Short-term rehab pros and cons
Shelly Mesure, MS, OTR/L
We have a term in our industry known as, “strong rehab potential” or “great rehab candidates.” But they all come with invisible pluses and minuses.These are the short-term rehab patients that can tolerate the Ultra High (2½ hours of therapy for at least five days per week). These patients tend to fall into the orthopedic diagnoses, such as, knee or hip replacements, and so on. However, patients with a long list of medical complexities sometimes complicates their rehab potential and may require additional services or even medical holds until the issues are resolved.
There are many pros to accepting these types of patients — the ones with higher reimbursement rates, steady recovery times, continuous rehab gains, with excellent clinical outcomes. The majority of these residents receives a shorter length of stay, but can tolerate therapy at the highest payment levels.
The con of this type of admission: they need to be replaced sooner. If a facility can develop a strong reputation in the community, it can usually benefit from a constant source of admissions with these types of diagnoses. If not, the facility must find a “head in the bed” sooner than the more typical patient admissions with lower reimbursement rates, less rehab, and longer lengths of stay.
Many of these patients tend to lead active lifestyles and have higher demands for clinical excellence and aesthetics. A provider is already going in the right direction if they can segregate these patients from the long term residents. Additional amenities will also help to draw these patients, such as free Wi-Fi, restaurant-style dining options, flat screen TVs, and so on.
Clinical treatment options also should include the latest types of modalities, such as diathermy to help address pain issues. Or scar tissue treatment and management options through nursing and rehab interventions
It's always a balancing act. These types of short-term rehab patients usually produce the highest reimbursement rates. However, if you're a facility that struggles with admissions and census, be aware that the length of stay will be shorter than your average admission.
Many times, providers admit patients to the first available open bed. This often results with the short-term patient residing in an area mixed with long-term residents. If the short-term patient is dissatisfied with the amenities or facility, many times he or she will “check-out” after a few days and request a discharge into a competing provider for the remainder of his or her recovery. It happens.
Another common mistake is the delay of therapy services. Centers for Medicare & Medicaid Services regulations allow therapy up to 72 hours to respond to physician orders. However, if a patient is admitted on Friday and doesn't receive therapy until Monday, this often becomes a disaster as the patient may “check out” and transfer to another facility as a result.
That's the kind of minus nobody needs to deal with.
Shelly Mesure ("Measure"), MS, OTR/L, is the senior vice president of Orchestrall Rehab Solutions and owner of A Mesured Solution Inc., a rehabilitation management consultancy with clients nationwide. A former corporate and program director for major long-term care providers, she is a much sought after speaker and writer on therapy and reimbursement issues.