Voices: Lisa Chambers, Chief Quality and Operations Officer, Blue Sky Therapy

This article is sponsored by Blue Sky Therapy. In this Voices interview, Skilled Nursing News sits down with Blue Sky Therapy Chief Quality and Operations Officer Lisa Chambers to get her take on the competitive advantage therapists have under PDPM, how SNFs are changing therapy utilization under PDPM, and how Blue Sky’s new dementia program is creating safer, happier environments for residents with dementia.

Skilled Nursing News: You’ve been with Blue Sky since 2002, most recently took on the COO position in 2018 along with your CQO position. Describe your role at the company and your most important duties entering 2020, and looking ahead at the next 12 months.

Lisa Chambers: I view myself as the overseer of ensuring quality care for our residents, a good work environment for our staff members, and a good relationship with our partners by providing resources, tools, and education. I think it’s important going into 2020 to have a voice and show our value as therapists. As we prepare for regulatory cuts coming our way, it is also important to make sure we maintain a balance between the appropriate service delivery and our financial model so that we can remain viable as an industry.  


I think as an industry, as therapists, we need to be able to show our value based on the outcomes we produce through our efficient and effective treatments, and patient satisfaction. As such, one of our focus areas in 2020 for our clinical programs is to continue incorporating technology systems, such as Jintronix.

Other than the outcomes, what are the biggest changes that you see in the industry today as a result of the transition to value-based care?

Chambers: I think PDPM is now headed on the right path to incorporate all those elements that we set out as therapists to deliver to our patients. Under PPS, we were forced into more of a scheduling and arbitrary benchmark-achieving type of mindset. Now the treatment focus is more on individual patient characteristics to achieve the desired outcome.


As we go to a more value-based care model, I think that the industry is heading in the right direction, because good care will be rewarded. As the emphasis has shifted to value, it promotes a more comprehensive care approach for the resident, thus achieving a better outcome.  

There has been a lot of uncertainty and concern about PDPM. What do you think is the biggest misconception in the industry now about therapy utilization under the new model?

Chambers: I think the biggest misconception is that people are pointing the finger at PDPM for some of the changes that are going on out in the industry. You seem to read only negative stories about PDPM — layoffs and salary cuts, higher productivity expectations and decreased therapy minutes — when in reality, PDPM is a small piece of those problems. It’s truly the shrinking census in the facilities and the changing payer sources that are out there.

Part of what we as an industry need to do is explain to therapists the “why” of any new change. At Blue Sky, that is what we really try to do: provide the “why” for our employees, and an explanation of how the company is addressing these changes while maintaining quality care for our patients.

What are you seeing in terms of how SNFs are changing the therapy utilization here in the first five months of PDPM?

Chambers: We are understanding better how therapy can be an advocate for capturing the correct characteristics for that patient on the MDS. I think a therapist’s value as a collaborator has increased because there are so many things on that MDS now that need to be coded. If you’re caring for complex patients, you need to get credit for that care, and we can help support you in capturing that information. Overall, our therapy utilization has not changed that much, as it has always been driven by patient need. 

Part of what we bring is additional knowledge. For example, therapists are trained to do standardized testing, and a lot of times people who are administering the BIMS haven’t had that training, so the results got skewed. You’ll have a lot of mild cognitive deficits go undetected if you don’t have a therapist involved — somebody who knows how to identify those mild cognitive deficits, and make sure that that’s communicated.

We talked about outcomes. Blue Sky has tracked outcomes since 2014. What are the major trends that you’ve seen in that time?

Chambers: We are able to analyze our outcomes in many different ways. We can look at it by payer source, by patient diagnosis or by individual therapist. We review our outcomes quarterly, and we look for any shifts in performance. Looking at outcomes by payer source when PDPM came in, we modeled our service delivery recommendations off of what we’ve done with our outcomes to achieve an effective and efficient service delivery model.

We at Blue Sky have seen our outcomes climb over the years, but as an industry, we do not have a standardized outcome to use. That’s a concern. GG is a nursing measure that we contribute to, but we don’t have a standalone that’s uniform across our industry. I think as we move into value-based care and we want to show our value, we’re going to need to have a standardized measure.

You launched the MIND Program recently to help families and caregivers care for dementia patients. Give us some background on the program. Why did you launch it?

Chambers: As a speech pathologist, residents with dementia are very near and dear to my heart. That is a population within the skilled nursing home that is growing and requires specialized training on how to bring quality activities to engage residents with dementia. 

We worked with dementia care specialists, had some people on our team go through the actual training to become certified as dementia care specialists, and from there, we developed our MIND program to help identify the stages of dementia that a given resident might be in, and what activities best fit that stage.

Our age-equivalent scores give a nice reference point for people, because it’s all about finding the best ability to function. We’re not talking about deficits, we’re talking about remaining abilities.

What are some of the outcomes that you’ve seen?

Chambers: We had a lady who, every day about three o’clock, she started calling out, trying to get up. They tried a lot of different things with her, and they moved her up by the nursing station which of course, at three o’clock that is shift change and the most chaotic time. The shift changes amplified her agitation. The therapist determined her cognitive stage and learned what she did in her prior life. It turned out she was a nurse, and when she was working, every day at three o’clock she came home and changed her clothes.

She was trying to get up and go change her clothes at the nurses’ station, so they changed her schedule. Prior to three o’clock they took her back to her room, they had a change of clothes laying out, a hamper. She changed her clothes and had no more agitation. We decreased her agitation and prevented potentially a bad fall for that resident.

Going along with that, what would you say are Blue Sky’s core tenets?

Chambers: I started with Blue Sky in 2002 and the message then was: Do the right thing all the time. That’s always been the message. Do the right thing by your staff, your patient, and your partners. As we’ve gone through changes as a company and different reimbursement changes, that message has never changed.

I think as long as we stick to that, we’re able to be successful in delivering quality care, and being a good partner to the skilled nursing facilities that we partner with, the home care agencies that we partner with, and also take care of our staff.

It is a time of a lot of change and upheaval. I think we need to keep an open mind, and instead of thinking about all the things that are out there that are negative and wrong, we need to see how we can impact them positively. What can we do as an industry to bring more value? We need to stay the course and remember why we’re doing what we’re doing: We are here to treat the patient and do it well!

Editor’s note: This interview has been edited for length and clarity.

Blue Sky Therapy delivers innovative physical, occupational and speech therapy services in skilled nursing homes, assisted living facilities outpatient therapy clinics and the home. To learn more about how Blue Sky can help you, visit blueskytherapy.net.

The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact [email protected]

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