When you can’t work harder, work smarter
When you can’t work harder, work smarter
The experts tell how to stay afloat
Subacute providers must continue to treat patients as effectively as they have in the past, but with the reimbursement constraints they face, they must learn how to do it more efficiently.
"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 Tuscaloosa, AL-based consulting firm.
Here are some tips from health care consultants on changes you might want to consider making in these tight budget days:
• Determine how you are going to deliver your services to meet the needs of payers. Look at things 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 the patient involved in their treatment from day one. "All providers talk about home programs, but you should challenge your therapists about whether they really think the patient would do it and did the patient do it. In many cases, the patient didn’t," Beckley says.
From the beginning, patients should go home with something to do. Patients 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," Beckley says.
It may be necessary to take a hard line on patients who don’t comply with a home treatment program, Beckley says.
If a patient can’t or won’t participate in a therapy program, the provider can talk with the referring doctor or give the patient a few more chances, but essentially, if a patient won’t invest in treatment, a rehab provider can’t afford to continue to waste its time on treatment.
Give patients homework
Beckley tells of one provider in an advanced managed care market that 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 to waste 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. A staffing pattern that works at one institution may not work at yours, Arnold warns. You need to take into account at 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 on every patient.
For instance, a typical physical therapy evaluation would assess range of motion, strength, balance, endurance, fine motor, and gross motor skills. But a patient who received a total knee replacement won’t need to be assessed for fine motor and gross motor skills, she points out.
"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," she says.
Shortening the evaluation process can help your staff start therapy sooner, shorten the length of stay, and will save money because there won’t be as much therapist time involved, Arnold points out.
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