2.   Discuss clinical decision making that is patient driven and fiscally responsible  Interpret the operational challenges and opportunities for therapy leadership in home health  Recognize the impact of regulation and payment on therapy referrals and care planning Objectives

3.   Kristin Mattson - PT  Director of Rehabilitation Development, Masonic Health Systems / Overlook Visiting Nurse Association  Dee Kornetti - PT  CEO, Co-owner, Integrity Home Health Care, Inc.  Sherry Teague - PTA  CFO, Co-Owner, Integrity Home health Care, Inc  Roshunda Drummond-Dye – JD  Director of Regulatory Affairs APTA  Moderator: Cindy Krafft - PT  President, Home Health Section APTA Our Panel

4.  After reading an article examining therapy visit distribution, the manager compares the included table to her own agency. She notices that her percentage of patients in the 0 – 5 tier is higher by 5%. She is concerned that the therapists are not doing enough visits per patient. Data Management

5.  Despite significant time and resources being spent on monitoring therapy reassessments, Andy PT did not complete one on a patient until visit #15. Looking at the schedule, Andy had made a visit to the home on #13. The supervisor wants to “correct” the error and now asks him to “fix it” by changing the documentation for visit #13. Rules and Regulations

6.  Mary works as a PT for a home health agency that utilized PTAs. She has been told that her focus will be evaluations, admissions and reassessments as well as supervisory visits per the state requirements. All follow up visits will be given to a PTA and assigned by the scheduler based on geographic location. Use of Assistants

7.  Mr. Walters is a “frequent flier” to the home health agency. He has CHF and Diabetes. He has had therapy involved in his last 3 admissions. This time the PT is upset about the referral stating “there is nothing we can do since he gets worse after every discharge and just comes back” Care Planning

8.  When answering OASIS M2200 – Therapy Need, the nurses rely on the therapists to supply a number of visits. The billing department is frustrated by the number of “downcodes” they are seeing each month because the number is “incorrect”. Data Management

9.  During a training on medication management, the PT staff assert that they are not able to complete drug regimen review as it is outside their “scope of practice”. Rules and Regulations

10.  The supervisor is frustrated due to the waiting list for PT evaluations. In addition, the PT department productivity number is below target. When reviewing schedules, the PTs are consistently booked full but the PTAs are not. Use of Assistants

11.  Melissa is a part time PT and typically works on Tuesdays and Thursdays. The agency has been discussing the idea of “frontloading” visits for certain patients but Melissa is resisting the idea. She insists it would be “too much” therapy and implies that this concept is motivated by the intent to increase therapy visits. Care Planning

12.   Kristin Matteson:  kmattson@overlook-vna.org kmattson@overlook-vna.org  Dee Kornetti:  dkornetti@homewithintegrity.com dkornetti@homewithintegrity.com  Sherry Teague:  steague@homewithintegrity.com steague@homewithintegrity.com  Roshunda Drummond-Dye:  roshundadrummond-dye@apta.org roshundadrummond-dye@apta.org  Cindy Krafft:  krafft@valuebeyondthevisit.com krafft@valuebeyondthevisit.com Contact Information

13.  References  www.apta.org www.apta.org  www.homehealthsection.org www.homehealthsection.org  www.valuebeyondthevisit.com www.valuebeyondthevisit.com