The Pulse

Patient Information: Male, Age 57

Tip #1: Use the Appropriate Type of Electrodes

Patient Information: Female, Age 77

Diagnosis: Hand Contracture / Stroke

History: This woman, a long-term skilled nursing facility resident, was referred to therapy for severely reduced range of motion (ROM) in the left hand resulting from a prior stroke. Previously, the woman’s caregivers were able to move her hand through full range of motion to provide care.

The Centers for Medicare and Medicaid Services (CMS) states that to be covered, skilled therapy services must meet the following conditions:
     • Ordered by a physician
     • Be related to an active written treatment plan
     • Be of a level of complexity and sophistication requiring the judgment, knowledge, and skills             of a therapist
     • Accepted under standards of medical practice
     • Are reasonable and necessary

Beginning October 1, 2018 (FY2019), SNFs will begin to face monetary incentives and penalties associated with hospital readmissions of Medicare beneficiaries, as a consequence of CMS’ SNF Value-Based Purchasing (VBP) Program. The SNF 30-Day All-Cause Readmission Measure will track all patients readmitted to the hospital within 30 days of being admitted to a SNF within 24 hours of a hospital discharge. If a readmission to the hospital occurs within 30 days of the SNF admission date, the readmission will count against the facility’s achievement and benchmark threshold to determine the financial penalty/incentive amount received. The VBP program mandates that CMS must reduce all SNF Medicare payments by two percentage points, then distribute incentive payments to all SNFs based on their quality performance, but not more than 60% of the total reduction. The best performing facilities will have the opportunity to earn back almost all of the 2% withhold, while the poorest performing facilities may earn back nothing.

Aging results in a decline in muscle mass (sarcopenia) with a resulting decline in muscle strength which may lead to decreased function and frailty. The geriatric population may have other comorbidities making exercise difficult. Recent research highlights the impact of frailty on individuals and how exercise and electrical stimulation may counteract this decline.

When working with individuals who have weakness bilaterally, therapists can use bifurcated lead wires to increase their treatment efficiency with PENS e-stim protocols by treating both limbs at the same time.

Patient Information: Female, Age 99

Diagnosis: History of Fall

History: This woman, a long-term resident of a skilled nursing facility, experienced pain,
stiffness, and decreased mobility after a fall in her room. Noting a decline in her ability
to walk and perform her normal activities, the nursing staff referred the woman to
therapy for functional rehabilitation.

Patient Information: Female, Age 95

Diagnosis: Knee Pain / Neuropathy

History: This woman, a long-term skilled nursing facility resident, was referred to physical therapy due to knee pain which affected her range of motion and ability to transfer with the nursing staff. Previously, she was able to transfer from the bed to chair with minimal (25%) assistance and attended facility activities.