Daily Editors' Notes

Questionable therapy practices could put operators to the test

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John O'Connor, editorial director, McKnight's Long-Term Care News
John O'Connor, editorial director, McKnight's Long-Term Care News

Ready to take the therapy services quiz? The good news is that it only has one question and it's multiple choice. But you don't want to fail. Ready?

What's likely to happen when long-term care managers turn a blind eye to the service and billing practices being done by therapy subcontractors?

A. Everyone gets to live happily ever after.

B. Nothing that can't be easily explained.

C. A publicity-loving lawmaker gets wind of the practice. He then directs the Government Accountability Office to look into the matter. Then a Katy-bar-the-door hearing is held in Washington. During the hearing, the most egregious practices are laid out in grisly detail, along with new regulatory-laden legislation intended to hold nursing homes more accountable.

If you selected either A or B, here's your grade: Epic fail.

When you talk to people who review nursing home documents for a living, it's amazing how often they describe therapy as a ticking time bomb.

It's not hard to see why. All too often, facility-level managers have essentially washed their hands of therapy management. Their view is that they have hired outside guns to take care of both the service and related billings. At the same time, many of the rehab companies are under tremendous pressure to meet ever-increasing revenue quotas. To paraphrase Bob Dylan, you don't have to be a weatherman to see how the wind might soon be blowing.

By the way, I am not in any way condemning the concept of subcontracted rehab services. When done correctly, this approach has been and continues to be a godsend. As a result, residents are getting needed services. In addition, experts from many of these firms are doing jobs that people at the facility can't or won't. And need I remind anyone what the big question was at many facilities before Medicare-covered rehab came along? For those of you with short memories, it was this: How are we going to get more Medicaid funding?

So, to be clear: I am not anti-rehab.

But to be equally clear, a dangerous mix of factors is making it all too easy for nightmarish rehab-related problems to fly under the radar (at least for now). Chief among them are long-term care managers who are not managing, and unchecked therapy company managers (especially at the regional level) who are being incentivized to max out related billings.

A story from Minnesota we reported on last week is illustrative. There, a federal judge refused to dismiss a whistle-blower lawsuit filed by an occupational therapy assistant.

Among other things, the suit alleges that therapists were making up numbers that had nothing to do with actual care — and then haggling over who got the billing credit. It's still unclear whether the case will be limited to one facility, or if it might be expanded to hundreds more. To be fair, we're talking allegations here, not a conviction. And an attorney for the defense has said the claims are “meritless allegations.”

But if your facility is not closely monitoring its therapy practices, you may have a lot more to worry about than failing the quiz above.

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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.

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