In our last blog post, we talked about the changes occurring in rehabilitation therapy now, and those that’ll continue to occur over the next few years. We’re not referring to the changes in treatment methods or modalities, rather how rehab departments will have to rethink daily activities and business models.
This is going to be true for all specialties, including physical therapy, occupational therapy and speech therapy, and all settings – but even more so in the skilled settings.
One of the major reasons is that HMOs are having an even greater impact on reimbursement for therapy treatments. This change is becoming more and more obvious in the skilled nursing sector, where in the not-too-distant past, therapy treatments were almost always paid for by federal Medicare.
Now in some facilities, up to 50% and more of the patients’ treatments are paid by private (HMO) Medicare, which totally changes the billing and reimbursement model.
Patients are allowed only a certain amount of funds (or minutes of therapy in this case) based on their doctors’ recommendations and their initial therapy evaluation. In fact, how the physicians phrase their treatment plan and how the evaluating therapists write up observations and plans can make all the difference in how many minutes of therapy the HMO will pay for.
In truth, the evaluating therapist and physician’s notes should pretty much be the same or very similar; however, the evaluating therapist can recommend additional treatments if they can demonstrate the need and the quality-of-life impact it will have on the patient.
Furthermore, if a patient isn’t given the number of minutes the treatment calls for, then the patient’s reimbursement amount is docked by the HMO.
TheraStaff has been in this industry long enough to remember when 65% efficiencies (that is, 65% of a therapists time is billable) was fine. Now 80% is the norm and we are seeing some facilities demanding 90% efficiencies from their therapists from the moment they enter the building.
Therefore, the therapist’s best bet is to arrive a minimum of 15 minutes early so that he or she can get settled and organized for the day. Facilities are requesting this level of efficiency not only to get more work out of the therapist but also to comply with a third-payer contract.
In our next blog post, we will discuss how some to these issues can be addressed. Topics covered will include:
• How therapists can make the most of their time in the facility.
• How therapists can elicit support from others at the facility.
• How therapists can get all treatment minutes with an uncooperative patient.
