CORFs aren’t for everyone; rules may be a burden

Program still receives praise

Some rehabilitation hospitals that once operated Medicare-certified, comprehensive outpatient rehabilitation facilities (CORFs) have given them up because they determined the extra reimbursement wasn’t worth the effort of complying with strict Medicare guidelines.

"We decided to simplify our lives," says Karen Bricker, MS, OTR/L, director of rehabilitation services at D.T. Watson Rehabilitation Center in Sewickley, PA.

Health Care Financing Administration policies require that providers have separate policies and procedures, separate charts, and designated space used only for treating CORF patients.

Cost vs. benefits

The requirements posed a problem for D.T. Watson staff, because their CORF was located within the rehab facility. Therapists who worked with CORF patients and with other rehab outpatients had to mark separate timecards for their time spent with Medicare patients.

"When we weighed the time and effort we had to put into maintaining a separate entity, it just didn’t make any sense," Bricker says.

Another rehab administrator, who asked that his name not be used, said the requirement for interdisciplinary team conferences for CORF patients was a death knell for a CORF at his fairly small hospital-based unit.

"We weren’t reimbursed for the team meetings. This meant that the physician and all the therapists were sitting in meetings when they could be treating other outpatients. It doesn’t make sense unless you have enough CORF patients so that you dedicate a group of therapists solely to your CORF," he adds.

Casa Colina Centers for Rehabilitation, with headquarters in Pomona, CA, closed three CORFs it had operated for many years when large numbers of managed care plans and independent physician practices in Southern California began providing their own outpatient services instead of referring patients to other rehab providers, says Lenore Hersh, director of planning and site development.

"They (payers) would discharge their patients from our acute hospital and send them to their own outpatient clinics," she explains.

Despite Casa Colina’s experience with CORFs, Hersh still believes in their efficacy. "Our situation was unique to Southern California," she says.

Mimi Stachowski, administration director for ambulatory services at Bryn Mawr Rehabilitation in Malvern, PA, implemented 13 CORFs in six states for her previous employer, Dallas-based Milestone Health Care, a contract management company. Here, Stachowski offers tips on how to make your CORF succeed:

• Make sure your CORF is easy to find and is easily accessible by patients with a disability.

A medical office building owned by a hospital is an ideal location, Stachowski says. The patients know where it is; it’s visible to the referring physicians; the space is free from hospital overhead; and it turns an unused space into a money generator.

• Develop your referral base and set up a comprehensive marketing plan before you open, Stachowski advises. "You cannot open a CORF and expect that patients are going to come to you. You have to have something to offer, and you have to have a good referral base to succeed."