Know what to ask

At a glance…

When considering hiring a third-party rehabilitation therapy provider, make sure to do your homework. This article will tell you what questions to ask and the answers to expect.

Experts agree, choosing a rehabilitation therapy provider takes diligent background work and knowing what questions to ask and what to look for. Long-Term Living asked some leading rehabilitation therapy companies exactly how to choose a third-party rehabilitation therapy provider.

Martha Schram, PT, president of Aegis Therapies, Delafield, Wisconsin, says it’s important to look at what differentiates a rehab therapy provider from the competition. “Research the company’s history, staff experience, and core clinical programs. Carefully check references from other clients,” she advises.

Paul Shaw, owner and CEO of Heritage Healthcare, says check the reputation of the company as it relates to providing therapy services in that geography or in a fairly similar geography. “That reputation should be on two levels. First, with the rehab/therapy company itself; does it have good references, referrals that can speak to the quality of the therapy delivered and its accuracy and consistency? Second, what is the reputation of the therapists in the company? Are they allowed to use their own clinical judgment to deliver the appropriate care to residents?”

Recruitment/retention

Schram also advises looking for a therapy provider that has an excellent recruitment program and first-class training programs so one can be assured of consistent, quality care for residents.

Christopher M. Bird, president, Peoplefirst Rehabilitation Services, a division of Kindred Healthcare, agrees that recruiting, retention, and training are paramount. “We have a proprietary database that tracks the active status of 500,000 therapists that are potential candidates for Peoplefirst. That’s really important in terms of knowing where and how we can recruit therapists. Retaining qualified therapists through training is also important.”

Schram says clinician recruitment and retention are critical to rehab program success and are often challenges. “The right rehab partner’s experience and commitment will provide a reliable and thoroughly trained rehabilitation staff. The result will be strong clinical outcomes and full regulatory compliance.”

Clinical improvement

A potential provider should also be able to demonstrate clinical improvement and marketing support including census-building. “A good contract rehab provider offers quality programs for patients with measurable results in areas such as wound care, pain management, falls/balance management, and urinary incontinence. The best rehab providers vigilantly monitor complex and changing patient conditions and partner in preventing unnecessary rehospitalizations,” Schram says.

“Demonstrating clinical improvement is becoming increasingly important to our customers,” Bird explains. “We’re constantly developing programs meeting the needs of that patient population in that particular customer’s site; particularly providing service for more medically complex patients with respect to wound care, cardio-pulmonary rehab, stroke recovery. Patients, families, and referral sources want to see to what extent those patients are improving.” It’s important to have that information by patient, site, discipline, and diagnosis.

Documentation, billing

Mary Van de Kamp, senior vice president of clinical operations for Peoplefirst, says in today’s environment, services are constantly being looked at to see if they are medically necessary and if the billing is being done correctly. With strong documentation, the ability for denial is mitigated by the fact the documentation is so strong.

The best therapy providers are well-versed in the industry’s existing and proposed regulations and state practice activity changes. “The ability to understand and manage programs such as the CMS Recovery Audit Contractor monitoring program is crucial. An effective therapy partner will be prepared to respond to and defend claims when audited and successfully help manage the review process. Providers who have effective clinical outcomes data will be better equipped to demonstrate value and positive clinical results for all delivered services,” Schram says.

Heritage’s Shaw says it’s important for the rehab company to understand how the facility operates and makes money. “Does the rehab company have reports and the ability to communicate back to the facility in a way that will share with them the whole partnering mentality around reimbursement?” he asks.

And if a denial is received does the therapy company have a good denials tracking program? “Ask what their history is with denials with the various fiscal intermediaries. Do they have a system in place to provide assistance on additional documentation requests? Will they help support and challenge the denial all the way up to and including an administrative law judge, the last place of appeal for claims?” Shaw explains.

Working as a team

A proactive customer relationship program is important. Communication among the rehab manager, director of nursing, administrator, and MDS coordinator are important on a daily and weekly basis, according to experts. Clear lines of communication mean there are no misunderstandings concerning care.

Contracts, noncompetes

Shaw says it’s important to know what the rehab company’s track record is for retaining contracts. “Ask if they have a history of turning over a lot of contracts or do they have longevity? What is their retention rate with contracts?” Once you are satisfied with the answer, be sure to read the fine print in contracts. Since therapists can work for more than one company, some companies stipulate if their contract is broken that the therapist cannot work for the facility through another rehab company. “Know and understand all stipulations inside the contract,” Shaw cautions. “Many times administrators are not diligent in reading the fine print and they’re surprised when they can’t get out of a contract. Know and understand what you’re signing off on.”

Qualities/Programs to Look for When Choosing a Rehab Provider

• Nationally recognized rehabilitation outcome measures

• Therapists trained in state-of-the-art clinical programs

• Capacity to enhance therapy programs and develop specialized programs to meet patient and market needs.

• A track record of service excellence

• Financial stability

• Superior staff retention

• A proven commitment to continuing staff education

-Martha Schram, PT, President, Aegis Therapies

To send your comments to the editor, e-mail mhrehocik@iadvanceseniorcare.com.

Long-Term Living 2010 February;59(2):24-25