7 Steps to Ensure a Smooth Transition to New Therapy Providers

Changing therapy providers in senior care communities is a complex process. It not only influences the quality of care residents receive but also has significant financial and regulatory implications for the community. Because of this, transitions must be carefully planned, managed, and monitored. But doing so can be challenging.

Angele Tran, OTR/L, CHC, CAPS, compliance manager at Friends Services Alliance Compliance Collaborative

To help, Angele Tran, OTR/L, CHC, CAPS, a compliance manager at Friends Services Alliance Compliance Collaborative, developed a seven-step process to guide the transition. Tran is also a licensed occupational therapist in Pennsylvania and has over 30 years in clinical and administrative experience.

Read on to learn how this model can help senior care providers make well-informed therapy provider changes, as well as what communities need to know about the transition process.

The Challenges of Transitioning to a New Therapy Provider

According to Tran, a breakdown in any of her seven-step process can lead to challenges, but three areas pose particular risks.

Senior care communities need to develop an effective communication plan to guide the transition. Miscommunication or lack of clarity in communication during the transition can cause confusion, which can affect therapy staff, the interdisciplinary team, administration, residents, and families. “Inadequate handoff of therapy documentation may result in delays in care and critical gaps in records needed to support payor claims,” Tran explains.

The issue of regulatory compliance is another potential hangup. “New therapy providers may not be fully aligned with federal, state, and payor-specific requirements, particularly regarding documentation standards and billing practices,” says Tran. Inconsistencies, including incomplete documentation and errors in billing and coding, can cause issues like compliance risks or payor denials. Thus, regulatory compliance requires extra attentive monitoring during and after a transition.

Senior care communities must also take an active role in quality assurance and ongoing auditing and activity monitoring. “Investing time and appropriate resources in proactive risk mitigation is far more effective than reacting to errors after they occur,” explains Tran. “While both internal and external audits play important roles, external audits provide an independent, objective perspective on the therapy program and enhance overall transparency. An effective audit and monitoring process should include timely follow-up, staff training completion, clear accountability, and consistent oversight of corrective action plans.”

Additionally, the therapy provider transition will impact residents, but the degree of impact will depend on how the community selects and vets the new provider. “Think of the process you have to hire staff – you want to have good staff to maintain the quality of resident care,” Tran says. “The same is true for hiring a therapy provider.” Senior care communities need to carefully choose new therapy providers with the goal of balancing continuity of care, financial stability, and compliance.

Common Mistakes in Transitioning to New Therapy Providers

When transitioning to new therapy providers, senior care communities often make the costly mistake of failing to maintain continuous oversight once they’ve contracted with the new provider. “There’s often an assumption that entering into a service agreement with an outside vendor, trusted for their expertise, means they will fully and faithfully deliver on every aspect outlined in the contract,” says Tran. “While that expectation is understandable, blind trust without verification can be risky.”

She poses the example of comparing hiring a therapy professional to the process of a restaurant owner hiring a professional chef to run a kitchen. The owner still needs to check in occasionally, taste the food, and make sure the chef is following health codes. Restaurant owners can’t simply trust the chef’s resume, since they’re still responsible for the meals that are being served under the restaurant’s name.

“In the same way, most therapy providers bill under the community’s Medicare number, not their own,” says Tran. “This means the community is ultimately responsible for ensuring that every claim submitted is backed by sufficient, compliant documentation that aligns with federal, state, and third-party payer requirements.” Many senior care communities don’t uncover broken processes or practices until something goes wrong, and they may find themselves facing regulatory noncompliance and repayment issues, as a result.

“Outsourcing services does not mean outsourcing accountability,” Tran emphasizes. “Communities must take an active role in overseeing the therapy provider’s work, regularly reviewing the documentation, processes, and claims to ensure compliance and prevent potential issues before they arise. This proactive approach helps avoid surprises and safeguards both resident care and financial stability.”

The Seven-Step System to Guide the Transition to New Therapy Providers

Tran has delivered direct care for contract and in-house therapy services as an occupational therapist, single-site therapy manager, executive rehab leader, and compliance manager. Through her experience, she’s learned about the successes and failures that can occur when communities change to new therapy providers. “I’ve gleaned the best practices through my personal experiences, conversations with senior living leaders, and interactions with many different organizations,” she says. To help communities prevent failures and ensure a successful transition, Tran created a seven-step process:

• Step 1: Assessing the need for a new provider. Identify the reasons for the change, such as performance issues, cost efficiency, service improvements, or clinical outcomes, and use these insights to choose the most suitable model: in-house, contract, or management. Budget planning is a critical component when transitioning to an in-house therapy model. Unlike contract therapy arrangements, the in-house approach requires direct responsibility for labor costs, recruitment efforts, and potential staff buyouts from the outgoing provider.

• Step 2: Establish a selection committee. Form a multidisciplinary committee to oversee the selection process, guided by defined criteria such as provider experience, therapist qualifications, corporate support, innovation in service delivery, regulatory compliance, and cost. At a minimum, the group should include the compliance officer, nursing home administrator, director of nursing, head of clinical operations, chief financial officer, and an information technology representative.
• Step 3: Conduct a market search and perform due diligence. Issue a detailed request for proposal (RFP) to prospective providers, outlining the organization’s expectations, goals, and timeline. Then, set up a systematic approach to review responses.
• Step 4: Contract negotiation. Develop a clear contract policy and negotiate an agreement that outlines services, roles, compensation, compliance, and performance metrics
• Step 5: Develop a transition plan. Establish a clear transition timeline with milestones such as communication with residents, families, and staff. Include other key areas in the timeline, such as ensuring the therapy provider’s EHR system is fully compatible with the community’s EMR to support seamless documentation and data exchange while maintaining strong data security protocols. It’s also important to plan for the secure transfer of resident therapy records and the onboarding and integration of the new therapy team into the community’s culture and workflows.
• Step 6: Implementation and monitoring. Onboard the new provider by aligning them with your organization’s culture and operations. Integrate the team by conducting joint staff training. Review and update existing operational policies or develop new ones to reflect the new therapy service model. Additionally, prepare for monitoring by scheduling mock audits, implementing performance tracking with established KPIs, and creating a system for collecting resident and family feedback.
• Step 7: Oversee the post-transition process. Ensure regulatory compliance through audits of therapy documentation and billing and monitoring the provider’s performance against established benchmarks and KPIs. Additionally, regular communication with the new provider can strengthen the partnership.

Planning for a Successful Therapy Provider Transition

Tran recommends that senior care communities start the process by determining why they are looking for a new provider, whether it’s to address a performance issue, improve outcomes, or achieve cost efficiency. Communities should also consider which therapy model will best help them reach their clinical, financial, and operational goals.

Communities should invest three to six months in planning and executing the transition to a new therapy provider. “The exact duration can vary depending on the size of the organization, the therapy model selected, the complexity of services provided, and the readiness of both the outgoing and incoming providers,” Tran explains. “However, this timeframe allows for a thorough, well-coordinated approach that prioritizes continuity of care and minimizes operational disruptions.”

When navigating the transition, it’s essential to ensure that residents feel supported and experience minimal or no disruption in their therapy services. “It is not uncommon for residents to develop strong, trusting relationships with their therapy team, who play a central role in their daily well-being,” says Tran. “Learning that a new provider will be delivering care can naturally cause uncertainty or anxiety.” She recommends that communities deliver a clear and transparent communication plan to keep residents, families, and staff well-informed during the process. This can help keep residents and families confident and minimize confusion during the transition process.

A Successful Transition: How One Senior Living Community Navigated the Change

Tran shares that one senior living community followed the seven-step process and successfully implemented a therapy provider change. The community had partnered with a contract therapy provider for eight years, but during the last four years, their annual audits revealed deficiencies in therapy service delivery and documentation.

Recognizing the need for greater oversight and alignment with their quality and compliance goals, the organization decided to transition from contract therapy to an in-house model. They developed a phased implementation strategy and successfully launched an in-house therapy program the next year. The community was able to seamlessly maintain service throughout the transition while improving their compliance performance, thanks to the strategic and well-planned transition.

Choosing and transitioning to a new therapy provider can often be a very positive experience, but the transition needs to be carefully managed. Tran’s seven-step process provides valuable guidance that can help communities navigate this challenging time successfully. By following a structured approach, communities can ensure a smoother transition that benefits both residents and staff.

Paige Cerulli

Paige Cerulli is a contributing writer to i Advance Senior Care.