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A Wide-Open Door of Opportunity
Home » News » A Wide-Open Door of Opportunity |
“Right now, skilled nursing facilities are looking at the best opportunity to grow census since PPS came into being in 1998,” says Fran Fowler, president of Fowler Healthcare Affiliates, Inc. The reason? A CMS rule change.
In May 2004, the Centers for Medicare & Medicaid Services (CMS) changed the rule (once called the “75/25” rule) regarding what types of single-joint-replacement patients can be admitted into acute inpatient rehab facilities. Following a formula phased in over three years, the new rule eliminates acute inpatient rehab unless joint replacements are bilateral, the patient is over 85 years old, or the patient’s body mass index is greater than 50.
“Orthopods are floundering nationwide—they don’t know what to do,” says Fowler. “They are looking for another venue for their patients. Nursing homes that can step up to the plate will capture these populations, and that’s where rehab comes in. It’s a golden opportunity for every long-term care provider.”
Because historically some acute units had as high as 40 to 50% of their total patient population as single-joint replacements, Mark Tellier, healthcare consultant and principal with Tellier & Associates, LLC, believes this is a relatively easy market for skilled facilities to step into. “The SNFs should be going after it,” he says. “If they have a good rehab program, and they’re marketing smart to those patients, it’s just low-hanging fruit.”
The kind of good rehab program that can target these patients is what newly created Aegis Acute Rehab has in mind with its Centers for Orthopedic Excellence. “We are taking underutilized beds in the skilled facility and converting them into an orthopedic unit that will concentrate on the ultra-high and very high RUG levels for patients who require intensive therapy,” says Maurice Arbelaez, president of Aegis Acute Rehab. “With 15 to 25 beds, we can bring in the short-term orthopedic Medicare Part A patients and other managed care patients who no longer meet the acute level of care. That will be a big boost to the SNF’s census.”
The Centers for Orthopedic Excellence would be a dedicated orthopedic unit in the SNF with its own separate entrance. “We don’t want to commingle our beds with the rest of the facility because then the efficiency of the unit falls off,” adds Bill Klemm, vice-president of finance for Aegis Acute Rehab. “We want all these patients in one location so we can have a dedicated nursing and therapy staff.” The management team includes a program director, a medical director and, in some cases, a community relations coordinator who could act as a liaison with the hospital to make sure all patients who require this level of care are admitted.
Because patients will be discharged home within 20 days, the short stays will increase patient satisfaction and improve the perception of the SNF in the community. “People will see that mom came into this facility and then went home,” says Klemm. “Down the line, when mom needs more care, she will remember the facility because she had good results and the people were great.”
As with any new venture, the first step is for a skilled facility to analyze the need within its community to determine what size unit would be appropriate. Arbelaez says that Aegis can help the facility perform its due diligence and align the unit with its local hospital and at least one orthopedic group. “You have to develop therapy protocols,” he says. “If you don’t manage the minutes carefully, then the program is not going to be successful. Because of the higher RUG categories, the SNF will get anywhere from $350 to $500 a day for these patients.”
Expertise is essential to success with these new units. “I think it would be hard for a SNF to do this on its own,” says Mary Guyot, RN, BS, CRRN, senior consultant at Stroudwater Associates. “The SNF should associate itself with people who have experience with a rehab model and rehab philosophy in order to have good outcomes.”
The orthopedic centers will also enhance the facility’s image, according to Stroudwater’s senior consultant Susan Kreps, PT, MBA: “If you have staff specially trained in orthopedics, with protocols and procedures specifically designed for the ortho population, the level of trust in the program increases. The rehab needs are not going to go away. If people can’t get rehab at the acute level, they are still going to need a rehab program.”
The transition time for the CMS rule is ticking away and skilled facilities must act soon. “Those that grab this opportunity will do well, and those that don’t will miss a significant opportunity for profit,” says Fowler. “An investment in therapy for these patients, in relation to the return—particularly if the facility has empty beds—is a no-brainer.”
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