When you can’t work harder, work smarter

The experts tell how to stay afloat

Rehab providers must continue to treat patients as effectively as they have in the past, but with the reimbursement constraints they face, they must treat them more efficiently as well.

"People are already working hard. It’s not like you can continue doing things the same way and tell your staff to work harder. You have to change the system in order to get increased efficiency," asserts Cheryl Arnold, MSA, PT, principal of Dynamic Rehab Solutions, a consulting firm in Tuscaloosa, AL.

Here are some tips from health care consultants on changes you might want to consider in these tight budget days:

• Determine how you’re going to deliver your services to meet the needs of payers. Look at methods that are not traditional rehab: holistic therapy, alternative medicine, and a heavy emphasis on patient self-directed treatment, suggests Nancy Beckley, MS, MBA, president of Bloomingdale Consulting Group in Valrico, FL.

• Get patients involved in their treatment from day 1. "All providers talk about home programs," she says. Ask if patients will do the therapy at home and have the therapists confirm that. Most patients, she says, don’t follow through.

From the beginning, patients should go home with something to do. They progress faster when they are active participants, Beckley says. "There is a responsibility on every health care giver — doctors, nurses, therapists — to provide a patient education program on the first day of treatment."

• It may be necessary to take a hard line on patients who don’t comply with a home treatment program, she says. You can talk with the referring doctor or give noncompliant patients a few more chances, but if they still can’t or won’t participate in a therapy program, you can’t afford to waste time on treatment.

One provider in an advanced managed care market, for instance, gives patients a home exercise program on the first visit, then schedules the next visit within 10 days, making a benchmark. The provider is capitated and can’t afford the time if the patient won’t invest in treatment.

• Consider changing your service delivery model. The solution you choose will depend on the special characteristics of your facility, Arnold says. She recommends forming teams — around patient care units, diagnoses, or programs — or forming a mixed diagnosis team.

• Consider changing your staffing patterns to use a higher ratio of paraprofessionals, but remember that a staffing pattern that works at one institution may not work at yours, Arnold warns. You need to take into account your state’s practice acts, what payers are willing to reimburse for, and your facility’s ability to recruit and retain staff.

• Streamline your assessment process. No longer does a rehab provider have the luxury of performing lengthy discipline-specific evaluations, Arnold asserts. She recommends assessing only items that affect a particular patient’s function instead of assessing everything for every patient.

A typical physical therapy evaluation, for instance, would assess range of motion, strength, balance, endurance, and fine and gross motor skills. But a patient who received a total knee replacement doesn’t need to be assessed for fine and gross motor skills, she says. "If you’re using a standard assessment form, the therapists either evaluate everything or have a lot of not applicable’ notations, which take time, and half the form doesn’t apply to that patient."

Shortening the evaluation process can help your staff start therapy sooner, reduce the length of stay, and save money because there won’t be as much therapist time involved, Arnold points out.

[Editor’s note: For more information, contact Cheryl Arnold at (205) 343-1882, Nancy Beckley at (813) 654-4130, or David Mungenast at (616) 965-3206.]