Is a CORF in your facility’s future? The marketplace may demand it

Your competition may be down the street

Are you one of the rehabilitation providers who once scoffed at the possibility of a skilled nursing facility taking your patients? Well, don’t make the same mistake about Comprehensive Outpatient Rehabilitation Facilities (CORFs). Those in the know say in the near future, CORFs could treat patients who now are treated in acute rehabilitation facilities.

Already, acute lengths of stay have been slashed to the point that many discharged patients still need the comprehensive, transdisciplinary rehab services that can be provided in a CORF, says Lenore Hersh, director of planning and site development for Casa Colina Centers for Rehabilitation, with headquarters in Pomona, CA.

"I heard numerous people in the rehab field dismiss the threat of subacute facilities," says private consultant Nancy Beckley, MS, MBA, recalling discussions of five or six years ago. "They laughed and said that an SNF couldn’t take their patients because it didn’t really offer rehab."

Time has proved them wrong. Now, some stroke and orthopedic

patients, who previously were admitted to inpatient rehabilitation, go directly from the acute hospital to a subacute unit or home with support from home health services.

As states develop managed care programs for their Medicare populations and managed care payers push for alternatives to acute hospitalization, an increasing number of Medicare patients are likely to be moved directly from the trauma center to the outpatient setting. Having a CORF could allow you to remain a player. (For tips on how to decide if a CORF will be profitable for your facility, see story, p. 92.)

CORFs are Medicare-certified facilities that provide a comprehensive range of interdisciplinary services in one location. Essentially, a CORF provides the entire gamut of services available on an inpatient rehabilitation unit, but does so on an outpatient basis for patients who don’t need 24-hour-a-day nursing care.

Treatment teams

The difference between a CORF and a typical outpatient rehab program is that the CORF staff treats patients as a team, with interdisciplinary team goals, rather than each discipline designing an individual treatment plan and working with patients individually, Hersh says.

For example, if a patient’s goal is to work on cognition, the physical therapist and speech therapist will include activities to improve cognition in their treatment sessions.

Medicare will reimburse a CORF for a wide variety of services, including social work, psychological services, and rehab nursing. A typical outpatient program is reimbursed only for physical therapy, occupational therapy, and speech therapy services.

In 1996, CORFs recorded more than 1 million patient visits. The number of Medicare-certified CORFs has increased from 318 in mid-1996 to 431 today, according to the American Rehabilitation Association in Reston, VA.

As baby boomers age, the number of Medicare beneficiaries who will need the services of a CORF is increasing. In fact, the number of Medicare beneficiaries has increased from 19 million in 1965 to more than 38 million in 1996. It is projected that by the year 2020, 31% of the population will be over 55, and 10% will be between 65 and 74.

Who’s your competition?

And, as the demand increases, so will your competition for these baby-boomer patients.

"Those of us who have been in rehab for a long time in traditional facilities tend to look inward and not realize that a provider down the street is really a competitor," says Beckley, president of the Bloomingdale Consulting Group in Valrico, FL.

In the future, your competition for medically stable rehab patients who are Medicare beneficiaries may be:

• hospitals that don’t have separate inpatient rehab units but are now looking into developing CORFS as a way to provide a continuum of care and get Medicare cost reimbursement for their patients;

• private practice, single-therapy clinics expanding their services to include other disciplines;

• private physician practices that are looking into developing their own CORFs.

Since the Stark II legislation governing self-referrals became effective in January 1995, physicians have had clearer definitions about what is allowed in financial relationships with facilities to which they refer patients.