Having my say: Top rehab pay for all

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Shelly Mesure, MS, OTR/L
Shelly Mesure, MS, OTR/L
EDITOR'S NOTE: “Rehab realities” is a new McKnights.com blog written by consultant Shelly Mesure (pronounced “Measure”). A former corporate and program director for major long-term care providers, her blog is updated regularly at www.mcknights.com.

Hypothetically, every therapy patient can be an Ultra High. The Department of Health and Human Services has issued reports indicating facilities have not reduced therapy RUG utilization to the levels anticipated.

In October 2010, MDS 3.0 initiated limits to concurrent therapy and reduced the amount of allowable minutes. While they learned a new, complicated system, employees were faced with the challenge of continuing to provide the best level of care to their patients, while finding new ways to seek the Ultra High and Very High RUG payment categories.

The Centers for Medicare &  Medicaid Services failed to realize that prior to PPS, therapy was provided routinely in excess of the Ultra High allowable minutes. I've witnessed a strong return of occupational therapy and/or physical therapy treatments provided twice a day (BID), which was routinely scheduled in the 1990s. Increased weekend therapy and evening treatment sessions also have re-emerged as a result of last year's changes.

If the Ultra High is the highest level of allowable treatment we may seek, it's our professional obligation to clinically provide these levels of service to every patient. Operational barriers always can be resolved.

I know some people might think this is impossible, but if we could provide this level of treatment routinely prior to PPS, why should we assume we couldn't maintain some of our old practices?

The biggest challenges are usually staffing and scheduling. However, the answer is somewhat easy.  When scheduling patient treatments, count each BID patient twice. For example, if treating a patient for 90 minutes by the same discipline, count them as two 45-minute sessions or possibly a 60-minute morning session and 30-minute afternoon session.

This approach should be used for assessing every patient. Many times our patients are short-term, with discharge plans to return home and the only skilled need is rehab.

If the therapist states this is too much for his or her patient, when asked why, it should only be explained with clinical reasons. Raise the bar of your clinical excellence.

Rehab Realities

Rehab Realities is written by Renee Kinder, MS, CCC-SLP, RAC-CT.  She currently serves as Director of Clinical Education for Encore Rehabilitation and acts as editor of Perspectives on Gerontology, a publication of the American Speech Language Hearing Association.

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