health diagnosis of Atrial Fibrillation. The same inaccurate documentation the SNF received from the hospital is the same documentation the SNF sent to the Home Health Agency.

Play Fetch!

Question for you: If a family member tells you that their loved one had a stroke and you, as a care provider, had no evidence in the medical records from the hospital of a stroke, would you explore the validity of that comment from the family member? Would you call the hospital and ask for the MRI results?

Outcome

Let’s look at this misdiagnosis journey. The diagnosis of a Right Cerebellar Stroke never made it in the medical records sent to the SNF, nor did they make it to the home health agency either. My uncle’s care pathway did not meet his condition. At the time of SNF discharge, my uncle’s condition absolutely did require the skills of a therapist! The care team missed an opportunity to deliver five-star care excellence to a fresh stroke patient!

• He never learned safe and effective showering techniques in therapy at the SNF.
• He did not have compensatory strategies for short term memory loss, and as a result, requires care from my mom and dad.
• He is not able to drive. He did not renew his driver’s license and his car has been sold.
• He needs reminders to drink fluids and to take his medications.
• He no longer can pay bills, manage his checkbook, and prepare his own meals.
• His quality of life is nowhere close to what it should be.

As a care provider, I see my uncle’s case not as a diagnosis, but rather, a once independent man who is no longer independent. My uncle was the perfect stroke patient, with excellent rehab potential, and an appropriate comprehensive therapeutic clinical pathway that met his needs would have benefited him tremendously.

Never underestimate what a family member brings to the table.

The SNF is not 100% to blame, of course. Our industry health information technology failed. It failed then and it is failing right now as you are reading my story. It must change!

If we had medical records that crossed the care continuum lines, the SNF and home health teams would have had at their fingertips, immediate access to my uncle’s hospital records, his MRI results, the cardiologist’s report, and the neurologist’s report….everything.

I read the entire 632 pages of my uncle’s hospital medical record. All throughout the record, Acute CVA was the admitting hospital diagnosis, “Acute Infarct in the Cerebella’s artery territory,” to be exact.

On the PDPM side of things: Atrial Fibrillation vs. CVA…I wonder what his BIMS score was in the SNF. Think about the SNFs missed revenue opportunities. Oh well, I threw them a bone…. they must not like to play fetch.

For a copy of the full story, please contact Gina at gelkins@fprehab.com

On May 1, 2023, the Center for Clinical Standards and Quality/Quality, Safety & Oversight Group issued Guidance to State Survey Agency Directors. This guidance covers multiple settings, including Long Term Care Facilities (Skilled Nursing Facilities (SNFs) and/or Nursing Facilities (NFs)) starting on Page 3. Below is the information all SNFs need to be made aware of:

1. 3-Day Prior Hospitalization Waiver Expires: all new SNF stays beginning on or after May 12th will require a qualifying hospital stay before Medicare coverage.
2. 60-Day Wellness Period Waiver Expires: For any new benefit period that begins on or after May 12th, the beneficiary will need to have completed a 60-day wellness period.
3. Alcohol-based Hand-Rub (ABHR) Dispensers Waiver Expires: CMS waived the requirement for ABHR dispensers for SNF/NFs at 42 CFR 483.90(a) during the PHE because of the need for the sudden increased use by staff and others of ABHR in infection control. The waiver of this requirement ends with the conclusion of the PHE.
4. Preadmission Screening and Annual Resident Review: (PASARR) Waiver Expires: CMS allowed nursing homes to admit new residents who have not received a Level I or Level II Preadmission Screening. CMS expects all providers to be in compliance with the requirements for PASARR with all admissions taking place after May 11, 2023.
5. Resident Roommates and Grouping Waiver Expires: CMS waived the requirements in 42 CFR 483.10(e)(5) and (7) solely for the purposes of grouping or cohorting residents with respiratory illness symptoms and/or residents with a confirmed diagnosis of COVID-19 and separating them from residents who are asymptomatic or tested negative for COVID-19. This waiver of these requirements ends with the conclusion of the PHE (note that Section (e)(6) was terminated on 05/10/2021 per QSO-21-17-NH).
6. Resident Transfer and Discharge Waiver Expires: CMS waived requirements of facility to provide advance notification of options relating to the transfer/discharge to another facility; the written notice of transfer or discharge to be provided before the transfer or discharge. This notice must be provided as soon as practicable (with some exceptions); to allow a long-term care (LTC) facility to transfer or discharge residents to another LTC facility solely for cohorting purposes. This waiver of these requirements ends with the conclusion of the PHE. (note that 483.10 (e)(3) was terminated on 05/10/2021 per  QSO-21-17-NH).
7. Nurse Aide Training Competency and Evaluation Programs (NATCEP) Waiver Expires: CMS waived the requirements which require that a SNF and NF may not employ anyone for longer than four months unless they met the training and certification requirements. CMS provided additional guidance for this waiver with the release of QSO-21-17-NH. CMS memorandum QSO-22-15-NH & NLTC & LSC terminated this blanket waiver, however, individual states and facilities could apply for a separate time-limited waiver of these requirements for instances where the volume of nurse aides that must complete a state-approved NATCEP exceeded the availability of approved training and testing programs. All individual waivers granted to states and individual facilities will terminate at the conclusion of the PHE, unless a facility or state has been granted a waiver that expires prior to the end of PHE. Uncertified nurse aides working in a Long Term Care facility covered by a waiver granted to a state or individual facility will have 4 months from the date the PHE ends (or from the termination date of the facility’s or state’s waiver, if earlier) to complete a state-approved NATCEP program. This includes those LTC care facilities, or facilities in states that were granted an extension of the waiver after October 6, 2022.
8. Requirements for Reporting related to COVID-19: Not all of these requirements expire. CMS is exercising enforcement discretion and will not expect providers to meet the requirements at 42 CFR 483.80(g)(3) at this time. All other reporting requirements referenced remain in effect until December 31, 2024.
   • 42 CFR 483.80(g)(3): Inform residents, their representatives, and families of those residing in facilities by 5 p.m. the next calendar day following the occurrence of either a single confirmed infection of COVID–19 or three or more residents or staff with new-onset of respiratory symptoms occurring within 72 hours of each other.
9. Requirements for COVID-19 Testing Expires: Testing regulation will expire with the end of the PHE, as noted in the IFC CMS-3414-IFC.

Source Document: Guidance for the Expiration of the COVID-19 Public Health Emergency (PHE) (cms.gov)

What would you do if a school-aged child, or even a teenager, came to you and said they are behind with their homework?

What would you do if a resident or patient came to you and said that they need physical help to get their shoes on, help to the bathroom, or help to get dressed?

What would you do if a primary care family member came to you and said that they are overwhelmed, are exhausted, and just cannot catch up?

You would help, right? We are all caregivers, that’s what we do. We help those who need help.

We help others in need the best way we can, so why is it so hard for us to ask for help? Why is it hard for us to admit that we are behind, overwhelmed, or even on the brink of losing it? Hey! Guess what?

You…are…human!

Shhhhhh, don’t tell anyone I told you, but human beings are not perfect. We make mistakes, we need help, we get overwhelmed and behind in our work. Telling someone who can help is not a sign of weakness or a notion that you cannot do your job; it is plain and simple — a sign that you are human, and that, my friend, is a person I want to work alongside of.

Admitting that we need help, we are overwhelmed, in over our heads, stressed, behind, tired, or lost (you fill in the blank) is a sign of strength, not weakness. It is okay to be in a place where you need help. I mean seriously! We tell our patients on a daily basis that it is okay to use an assistive device, compensatory strategies, thicken liquids, a walker, or even a splint or brace. Yet, we don’t listen to our own advice. Why?

I think it is plain and simple…we don’t like to have to admit when we are wrong, need help, or admit that we hadn’t considered a perspective opposite of our own. The problem is that we hide our mistakes, don’t hold ourselves accountable, blame others or circumstances, and maybe we even withdraw. That is the human part of being human that will make people not trust us and not believe us, and surely question our integrity, work ethic, and ability to perform our job role.

How do you overcome the human side of being human?

In my professional life, I revert back to Functional Pathways’ core Values and Fundamentals. These Values and Fundamentals guide us on how to be an elite employee. With these as my foundation, the next step is letting down my guard and allowing myself to be vulnerable.

It is extremely hard to admit when we’re wrong, to take responsibility when we’ve messed up, and even when we do not do what we say we’re going to do, but own it anyway! Start small, admit when you’re wrong, and grow. I’ve always said that when things are easy and without difficulty, we stay status quo. It’s when things get tough, burdensome, or difficult, that’s when we grow the most! Embrace the difficult times; your growth depends on it.

……And while you are growing, know that it’s okay to get overwhelmed and behind. Ask for help! Escalate the problem, because help is just a phone call, a text message, or an email away. You are a part of the FP family, which includes our client partners, and we support one another every day, all the time

Always.

The phrase “to judge a book by its cover” is described by “Word Histories, ‘TO JUDGE A BOOK BY ITS COVER’: MEANING AND ORIGIN” as “Of American-English origin, the phrase to judge a book by its cover, and its variants, mean to make assumptions about someone or something based on appearance or on superficial characteristics.”

We are all guilty of this, aren’t we? Unfortunately, too often than not we do, even if it is just for a split second, and we try not to do this.

Last time I wrote about my mother’s beautiful hands. On the outside of those hands, you could see signs of aging and arthritis. But underneath, the stories those hands could tell would be magnificent!

This blog will talk about judging others without even realizing it. I am not writing this to cast blame, but rather for self-reflection. We do not intentionally do this. It is just human nature. Let me explain by telling you a story.

My husband and I had to take our car in for service, and we dropped it off and took our other vehicle to a local family restaurant for breakfast on an early Saturday morning. When we walked into the side dining room, there was a very long table with approximately 33 men and two women sitting there, and they all had leather jackets and vests on. I felt intimidated initially when I saw them all sitting there. Yet I have always been fascinated with motorcycle riders and all of their colors.

My husband and I looked over the menu and ordered, and then we sat and talked about what we were going to do on that beautiful Saturday morning after the car received its oil change. At one point I looked at my phone because I received a text message, and then once I looked back at my husband, he said to me, “Look honey, those two men have their Bibles out,” as he was discreetly pointing over to the long table of riders.

My heart dropped. I then felt like that smashed, stepped-on spilled egg on the floor. I felt awful for what I thought in my head when I first walked into that room.

When looking at their colors and patches on their leather, I realized that they were a Christian riders’ group, and as stated on their website, their vision is “changing the world, one heart at a time”. Boy, did that pierce my heart because of my initial interpretation of them.

At the top of the hour, one of the men said, “It’s time to begin.” Then they had their group meeting, which started with them stating, with their hands over their heart, reciting the Pledge of Allegiance, hands folded reciting a pledge to Christ, followed by a pledge to their association.

For most of you who know me, I can be a pretty emotional person. When something speaks directly to my heart, as this did, I simply get emotional. This moment took my breath away because in the midst of a dining room full of patrons, these intimidating-looking men were changing hearts…mine included.

So….have you ever judged a book by its cover? Have you ever looked at someone and immediately have an interpretation or an opinion about them? Have you ever seen someone with tattoos, or piercings on their face, or hair color that is not of a natural color? Most of us probably have seen and interpreted as such. I often wonder, how people interpret me since I do have a “mad resting face.” My mad resting face makes me look like I am mad, I’m not enjoying myself, I’m not approachable, or I’m just not a happy person. (fill in the negative thought here).

Have we ever looked that our patients that way? Whoa!…What?!? Yes, have we? What I mean by that is, have you ever received a new admission and the patient is angry, combative, confused, just not our “ideal vision of a patient?” Perhaps. Or maybe we see the shell of a patient who is dying of cancer, has a traumatic brain injury, or Alzheimer’s Disease. Do we ever say to ourselves, or to our teammates, “They are never going to go home…” or “They are never going to get better…”, or “I can see we are going to have our work cut out for us in therapy; I don’t think they will even participate”, or anything like that?

We have to remember that what we see on the outside, most likely is not what actually is. We have to explore the patient’s medical history, their psychosocial history, their living environment, and how they function in their community. Just because we had them in therapy before, or we “know the resident well,” does not give us the authority to determine whether a thorough screen or evaluation is needed or not, based only off our own judgements. Do we dismiss a patient’s access to care, simply because they are a “frequent flyer,” or because she is in her 80s, or because he has Alzheimer’s?

We must read the book and not simply judge it by its cover.

Gina Elkins has over 27 years of Post-Acute Care experience not only as a Licensed Physical Therapist Assistant but also as a multi-site rehab operations manager. Gina holds a certification in Health Care Compliance and is an Officer of Healthcare Compliance, Certified. Gina serves as Functional Pathways’ Senior Director of Compliance and Regulatory Strategy, Privacy Officer.

This article is original content by Gina Elkins and may not be shared, modified, or reproduced without written consent of Gina Elkins gelkins@fprehab.com.

These hands: just imagine what they have done over the years and now show signs of aging.

These hands bathed me, dressed me, nursed me, washed, combed, and blew dry my hair. These hands paid bills, packed my lunch, laundered my clothes, and picked me up and held me when I was sad.

These hands took care of her dying mother, cared for her dying father, and now take care of her brother. These hands painted ceramic figurines in the 70s, held a tennis racket, covered me with sunscreen in the dog days of summer so I would not sunburn, held playing cards, bingo daubers, church missalettes, and the Eucharist during communion.

These hands cooked my meals, did the grocery shopping, and held my father’s hand as they walked down the street. These hands packed a tunneling wound, flushed a feeding tube, and gently caressed the painful extremity of a loved one.

These hands used one of the first microwaves, cell phones, and remote-controlled televisions. These hands cared for my daughter and my son, my niece, and my sister.

These hands effectively and efficiently organized medical records for 30+ years. These hands held mine in the darkest days in my life, and these hands prayed every day for everyone she could, but not herself.

These hands now have difficulty holding cups, pens, scissors, laundry basket handles, pot and pan handles, and the vacuum cleaner handle.

These hands have painful joints and a frozen thumb. These hands have crooked fingers, making typing slower and sometimes impossible.

These hands make it difficult to open jars, disposable water bottle caps, pick up small objects, and manage snaps and buttons.

These hands no longer look youthful. She says they look ugly, but I tell her that I think her hands are beautiful. The stories these hands could tell us if they could talk…. THESE hands!

Never underestimate the role an occupational therapist and occupational therapy assistant can have on these hands. With their help, these hands can continue to write her story.

These hands…

For more information on what Occupational Therapy can do for your hands, please contact PEAK Senior living via phone (844-690-2330) or email (mhorn@fprehab.com).

Gina Elkins has over 27 years of Post-Acute Care experience not only as a Licensed Physical Therapist Assistant but also as a multi-site rehab operations manager. Gina holds a certification in Health Care Compliance and is an Officer of Healthcare Compliance, Certified. Gina serves as Functional Pathways’ Senior Director of Compliance and Regulatory Strategy, Privacy Officer.

This article is original content by Gina Elkins and may not be shared, modified, or reproduced without written consent of Gina Elkins gelkins@fprehab.com.

On November 1st, 2022, the Centers for Medicare and Medicaid Services (CMS) issued the calendar year (CY) 2023 physician fee schedule (PFS) final rule. Below is a high level overview of some of the information taken directly from the CMS CY 2023 Fact Sheet.

CY 2023 PFS Rate Setting and Conversion Factor

Budget neutrality adjustments are required by law to ensure payment rates for individual services don’t result in changes to estimated Medicare spending. The required statutory update to the conversion factor for CY 2023 of 0%, and the expiration of the 3% supplemental increase to PFS payments for CY 2022, the final CY 2023 PFS conversion factor is $33.06, a decrease of $1.55 to the CY 2022 PFS conversion factor of $34.61.

Telehealth Services

For CY 2023, CMS finalized a number of policies related to Medicare telehealth services, including making several services that are temporarily available as telehealth services for the PHE available at least through CY 2023 in order to allow additional time for the collection of data that may support their inclusion as permanent additions to the Medicare Telehealth Services List.

CMS finalized their proposal to extend the duration of time that services are temporarily included on the telehealth services list during the PHE for at least a period of 151 days following the end of the PHE, in alignment with the Consolidated Appropriations Act, 2022 (CAA, 2022). This finalization includes:

• Allowing telehealth services to be furnished in any geographic area and in any originating site setting (including the beneficiary’s home);
• Allowing certain services to be furnished via audio-only telecommunications systems; and
• Allowing physical therapists, occupational therapists, speech-language pathologists, and audiologists to furnish telehealth services.

Chronic Pain Management and Treatment Services (CPM)

CMS finalized new HCPCS codes, G3002 and G3003, and valuation for chronic pain management and treatment services (CPM) for CY 2023. CMS believes the CPM HCPCS codes will improve payment accuracy for these services, prompt more practitioners to welcome Medicare beneficiaries with chronic pain into their practices, and encourage practitioners already treating Medicare beneficiaries who have chronic pain to spend the time to help them manage their condition within a trusting, supportive, and ongoing care partnership.

The finalized codes include a bundle of services furnished during a month that CMS believes to be the starting point for holistic chronic pain care, aligned with similar bundled services in Medicare, such as those furnished to people with suspected dementia or substance use disorders. CMS has finalized the CPM codes to include the following elements in the code descriptor:

• diagnosis;
• assessment and monitoring;
• administration of a validated pain rating scale or tool;
• the development, implementation, revision, and/or maintenance of a person-centered care plan that includes strengths, goals, clinical needs, and desired outcomes;
• overall treatment management;
• facilitation and coordination of any necessary behavioral health treatment;
• medication management;
• pain and health literacy counseling;
• any necessary chronic pain related crisis care; and
• ongoing communication and coordination between relevant practitioners furnishing care, such as physical and occupational therapy, complementary and integrative care approaches, and community-based care, as appropriate.

Audiology Services

CMS finalized a policy to allow beneficiaries direct access to an audiologist without an order from a physician or NPP for non-acute hearing conditions. The finalized policy will use a new modifier ─ instead of using a new HCPCS G-code as we proposed ─ because CMS was persuaded by the commenters that a modifier would allow for better accuracy of reporting and reduce burden for audiologist.

The service(s) can be billed using the codes audiologists already use with the new modifier and include only those personally furnished by the audiologist. The finalized direct access policy will allow beneficiaries to receive care for non-acute hearing assessments that are unrelated to disequilibrium, hearing aids, or examinations for the purpose of prescribing, fitting, or changing hearing aids. This modification in CMS’ finalized policy necessitates multiple changes to our claims processing systems, which will take some time to fully operationalize, but audiologists may use modifier AB, along with the finalized list of 36 CPT codes, for dates of service on and after January 1, 2023.

CMS finalized the proposal to permit audiologists to bill for this direct access (without a physician or practitioner order) once every 12 months per beneficiary. Medically reasonable and necessary tests ordered by a physician or other practitioner and personally provided by audiologists will not be affected by the direct access policy, including the modifier and frequency limitation.  

Some other final rule information include: See CMS CY 2023 Fact Sheet for more information:

Evaluation and Management (E/M) Visits

Behavioral Health Services

Opioid Treatment Programs (OTPs)

Dental and Oral Health Services

Skin Substitutes

Colorectal Cancer Screening

Preventive Vaccine Administration Services

Source Document: CMS CY 2023 Fact Sheet