Harmony Healthcare Blog

Chronic Disease Management in the Skilled Nursing Facility Population

Posted by Kris Mastrangelo on Tue, Aug 26, 2014

While there is a great deal of focus on the management of post acute patients in the SNF population, many of whom will return to the community, management of long term care patients is equally essential to the provision of services along the continuum of care.  According to CMS regulations, long term care patients have a right to function at their highest practicable level, including the delivery of services to slow the progression of decline, as long as these services meet the definition of skilled criteria.

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Topics: ADL Coding, Skilled Therapy

Keep Dementia Training Front of Mind

Posted by Kris Mastrangelo on Fri, Jun 13, 2014

Keep Dementia Training Front of Mind:  Harmony often discusses clinical review of individual patient interventions with the rehabilitation and nursing team regarding identification, assessment, and management of patients with advanced dementia.  While treatment of low functioning, demented, or long term patients is challenging, Harmony believes that with increased training regarding targeted strategies, this particular group of residents will benefit greatly from skilled interventions. There are three levels of Rehabilitation that meets skilled criteria in the SNF setting.

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Topics: SNF, Therapy, Nursing, Dementia, Skilled Nursing, Skilled Therapy, Rehabilitation, Alzheimer's, patient intervention

Therapy Screening Techniques: The Critical Role of the Nurse

Posted by Kris Mastrangelo on Wed, May 14, 2014

While there is a great deal of focus on the management of post-acute patients in the SNF population, many of whom will return to the community, management of long term care patients is equally essential to the provision of services along the continuum of care. According to CMS regulations, long term care patients have a right to function at their highest practicable level, including the delivery of services to slow the progression of decline, as long as these services meet the definition of skilled criteria. In order for these services to be skilled, they must be considered reasonable and necessary and require the skills, knowledge, and judgment of a licensed qualified professional based on their inherent complexity. 

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Topics: Therapy Documentation, Skilled Therapy, Skilled Nursing Documentation, Care Planning

Skilled Therapy Documentation The Importance of Weekly Progress Notes

Posted by Kris Mastrangelo on Fri, Mar 28, 2014

Increased efforts to audit Medicare records by Medicare Administrative Contractors (MACs), as well as other subcontractors of CMS, should make all providers very conscientious regarding skilled documentation that without question supports the need for daily skilled care.  

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Topics: Therapy Documentation, Documentation, Skilled Therapy

Nurses Rule the World

Posted by Kris Mastrangelo on Sun, Aug 11, 2013

For those of you that have heard me speak about Medicare, Therapy, Case Mix, MDS, PPS or simply my four daughters, there probably has never been a session that I do not utter my favorite words that “Nurses Rule the World!”  Being intimately familiar with the day-to-day tasks (or should I say night-to-night tasks, as well) of patient care, medication administration, documentation, physician interactions, family discussions, caregiver communication, and so on, only one in the healthcare field sees the heart, sweat and tears this profession renders to their patient caseload.  Too often, the value of the nursing profession is taken for granted, especially when they do their job well.  Frequently, the field underestimates the complexity and finesse required to successfully care for the geriatric patient.

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Topics: Medicare Part A, Skilled Therapy, Skilled Nursing Documentation, Skilled Nursing Facility

Medicare Part A Benefits and The Challenging Patient

Posted by Peter Mastrangelo on Fri, Apr 20, 2012

Goals for Challenging Patients - Medicare Minute

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Topics: Skilled Therapy, Medicare Part A, Medicare Part B

Rehab Goal Setting

Posted by Elisa Bovee on Wed, May 26, 2010

Rehab Goal Setting
 
Rehab documentation should always show the benefit they are having toward the patient's overall function. 
 
Measurable progress should be shown, and rehab goals should be specific to the patient. Short-term goals should have greater detail and be measurable.  Harmony recommends identifying what the patient must be able to do in order to return home safely. Patients may be able to perform activities independently while participating in skilled therapy sessions but may not be well conditioned enough to perform these activities repeatedly at home. 
 
 
Patients do certain activities repeatedly at home, for example: 
 
Consider how many times a patient must stand up and walk to the bathroom during the day and at night
How long can the patient stand to perform basic bathing and grooming tasks? 
Is the patient able to stand and prepare an entire meal?
How far can a patient walk down store isles; can they bend repeatedly to collect the items in their basket?
How far is the mailbox from a patient's front door of their home or apartment? 
 
Barriers identified that impede progress should be stated positively and the therapist should identify what they are doing to compensate for the barrier.  Stating the patient has made slow gains does not demonstrate the positive outcomes that have resulted thus far from skilled therapy intervention. Harmony recommends each therapy progress note contains a positive comment or outcome for each goal area that is a direct result of skilled therapy intervention.

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Topics: Rehab Goal Setting, Skilled Therapy

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