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PDGM Therapy: Is PT Always Indicated for a M1860 Mobility Deficit?

Posted by Melissa Cott on Feb 10, 2020

When a mobility deficit is recorded on OASIS D’s M1860 is physical therapy always indicated?

Elimination of OASIS D Therapy Threshold Creates Reimbursement Restrictions

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As of January 1, 2020, home health agencies can no longer establish a number of therapy visits that they know will  be reimbursed by Medicare. HHAs that provide therapy now must determine if therapy will be provided at the expense of other services such as skilled nursing or home health aide.

Consequentially it’s more important – than ever – to have some parameters by which an HHA will provide therapy – or not.  Since providing therapy is often done at the expense of other services (typically the cost of therapy is more than nursing or home health aide) it’s important to have some ‘ground rules’ for providing therapy to make sure its benefiting the patient and allowing the Agency to still make a profit on the episode.

The Patient HAS Rehabilitation Potential.

Physical Therapy is Probably Indicated When Prior Function is Better than Current Function.

First, review OASIS D GG0100B and GG0100C.

If prior mobility/stair functionality was BETTER than the patient’s CURRENT mobility/stair functionality, therapy is probably indicated.  For example. If the patient’s PRIOR ability for GG0100C Stairs is a “3” - independent, and the patient’s CURRENT ability on the Start of Care OASIS D assessment is...

“2 - Requires use of a two-handed device (for example, walker or crutches) to walk alone on a level surface and/or requires human supervision or assistance to negotiate stairs or steps or uneven surfaces”

...assisting the patient to recover to PRIOR levels is justified.

OASIS-D-M1860-AmbulationThe Patient Does NOT Have Rehabilitation Potential.

What if Prior Function is the Same or Worse than Current Function?

The patient HAS a daytime caregiver. If the patient has a daytime caregiver and current function is the same or better than prior function, we recommend considering NOT providing physical therapy for a chronic mobility deficit.  Since there is little or no rehabilitation potential, providing critical resources to a patient that will experience little or no benefit would not be recommended. If there is a new caregiver that would benefit from mobility-assistance strategies, consider putting in 1-3 therapy visits for caregiver training.

The patient does NOT have a daytime caregiver. We recommend considering maintenance therapy if the patient is alone during the day – i.e. there is no available caregiver to assist the patient with mobility during daytime hours and, according to a physical therapist who has assessed the patient, decline in ability is likely without skilled maintenance.

Best Practice Skilled Nursing Assessment Strategies for Gait & Mobility

  • Assess for obstacles in the home that are preventing safe mobility.
  • Assess presence and/or level of pain affecting mobility.
  • Assess the patient's strength, joint ROM, endurance and their effect on safe mobility.
  • Assess input, output and nutritional pattern and their effect on mobility.
  • Evaluate the patient's use of assistive devices and if training is needed.
  • Assess the patient’s or caregiver’s understanding of immobility and its implications.
  • Check for skin integrity for signs of redness and tissue ischemia (especially over ears, shoulders, elbows, sacrum, hips, heels, ankles, and toes).
  • Note elimination status (e.g., usual pattern, present patterns, signs of constipation).

 

For more information on Medicare's Home Health Care Quality Indicators click here.

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