1 NRH Medical Rehabilitation Network Adding Life to Years
2 Paul R. Rao Ph.D. CCC CPHQ FACHE Vice President, Clinical Services, Quality & Compliance National Rehabilitation Hospital 102 Irving Street NW Washington D.C Office Cell Fax
3 Leader in Medical Rehabilitation NRH, within the nation s capital, is licensed for 137 rehab beds, is the largest freestanding rehabilitation inpatient facility in the region & one of the 10 largest in the nation. Largest outpatient rehabilitation network on the east coast. NRH has been ranked as one of the top hospitals for medical rehabilitation in the nation by U.S. News & World Report for 14 consecutive years. Identified as World Class since 2006, based on Watson/Wyatt Employee Satisfaction Index-73 ESI.
4 Employer of Physical Therapists Number of NRH Team Member PTs out of 1000 NRH employees nearly 20% of staff Acute the Washington Hospital Center n=20/20 In-Patient Acute NRH n=24/24 Out-Patient Medical Rehab Network n=155 Total FTE Physical Therapists=194/199
5 Labor Shortage: Physical Therapy- A Rehab Hospital Perspective Historical Context: Reimbursement and Compliance of the Centers for Medicare & Medicaid Services (CMS) and Managed Care requirements drive the employment market in acute rehabilitation. The inpatient acute rehabilitation industry consists of 240 free standing rehabilitation facilities and over 1000 rehab units within acute care hospitals. PT labor pipeline has been saw toothed. The most recent radical shifts occurred following the BBA of 97 followed by the CMS Prospective Payment System in 2002.
6 Acute Care Rehab Drivers DRG Model of payment since shorter stay, greater pay and PTs are key to determining if patients can go home or be discharged to another level of care. PTs often asked to evaluate the acute care patient within 24 hours of admission including the ICU to determine viability of safe discharge. Acute Care hospitals are not paid per se for the PT intervention but must have PT expertise and adequate staffing for PT Evaluations and treatment and reduce length of stay- hence more pay!
7 Acute Inpatient Rehab Drivers Medicare Requirements: Medicare statutebeneficiary is entitled to coverage of reasonable and necessary inpatient hospital care, including inpatient rehab services PT one of 3 required disciplines for each inpatient rehab admission; Acute inpatient rehab patients must receive 3 hours of therapy from PT/OT/SLP for 5 of every 7 days
8 Recovery Audit Contractors: 2009 The greatest recoveries, net of appeals, for inpatient hospital services included claims for excisional debridement, inpatient rehabilitation services following joint replacement surgery, surgical procedures in the wrong setting, cardiac defibrillator implant in the wrong setting, treatment for heart failure and shock and respiratory system diagnoses with ventilator support.
9 RAC Audits thus Push for more intense and concurrent compliance with 3 hour rule intervention e.g., PTs, OTs, and SLPs as facilities can receive retrospective denials as far back as Oct and receive 9-12% of recoverables for all denied stays that are upheld.
10 Out-Patient Rehab Drivers Therapy Caps CPT code complexities Not able to bill for unsupervised services No allowance for co-treatment with other disciplines Reduction in allowance for group therapy- more 1:1 The expectation is that the rehab services require the skills of a therapist which include: Experience Knowledge Clinical judgment Decision making abilities Safety reasons
11 New Drivers Economy Healthcare Reform Age Wave Prevention Technology
12 Vacancy Rate Reduction Using a Marketing Strategy Year Acute Care Acute Rehab OP Rehab % 15% 13% % 0% 7%
13 Recruitment/Marketing Strategies Scholarship Reduction/Sign-On Bonus Relocation Assistance Reputation as a Magnet Hospital Recruit Your Best & Brightest Students 75% of Market Consider International Market esp. England and Philippines Hire PT Assistants to supplement the therapy pool
14 Retention Strategies Merit Raises & Market Adjustments Mentorship Career Ladder: Director, Manager, Supervisor, Senior, Resource Clinician, staff PT Reward for Specialty Certifications Fund Courses/Classes Research Opportunities & Faculty Appointments Expand Career Learning/Career Options e.g., transfer to a different program or level of care Recognition & Rewards e.g., pay for APTA membership, campus parking, internet access Opportunity to be a Change Agent
15 Other Quality of Life Retention Strategies Day Care On Site Flexible Hours e.g. 4 ten hour days Job Share Collaborative work culture: New Value Transfer to flexipool Comp Time for Weekend Coverage
16 Competition from Other PT Practice Venues Direct Access in over 40 states School Systems Home Care Long Term Care Private Practice Cash Only niche
17 Future Scape Evidenced Based Practice Outcomes as a Foundation of Evidence for Efficacy and Effectiveness Medicare Direct Access to Physical Therapists Electronic Medical Record and Tech approaches to work e.g., performance appraisal, scheduling Increased use of PTAs as a lower cost alternative Decrease variability of Practice Act Laws by state DPT as norm by 2020 currently 75% of PT grads have a DPT 92% of PT Programs offer DPT. CMS Bundling Plan by could have a sea change on all post acute care, including prospects for PT & other allied health fewer Medicare beneficiaries qualifying for post acute care and thus less of a need for PTs.