Top therapy reimbursement for everyone: here's how

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Shelly Mesure, MS, OTR/L
Shelly Mesure, MS, OTR/L
As a consultant who specializes in enhancing clinical and financial outcomes through rehab, nursing and the MDS process, I'm excited to have you join me in this new blog.

“Rehab realities” is designed to serve all kinds of long-term care professionals, to help explain the rehab perspective when dealing with new and changing regulations.

As an occupational therapist specializing in long-term care and skilled nursing settings for more than 10 years, I've had the opportunity to work with clients throughout the United States. I also have taught popular seminars and presented at numerous conferences throughout the years. My goal is to help you clarify rules and explain things in a practical manner — one that you can apply at your own facilities.

I look forward to discussing a wide variety of rehab-related subjects, including one that everybody should be aware of right away: Every therapy patient can be an Ultra ...

Hypothetically, of course. 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 significantly complicated operating systems in long-term care facilities throughout the country. MDS 3.0 initiated limits to concurrent therapy and reduced the amount of allowable minutes. Facilities 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.

I've worked with facilities to implement therapy schedules, better utilize staffing hours, and focus on direct patient care. CMS 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 OT and/or PT 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. It should be clinical explanations only for the use of lesser therapy services; and operational barriers can always 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.

Shelly Mesure (say "Measure"), MS, OTR/L is the president 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.

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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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