Rehab Physical Medicine

CARF Preparation, Physician Education, Rehab Physical Medicine

Well here we go into a new year! It seems as though I just got used to writing 2013! Now I have to work on 2014! Cheers to cognitive flexibility and learning!

The last discussion of 2013 was about vision statements that answer the question of “Why we are here?” As your organization embraces CARF preparation it is important to understand where the mission statement and core values fit in. So, let’s explore the mission statement and core values.

The mission statement talks about the present and defines how you will get to where you want to be. What you do may change as time goes by but will always tie back to the vision for the organization/program. Doctors may not know it, but they do care about the mission statement because it answers the question, “What do we do?” Many of us are most comfortable with the here and now and have a large investment in what we do as it impacts our day-to-day lives. Put in this context, doctors are usually quick to get involved in a discussion about the organization’s/program’s mission!

With vision and mission statements covered, what are core values and where do they fit in? Core values are several statements that describe the principles that drive the organization’s/program’s internal conduct as well as its relationship to the world. The core values encompass the ethics, principals, and beliefs of the organization/program.

Hmmmm…….adding core values to the mix always confuses me. However, I have found that if I pay attention in the world, many of the companies that we regularly deal with put these principles out to the world. For example, I found myself ordering boots for me during the holidays (when I was supposed to be shopping for my family, what is that about?). The boots arrived from Zappos.com and as I excitedly, albeit somewhat embarrassed, tore open the box, I noticed on the side of the mailing box, “Zappos Family Core Value #8: Do More With Less.”

Core values are probably absolute and unalterable principles such as honesty, respect, and continual self-improvement. I think when we stop to think about what principles drive our organization’s/program’s internal conduct as well as its relationship to the world, they are pretty easy to identify.

Clearly vision, mission, and core values work in harmony. The vision statement describes what the organization/program wants to be in the future, the mission statement describes what the organization/program wants now, and the core values guide an organization’s/program’s internal conduct as well as its relationship with the external world.

If you need help in engaging your doctors with creating the vision, mission, and core values, contact Donna Jo Blake, MD, BRB Consulting, Inc. for physician-to-physician guidance and training. As your doctors take ownership of the vision, mission, and core values of the organization/program, they will become more effective program advocates and leaders.

CARF Preparation, Physician Education, Rehab Physical Medicine, Vision Statement

Vision Statement-CARF Preparation for Physicians

We have a “vision statement”, so what?

I thought I’d write about “vision statements” today because this comes up so often in discussions with leadership, especially when discussing where to place resources. It’s an important concept but how many of us have been taught to write a vision statement or to even think in these terms? I know most doctors I’ve talked to about a “vision statement” for their organization or program are bored as soon as the words leave my lips!

But doctors do care about the vision of their organization/program, because they care about the future of that organization/program!

The vision statement answers the question of “Why are we here?” It paints a vivid and clear picture of the future of the organization and/or program. As described by Simon Sinek in his Framework of the Golden Circle, the clarity of WHY provides purpose, cause or belief and serves as the single driving motivation for action. (http://www.startwithwhy.com/portals/0/why_u_course/pdfs/c1_framework.pdf)

The vision statement communicates to the world the reasons for what we do and does not change when the market changes. The vision statement talks about the organization/program’s future. As you and your doctors communicate with leadership, stakeholders, persons served or one another you must know why you exist!

If you need help in engaging your doctors with creating the vision statement, contact Donna Jo Blake, MD, BRB Consulting, Inc. for physician-to-physician guidance and training. As your doctors take ownership of the vision of the organization/program, they will become more effective program advocates and leaders.

CARF Preparation, Physician Education, Processes for Provision of Services, Rehab Physical Medicine

Processes for Provision of Services

Happy autumn! This is my favorite time of year with crisp temperatures and beautiful colors! I’ve gotten to travel some this autumn and see how autumn dresses in different parts of the country. This is the Animas River near the San Juan Mountains.

In my travels, a couple of weeks ago, I was discussing the future processes for provision of rehabilitation services with a group developing a new rehabilitation facility. Someone in the group asked what “processes for provision of services” meant. The question made me hesitate because I thought it was obvious. (I thought I knew what I was talking about…..but….) .

Yikes! After I did a little research about processes for provision of services I realize that this is not an obvious concept. Each of us doctors has our own experiences with processes for provision of services that began when we were medical students. These experiences were primarily within the curative model of care. As we are now providing physical medicine & rehabilitation care, we work in a model of care that may include some curative aspects of care but definitely includes restorative care. So…….what processes for provision of services are used?

I think for the doctors in your program/organization, what is important is that CARF expects that an interdisciplinary, patient-centered approach be used.

If you need help in assisting your doctors understanding of interdisciplinary, patient-centered services contact Donna Jo Blake, MD, BRB Consulting, Inc. for physician-to-physician guidance and training.

CARF Preparation, Physician Education, Rehab Physical Medicine, Scope of Services

By the way, what are our “scope of services”?

I picked the “scope of services” as my discussion topic today because I am frequently surprised that the really smart doctors who I interview during CARF surveys are perplexed by questions regarding their scope of services. I have found that with simple conversation about what these doctors do and…..maybe….a few leading questions, the doctors usually discover that in fact they do know their scope of services.

Why is scope of services such an alien concept to doctors? I don’t know for sure but I think it is most often that the doctors are not familiar with the concept of “scope of services” rather than they do NOT KNOW what services are provided and not provided by their program/organization.

Below I have provided a basic description of scope of services. Share this with your doctors and then get your doctors involved in defining the “scope of services” for their programs/organization.

The scope provides information that helps describe what services the program/organization has to offer. The scope distinguishes the program/organization so that persons served, families, or referral sources can determine whether the services offered would meet their needs, in what setting the services are offered, the hours and days the services are provided, and fees involved.

Why should the doctors be involved in defining the scope of services?

Doctors provide the medical care for the scope of services offered by your program/organization. Their knowledge and skills play an important role in defining the scope of services.
Doctors working in physical medicine and rehabilitation depend on a team to provide comprehensive services. They must know what is and is not available for their patients.

Once you and your doctors have defined the scope of services offered, then it is important that you share this information with interested parties. Interested parties include persons served, families/support systems, referral sources, payers and funding sources, and the general public.

Now that the doctors are clear about the scope of services, get them involved in sharing this information with those folks critical to your program’s well-being and growth. Doctors can be a powerful force in getting the word out!

If you need help in engaging your doctors with defining the scope of services, contact Donna Jo Blake, MD, BRB Consulting, Inc. for physician-to-physician guidance and training.

CARF Preparation, Physician Education, Rehab Physical Medicine, Stakeholders, Uncategorized

Who are stakeholders and why do they matter?

Stakeholders – Do your doctors know them?

Stakeholders are the individuals or groups who have an interest in the activities and outcomes of your organization and its programs and services.

Why are stakeholders important?

Stakeholders are critical to the health of organizations and programs.
Without stakeholders’ interest, satisfaction, and support of services, there would be no demand for your services and your programs would not survive!
High stakeholder interest, satisfaction, and support of programs reinforce your services and the programs as essential.

Why should your doctors get to know your stakeholders?

Doctors are in natural leadership roles as the medical directors of your programs
A strong relationship between your doctors and stakeholders arms the doctors with information to support your services and implement change

Get your doctors involved with your stakeholders!

If you need help in engaging your doctors with stakeholders, contact Donna Jo Blake, MD for physician-to-physician guidance and training. As your doctors become better acquainted with stakeholders and the role stakeholders play in the health of the organization, your doctors will become more effective program advocates and leaders.

Rehab Physical Medicine

CMS Responds to Concerns of the Field

The power of the people...clearly this change from CMS reflects what is right with the world- okay maybe not the whole world, but certainly the World of Rehab! After extensive communication and outreach by numerous professional organizations including AMRPA, APTA, AOTA and more, CMS recognized some of the inherent problems with Transmittal 72. After significant efforts from the Rehab community and individuals who would be effected by the suggested change, CMS listened!

On February 17, 2012 , CMS rescinded the information and implemented the language below.

Orders for outpatient services (as well as patient referrals for hospital outpatient services) may be made by any practitioner who is:

Responsible for the care of the patient;
Licensed in, or holds a license recognized in the jurisdiction where he/she sees the patient;
Acting within his/her scope of practice under State law; and
Authorized by the medical staff to order the applicable outpatient services under a written hospital policy that is approved by the governing body. This includes both practitioners who are on the hospital medical staff and who hold medical staff privileges that include ordering the services, as well as other practitioners who are not on the hospital medical staff, but who satisfy the hospital’s policies for ordering applicable outpatient services and for referring patients for hospital outpatient services.

The CMS Memo on Hospital Outpatient Rehab – February 17 2012 (click to view PDF version) supersedes the guidance for §482.56(b) (Tag A-1132) and §482.57(b)(3) (Tag A-1163) found in SC-11-28 (May 13, 2011) and State Operations Manual (SOM) Transmittal #72 (November 18, 2011).

The new guidance evidences the importance of access and that quality care remain principals upon which CMS seeks to ensure the delivery of provider services. This revised language reinforces these concepts, assuring ongoing rights for individuals in need of rehab.

As providers and recipients of care, it is reassuring to know- that with enough coordinated efforts, change can and does happen – even in CMS.

Way to go Rehab!

To learn more about managing change in your organization,
contact BRB Consulting today.

CMS, Legislative Issues, Performance Improvement, Rehab Physical Medicine

Keeping Track of CMS….

As 2012 begins, everyday life seems to be getting more complicated. Not only have the political campaigns taken hold of the airwaves-yes there is an election in 9 months; the weather has many of us trying to choose between shorts and parkas; and as part of the regular day-to-day quality care practices, Rehab providers strive to deliver optimal care in this increasingly complex environment. This month’s topic focuses on one of CMS’s newly revised regulations designed to “improve service delivery”.

Sometimes- new revisions simply DO NOT appear to that.

For example, CMS Transmittal 72 11182011 was released in November 2011 under no special circumstances or with any requests for comments. The transmittal states that all orders for rehabilitation therapies both inpatient and outpatient must be written by a practitioner aka doctor or nurse practitioner who is a part of the hospital staff where the patient is to be treated. On inpatient- this is not a big deal. It actually works, when patients receive care in a hospital, every doctor who delivers care in that space is a part of the staff. Even if the patient came from another state, that new patient will become part of the admitting doctor’s service and be under her care for orders.

BUT on outpatient, the interpretation and implementation of this transmittal can be VERY BIG deal…so let’s consider a real life situation and analyze that.

For a patient who has received special hospitalization in other city, county or even state, the special therapy orders written by the discharging doctor would not be valid at the patient’s local hospital. Like a person who suffers a spinal cord injury while driving from SC to Florida, is injured in Atlanta and receives care at the special rehab spinal cord center in Georgia.

Once the discharge plans were set, the patient going back home to SC would have to see the hospital staff doctor in SC to get new orders to be treated at the local hospital in his hometown town. Probably- not too quickly either- you know how long it can take to get a non-emergency appointment….plus there is that additional financial cost of co-payments plus the real effort for the patient and family in arranging an additional trip to the new “hospital” doctor. Clinically, the first doctor knew the patient and his history and wrote the outpatient treatment orders based on those needs; but the new doctor must start at the beginning….maybe giving similar orders- BUT may not.

Maintaining quality care and improving access are concepts regularly stated by CMS. We are just not sure this transmittal’s regulations meets those two goals…what do you think?

AMPRA is actively monitoring the next steps from CMS and the response from the Rehab industry on Transmittal 72111802011. If your organization has have you been affected by this practice – Please contact AMPRA.

Looking to learn more about regulations, quality care and how to positively impact your organization- BRB Consulting would welcome hearing from you. Contact us today.