Q&A With Hilary Forman ... (Continued from page 28)
for specific patient populations and strategized
on gym redesign to allow for socially distanced
group treatment. Also, we have allocated
specified hours and spaces that could be utilized
for group therapy (e.g., only at day’s end, prior
to scheduled cleaning and disinfecting or early
morning for COVID-19-negative patients
following evening cleaning to mitigate exposure
from others).
Q: What strategic suggestions can you offer
SNFs to make a short- and long-term impact
on their fiscal bottom line?
A: For those SNFs that rely on a therapy
company to support their rehab team, ask what
additional resources are available (beyond the
provision of traditional therapy services) to help
meet specific organizational goals. Are there
additional services to help improve efficiencies
(such as workflow and/or documentation
redesign) that will ultimately help to offset the
cost of therapy? How is your current partner
strategically contributing to your program’s
overall performance (not only from a clinical
perspective, but also an economic one)?
Now is the opportune time to assess whether
your therapy contract is equitable, strategically
well-aligned with market dynamics and
reflecting the drastic changes brought by
COVID-19. Evaluate your options, because
there is not a one-size-fits-all answer to the
question “What’s the best structure for therapy
contracts?” SNFs must first clearly define their
own organizational goals and vet what model
best suits their needs. For example, smaller
SNFs may simply want a contract based on one
of the several traditional rate structures, while
some providers may want to consider a holistic,
partnership approach that includes strategy
consulting and services for the whole house
to drive net performance and will consider
pricing based on a “percent of the whole” per
diem reimbursement rate. Many not-for-profit
organizations value the benefits associated with
maintaining in-house therapy departments
but may want to consider the advantages of
accessing resources, utilization pathways (to
manage efficiency/cost) and clinical pathways
(to assure exceptional outcomes) via experts
that specialize in therapy management.
Therapy contracts should be customized to
reflect what is most important to you as a
provider (e.g., patient-centered care, payer mix
targets, clinical outcomes that drive network
partnerships/census, revenue targets). As
such, partnership agreements should reflect
different rates for different payers and account
for Institutional Special Needs Plans (I-SNPs)
and Managed Medicare Part B, if applicable.
Also, consider the advantages of pricing and
terms based on incentives for driving quality
outcomes, performance outcomes and/or fiscal
cost savings.
Moreover, whether in house or outsourced
to a rehab company, therapists on site at
your community are in a unique position
to strategically drive outcomes. Specifically,
consider whether your therapists:
• Are highly trained and expected to work
at the top of their license to maximize care
planning and outcomes;
• Understand/are interested in your
community’s overall goals and are able to
align initiatives in support of those goals;
• Are able to support big-picture initiatives
that impact Star Ratings and Quality
Measures and/or support case mix index
(CMI) processes to help the community’s
overall standing;
• Proactively provide solutions during the
COVID-19 crisis such as virtual support
and education for leadership and frontline
teams to ensure safety and high-quality
patient care; out-of-the-box therapeutic
solutions to maintain high-quality
functional outcomes throughout the
pandemic; and willingness to help source
personal protective equipment (PPE) and
take the lead in infection control initiatives.
I hope some of these tips help providers as they
carefully consider next steps and look toward
the future!
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