Surviving Healthcare Reform – Strategies to Ensure your Rehab Business Thrives! Diversify!

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NARA Friends Sharing Thoughts About Senior Living in the New Year

Senior Living communities boast a flurry of services to promote active aging for seniors.  Among those services, is therapy.  Therapy comes in various options for residents in most Senior Living communities, and given the changing climate of healthcare reform, your diversification into rehab environments is more important than ever.   Have you considered…Home Health, outpatient, wellness programs, and community engagement. 

Home Health (HH) services are available for residents who meet Home Health Agency (HHA) requirements.  These requirements include:  the resident is homebound and requires the assistance of a person or device and leaving the home is a taxing effort. HH is reimbursed through Medicare Part A, often times at no cost to the patient/resident.   For residents with Medicare Advantage plans, coverage will vary based on the plan.   HH goals target getting patients functioning to no longer be homebound.  Historically, HH services have been provided on average of 2 visits per week for 60-120 days.  As we continue to work to decrease length of stay (LOS) and increase outcomes, we’re seeing HHAs front load visits and taper as residents exhibit progress.  Trends indicate shortened LOS and increased functional outcomes.   

Outpatient (OP) services are available to any resident who has a physician’s order.  Medicare requires the therapy services to be medically necessary and requiring the skills of a therapist.  These services are reimbursed through Medicare Part B, generally covered at 80% plus supplemental coverage up to 100%. As stated above, for residents with Medicare Advantage plans, coverage will vary based on the plan. OP goals target restoring function or adapting/modifying environment to improve function.  OP services were historically provided on average of 3 times per week for up to 8 weeks.  Consistent with HH front loading, we are seeing improved functional outcomes and decreased LOS with the increased frequency at the initiation of services, tapering to a lesser frequency as residents are progressing towards meeting goals. 

Wellness services and community engagement are viewed as maintenance or fitness in nature, not requiring the skill of a therapist to provide.  Wellness services may be provided by the community’s engagement or activities team and/or by the on-site therapy team.   These services may or may not have a fee associated with them depending on who is providing the service.  These services could include group fitness class such as seated stretching, yoga, balance, etc.  Additionally, you will likely find individual wellness options. 

Healthcare Reform is essential in the healthcare environment in which we live, even in Senior Living.  As providers, we must do our part in accomplishing the Triple Aim by decreasing cost, improving outcomes, improving population health and the patient experience.  Through the progressive approach of providing higher frequency at the initiation of therapy and tapering as goals are met, we are supporting the Triple Aim.   As we navigate the most appropriate therapy services option for each resident, we must view the resident as a whole, ensuring we are meeting all needs. 

Let’s take the patient/resident who had a total knee replacement (TKR) who presents with otherwise stable health.  Would the patient and the Triple Aim be better served by providing services through HH or OP?  In the chart below you will see a comparison of HH vs. OP using industry averages.  You will discover in this scenario, a $2,000 cost savings for OP over HH services in a medically stable resident/patient.  Taking it a step further, the average cost for a SNF stay for a TKR would have been $6,762 based on a 14 days LOS.  This patient was much happier being in an AL setting vs. the SNF setting.  In this scenario the orthopedic surgeon provided a daily treatment plan that was delivered by the therapists. 





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This perspective is being presented to simply make you think about alternative options that may serve our seniors better.  I am not advocating to bypass a SNF or HH services if medically indicated.  My hope is that you have a new perspective that will encourage you to look for non-traditional discharge options to best meet the care needs of the seniors you serve.


Rita Cole

Clinical Director at Optima Healthcare Solutions

[email protected]