Do-It-Yourself can be a great route for small household chores. Just look up a YouTube video to learn how to install a dimmer switch or unclog a pesky garbage disposal.
While providing therapy for skilled nursing patients obviously has much greater ramifications than getting shocked by a 110-volt outlet, the SNF operators who historically have managed their own therapy departments seem to be realizing the significant value a specialized therapy partner may bring with the Patient-Driven Payment Model (PDPM)
As an outsource therapy provider, we take great pride in the strength of our therapy clinical practices. Building strong proprietary clinical pathways and protocols has been core to our service offering for over a decade. Performing thorough patient evaluations also has been a centerpiece of how we have provided therapy in the communities we serve. Identifying skilled need, documenting for compliance and helping generate strong outcomes and lower rehospitalizations has been part of how we have done business.
With PDPM, the value of clinical pathways, thorough evaluations, and measurable outcomes now take center stage with the change in how SNFs get reimbursed. As a result, we are seeing an uptick in the number of SNF communities that historically have managed their own therapy services begin to seriously explore moving to an outsource partner. Why? Here are some of the top reasons.
Clinical Guidelines and Pathways. With the elimination of therapy minute thresholds under PDPM, clinical pathways remove arbitrary care management decisions and give assurance that services are appropriate and defensible. Better therapy providers ensure that your therapists and facility utilize care pathways, diagnosis-related clinical protocols, comprehensive interdisciplinary training and documentation that supports skilled need and the conditions of participation. In addition, most therapy providers have collected and refined specific clinical pathways with key clinical markers for hundreds and even thousands of potential patient diagnoses, many with the most common comorbidities. With an external therapy partner, SNFs can benefit from this vast knowledge base and have more confidence in their treatment plans.
Thorough Patient Evaluations. After 20 years of focusing on therapy minutes, therapists need to prioritize comprehensive evaluations, coordinate findings with other evaluators of the interdisciplinary team (IDT) and jointly develop a plan of care specific to each patient’s comprehensive needs. This coordination is also important for documenting acuity associated with the Nursing, Non-Therapy Ancillary, PT, OT and SLP CMI scores associated with PDPM. All three therapy evaluators can help the IDT identify conditions that contribute to all five CMI scores. An external therapy partner should bring a thorough set of evaluation tools to help optimize the evaluation process that will be critical to establishing the reimbursement rates.
Compliance Support and Medical Review. Clinical predictive pathways guide therapists to provide services based on the conditions and features of the patient as defined by PDPM guidelines and give SNFs confidence that each patient receives evidence-based levels of care. Sophisticated contract therapy providers conduct a host of audits and internal reviews that should complement your your Quality Assurance – Performance Improvement program. Finally, therapy providers support your therapy-related medical review claims and should include RAC-certified auditors/reviewers who assist with managing the claim from the initial review (ADR) through ALJ and indemnify you for unpaid denials.
With so much riding on the move to PDPM, it’s clear why more SNFs are turning to external therapy partners to have their back when it comes to this significant change. More importantly, partnering with an expert in patient rehabilitation will be a differentiator with patient outcomes, patient satisfaction and key referral sources.
David Tate is Reliant Rehabilitation’s Chief Strategy Officer.