A Pathway for Future Success

Mid South Rehab and our Strategic Partners demonstrated amazing advancement in all facets of clinical operations and quality in 2018. Through the development and implementation of innovative and cutting edge strategies, we demonstrated optimal clinical and operational effectiveness while preparing for current and future regulatory and reimbursement changes. Our steadfast commitment is to ensure we are at the forefront of providing the highest level of quality care to achieve optimal outcomes for our patients in the most efficient manner. To this end, care delivery in rehabilitation clinics throughout our company and in our partner facilities showed the highest level of functionally effective outcomes combined with optimal financial stewardship. Planning, training, education, and implementation of key clinical and operational strategies has served as a catalyst to our future success in 2019. Some of the most noteworthy achievements of 2018 included:

1. Medicare Part A - Patient Driven Payment Model plan development and implementation:

a. Over the last 2+ years we have participated with multiple national long-term care and rehabilitation associations, the APTA, and national lobbyist efforts to advocate for fair and appropriate reimbursement during the rule making process for Medicare Part A payment reform. In 2018 we enhanced these efforts to an even higher level to advocate for the best interest of our patients, strategic partners, and Mid South Rehab. These efforts included direct advocacy efforts in many areas that included but were not limited ensuring the use of standardized and objective patient characteristics and functional measures to drive fair reimbursement. We additionally participated with drafting and providing comments to CMS through our membership in a national rehabilitation association.

b. Throughout 2018, we provided the latest and most precise updates and education to our employee and strategic partners as well the long-term care industry. This included updates throughout the rule making process including the proposed rule release and continuously leading up to the final rule. We were key note speakers at the Independent Nursing Home Association in June of 2018, where we presented on the newly proposed PDPM model when it was first announced. This was followed by continued and updated education throughout 2018.

c. Our comprehensive strategic plan development and rollout to ensure PDPM success was communicated to all employee partners and strategic partners with beginning stages undertaken in the last quarter of 2018.

2. Standardized Outcomes Measures:

In keeping with our commitment over the last 4 years to continue assessing and electronically documenting, tracking, and reporting standardized functional outcome measures, we continued to train and certify all full time PT’s and OT’s to report on self-care and mobility care item sets and all ST’s in NOMS. In October of 2018, CMS adopted most of the care item set into Section GG on the MDS for tracking functional outcomes of patients in a Medicare Part A stay. The progressive training of our therapists over the last 4 plus years allowed us to transition seamlessly into the use of Section GG as our new electronically reported standardized functional outcome measure.

The data we have collected in the last 4+ years allows us to compare our outcomes with rehab providers across the country in a national database, and our outcomes have proven to be well above our peers. Section GG will be one of two key components in the new PDPM payment model that determine the facilities reimbursement for PT and OT therapy services provided. Our PT’s and OT’s are the experts in this area of functional scoring through their extensive training, which will ensure optimal and fair reimbursement to our facility partners and optimal regulatory compliance. The certification of all full time SLP’s to report outcomes through the National Outcomes Measurement System (NOMS) continues to allow us to compare our speech outcomes nationally against other industry leaders who have also been selected to report in this system.

3. Medicare Part B regulatory and reimbursement changes:

From the repeal of the therapy CAP in February of 2018, to preparation for the removal of functional limitation g-code reporting that occurred in January of 2019, Part B therapy underwent significant shifts in regulations in 2018. Through progressive training and education of our staff and facility partners and advocacy through professional organizations, we were able to stay at the forefront of these changes and see great success. In 2018, CMS established a new Part B therapy “threshold” of $3,000 annually per beneficiary for PT and ST services combined and separately for OT services. This became and continues to be the standard threshold at which CMS audits or reviews may occur based on billing patterns of the provider. We proactively developed a revised internal monitoring process to match this regulatory change and ensure compliance. Through this new process we closely monitor for appropriate utilization of CPT codes billed while ensuring optimal care for the patients and reimbursement for services provided. In 2018, we were able to continuously and proactively prepare for and implement plans that ensured success with all Medicare Part B changes.

4. Clinical Program Development and Enhancement:

2018 was a year of substantial growth in the advancement of clinical education and programs for Mid South employee partners including new areas of focus in patient treatment. Mid South partnered with multiple employee partners by investing in their professional growth and development through continuing education initiatives that resulted in the highest level of clinical expertise and care delivery to patients. New areas of clinical expertise and certification included, but were not limited to:

a. Dementia Training and Certification Program: The dementia program included comprehensive training, education, and certification courses conducted by Mid South’s own, Haley Brumfield, OT. The course, approved for 7 hours of continuing education credit, provided comprehensive training and education of facility and therapy staff simultaneously to understand, assess, and treat dementia residents holistically through an interdisciplinary “team” approach.

a. Dry Needling Training and Certification Program: Mid South hosted a dry needling certification course for 5 Mid South PT’s at our 360 Total Rehab Outpatient Clinic in Flowood, MS. In addition to this training, we were able to partner with multiple additional therapists to attend different dry needling certification courses throughout the year. The course hosted by Mid South as well as the other courses attended by employee partners consisted of over 50 hours of training for Mid South PT’s to become board certified to perform this brand new and revolutionary treatment procedure.

Facilitating and Nurturing Excellence in Clinical Education:

Mid South Rehab continued to nurture the clinical education relationship that has been developed with numerous PT, PTA, OT, COTA, and SLP programs in MS, AL, TN, and AR. In 2018 we continued to serve as a leader in clinical education by providing student clinical rotation sites for William Carey, UMMC, Jackson State, MUW, UCA, UT, and many additional therapy educational programs. One of the most notable partnerships is with the newly established PT program at William Carey University, where Mid South is an active member of the Advisory Committee. As a member of the Advisory Committee, we frequently assist the university in serving as guest speakers and lecturers and providing feedback on best practices and educational strategies and initiatives. Our extensive network of expert clinicians and strategic partner facilities offer the highest level of

clinical education experience.

We were truly blessed as a company in 2018 and saw our great, mighty, and loving God bless us tremendously as we sought to honor Him by utilizing all of the gifts, talents, and abilities He has given us to serve our patients, strategic partners, and one another in love. Through an unending and unwavering commitment to honor God through our service we know that He has great plans for all of us in 2019!

God bless you all!

Mark Buckley, DPT

VP of Clinical Operations

John 13:34-35 New International Version (NIV)

34 “A new command I give you: Love one another. As I have loved you, so you must love one another. 35 By this everyone will know that you are my disciples, if you love one another.”