What administrators need to know about therapy metrics
Administrators have multiple departments to oversee, so it is important that they have a method to determine if their therapy department is running efficiently, meeting its goals and adding to the strategic success of the facility. There are several metrics and indicators of a successful therapy department.
To begin, the therapy department should be tracking and trending therapy metrics on a timely basis. This is a great way to start driving progress and growth in your therapy department. When staff are aware of their performance and understand that it is being monitored, it often spurs on improvement.
Important therapy metrics include productivity, RUGs distribution, Part B billed units or revenue, PPS delivery overages, overdue documentation, late treatment entries and cost per minute of therapy. This list of metrics includes reimbursement, compliance and quality areas. All of these area are important and are not exclusive of each other, so when one improves, it assists the others to improve.
Therapy productivity should be tracked individually, per discipline and by department. Rehab managers should be tracking this weekly so that they can make positive decisions on the amount of regular staff and per diem therapy that is required in real time. Rehab managers also should use this information to guide the department in therapy initiatives to grow and to enhance the department such as vestibular or dementia programs. Administrators should be looking at productivity on a monthly basis and trending the productivity on a quarterly basis. As a department's metrics grow, efficiency can be added, which takes into account PTO time.
RUGs distribution analysis is important to track for compliance, clinical outcomes and financial reasons. Tracking RUGs leads to the development and maintenance of processes to determine the appropriate level of therapy to achieve the resident's highest functional level. Tracking this information assures the therapy department does not fall into a habit of treating all residents at the same level instead of individualizing each resident's plan. PPS overage tracking is closely related to RUGs distribution. It assists to determine how well the team is adhering the resident's treatment plan. It is often an indicator that the plan needs to be revised.
Part B units or revenue is an indication of the level of services your long-term care residents are receiving. These metrics are just a start in developing and maintain a strong Part B program. We often look for the obvious declines in function including transfers, ambulation, bed mobility, dressing and bathing. There are other areas including positioning, eating and cognition that are often missed but full of opportunity. Observing the residents during meal time, activities and on the unit will assist in identifying the residents that may need therapy for proper positioning. Positioning in bed should not be omitted as this can lead to pressure issues and contractures. Observation during meal times focusing on issues with holding silverware, plates that move on the residents and other resident eating difficulties can also be an indication of therapy needs. Assessing cognition and applying the findings to an individualized care plan can lead to a significant increase in quality of life for the resident and can assist staff in better caring for them. Cognitive testing should be a part of therapy standardized testing to determine the resident's current cognitive level. This information can be shared with the IDT and applied in all areas of care from Nursing to Activities. Part B programming is an ongoing process and the possibilities are endless. It is important for this to be a part of your department's continuous development and that you understand the needs of your population so that they can be served best.
Overdue documentation and late treatment entries are indicators of how the department is running in terms of compliance. Timely documentation and treatment entries are important in maintaining the highest quality and accurate documentation. With the new changes to the Medicare Benefit Policy Manual, it is increasingly difficult to document with enough specific information to justify that the skills of a therapist are required to treat the patient. Point of service documentation assists the therapists to get the details of the skilled service that will support the therapy claim. Point of service documentation will also support the most accurate therapy minute delivery. Documentation audits should also be ongoing and the results lead the department to the areas of concentration for improvement.
Cost per therapy minute is a metric that compares all of your reimbursable therapy minutes — whether they are obtained through Medicare A, Medicare Advantage Plans, Medicare Part B, Hospice, private or other payer sources — to the cost of providing the therapy, including the therapy staff salaries, PTO time and support therapy staff and rehabilitation aids. Productivity, staffing patterns (including per diem staff), salaries and benefit structure will all effect this metrics.
There are dozens of therapy metrics and each administrator and therapy manager should determine the most important metric to track in order to meet the facility's strategic objectives. Tracking these metrics on a monthly basis allows the department to identify risks and opportunities and to react quickly. Trending these metrics on a quarterly basis allows enough data to average and provides a clear picture of where the therapy department stands. Benchmarks will assist to guide the therapy department in working toward their goals. Developing a therapy dashboard that can be shared and analyzed between the departments will improve communication and drive important therapy metrics.
Stacy Darling, MBA, MPT, AT, RAC-CT, is the vice president of operations at Post Acute Consulting.