OpenPlacement Blog

Shelly Mesure, Our Featured Health Care Trailblazer

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This week's healthcare trailblazer is none other than the author of McKnight's Rehab Realities , Shelly Mesure. As an advocate for improved healthcare policies and procedures,  Shelly utilizes her background in occupational therapy and education to provide advice for best practice on documentation and other rehabilitation topics.

Shelly's background is also diversified by the relationship her company Orchestrall Rehab Solutions has established with China.  She proves herself to be an industry leader and innovator. Read on to find out how she transformed her company A Mesured Solution, Inc into an international corporate partner.

Can you tell me a little more about your background and how you became a professional blogger for Rehab Realities on the website

My background begins as an Occupational Therapist. I’ve always loved the elderly population, so this guided me to work in long term care when I graduated as a therapist. My jobs led me towards management roles, and eventually corporate management. In 2007, I left my last full-time job and decided to pursue teaching. I was fortunate to have a relationship with Cross Country Education, and my love of travel combined perfectly with the seminar style of teaching. Through my teaching, I started consulting, and combined the two roles into my everyday business. As a consultant or seminar instructor, it’s critical to stay up-to-date on the latest trends and new regulations. I rely on many websites and various sources for gathering my information. I’ve always enjoyed McKnight’s “Ask the Expert” columns and other blogs, but realized they were lacking a rehab point-of-view. When I reached out to the editor, he was very receptive to my ideas and we began the blog in 2011.

What are some of the challenges of translating government regulation into everyday clinical practice and what do you consider best practice?

Translating is the perfect word. It’s difficult at times to determine best practice when many areas of new regulations have unlimited versions of interpretation. When new regulations are initiated, I listen and read the regulations very carefully. I find that taking many of the terms literally, helps to clarify any ambiguity. To determine best practice, I utilize my seminars to talk with other therapists and assistants throughout the country. I also have many colleagues from larger corporate companies that are good resources to examine their interpretation. Best practice is always about doing what’s best for your patient, while complying with all government regulations.

The relationship you have with China as Senior Vice President of Orchestrall Rehab Solutions is very interesting. How has eastern medicine been successfully integrated into your company’s philosophy?

I joined my consulting business with Orchestrall in January of 2012 to establish their rehab division for the company. Orchestrall is a Chinese-based company, with one office in the United States. While I’ve been able to add many new projects to our U.S. business through consulting and teaching, my role with Orchestrall has allowed me to work on projects involving combining western medicine practices with current eastern medicine throughout mainland China. My research of current rehab practices in China has definitely given me a unique perspective to our own problems with our U.S. Healthcare system. Many of these projects are still in the conceptual stage, but I’ve been able to present at conferences and work on strengthening Chinese government relations through the Orchestrall group.

What is the purpose of your company A Mesured Solution, Inc and what areas of Medicare/Medicaid do you focus on?

A Mesured Solution is my original consulting company that was started in 2007. We primarily work with small privately-owned healthcare providers to comply with government regulations. We also work with these companies to improve their best practices through operational analysis and training. Training is the strongest aspect of our consulting, because we consider ourselves the “roll-up your sleeves” consultants. My philosophy is that consulting through locking yourself in a conference room and completing audits, only helps the companies know what problems they have made. It doesn’t help them figure out how to fix or avoid repeating the same problems. We find the problems, then we help our clients fix them while complying with regulations and emphasizing best practice.

As an advocate for telehealth technologies for rehabilitation support, where do you think there are gaps in communication between providers and clients?

Determining what it means for clients to demonstrate “independent carry-over”. Training and education are a significant part of our therapeutic practices, however, we need to be realistic of our expectations on what our clients are able to do on their own. I feel telehealth is a big part of improving communication and creating easier ways for clients to be more compliant with home exercise programs, medication management, and all other areas of our recommendations.

Do you think there is a gap in care transition and if so, what kind of existing tools and resources do you refer your team members to to resolve this problem?

I do think there are issues with care transitions in Nursing homes regarding the transfer of medical records between facilities. For example, they are not always completed correctly and may lack information or contain information that is irrelevant. This is especially important when considering medically complex cases that require specific care instructions. I would like to acknowledge and credit some healthcare providers at receiving facilities who do take the time to make direct calls to the rehab department or hospital with the goal of obtaining the missing patient information.

Making sure that hospitals and other facilities have policies and procedures in place is a start to helping resolve this issue. Also making follow-up phone calls makes a difference in the quality of continuing care.

A lot of the exercise apps today don’t address the issue of patient compliance. Orchestrall is currently working on developing a mobile app called iHab that gives real time feedback to patients on home exercise programs. The program can also be prescribed and customized by therapists.  We are hoping to get it out by the end of the Summer.

In what ways can you advise therapists to also become leaders in their profession?

Advocacy is a major aspect of our industry. As new government regulations continue to push us in one direction, we need to push back in some areas to ensure our patients continue to receive the best care possible. Access to healthcare and especially rehab is still a major problem in the U.S. Many years ago I broke my leg and required extensive outpatient therapy to recover. I have insurance, and my major medical bills were covered. My out-of-pocket co-pay for therapy was $30/visit. I required therapy 3x/wk, but probably more if I could have afforded it. Furthermore, I needed this therapy for 3 months before I was finally able to finish my recovery process on my own. Luckily, I’m a therapist, so I knew what it would take to make a full recovery, and I had my physical therapist emphasize the home exercise program throughout my recovery. It will be interesting to see how the new healthcare regulations from the Affordable Care Act will impact the industry in 2014. it focuses so much on covering the population without insurance, but would my story be different if I broke my leg in 2014?

Finally, can you share a memorable experience you had while working with the elderly in the U.S. or China?

As a clinician, we always have our favorite patients that we will never forget. I am blessed with many of these patients, but there was one gentleman that I remember clearly. His name was Charles, and he had dementia with lewey-bodies. He was in his early 60s and when he arrived at our SNF (Skilled Nursing Facility), he was extremely agitated and was labeled with a long list of behavioral issues. His wife was extremely supportive and was at the SNF every day. He required PT and OT services, and I spent the first few sessions just trying to establish my rapport with him. By our third visit, he was convinced I was his daughter, although I have no idea why. Charles and his wife were both African-American, and I’m not. I met his daughter and she looked nothing like me, but he was convinced I was her. So, I used this connection to my advantage and was able to help him transition successfully to the SNF environment, participate in all of this therapy, and make a full recovery. His wife was so supportive and we became good friends through this process. Charles remained at the SNF for long-term care placement, but always gave me a big smile and warm hug every day when I would see him at the facility.

About Shelly A. Mesure
Shelly A. Mesure, MS, OTR/L _received a bachelor’s degree in Rehabilitation Services with a minor in Gerontology from The Pennsylvania State University and a master’s degree in Occupational Therapy from Rush University in Chicago. She is a nationally recognized industry expert and speaker specializing in training and seminars throughout the United States on translating government regulations to everyday clinical practice. She is also the SVP of Orchestrall Rehab Solutions, providing on and off-site consulting services throughout the U.S. and China. In 2012, Ms. Mesure was a featured speaker on rehabilitation at the China Sourcing Summit in Hangzhou, China. In addition to authoring the blog Rehab Realities through, Ms. Mesure has also developed various workshops and educational programs, including webinars and six-hour live seminars for continuing education. In 2011, she was featured in News-Line for Occupational Therapy for her efforts in continuing education and consulting work._