If you change nothing, nothing will change.

Twenty years ago therapy was cost-based reimbursed. We had huge therapy rooms and tons of therapists. Back then our goal was to get all our patients to stay for 100 days, because the longer they stayed the more we made. The problem is that although the reimbursement systems have changed, the way we provide therapy really hasn’t. I still walk into facilities that only provide therapy Monday through Friday, where their therapists work eight-hour shifts, from 7:00 AM to 3:00 PM. You may be asking what’s wrong with that.

What’s wrong with that is that limiting therapy to 7:00 AM to 3:00 PM will keep your average length of stay (ALOS) too high for you to be able to participate in risk sharing programs. Studies have shown that for every day someone is completely bed-bound, they will need five days of therapy to recover. And for every day they are inactive, it’s takes two days of therapy to recuperate. So here’s the issue:

If someone is in a skilled nursing community that is providing therapy only five days a week, and is inactive two days every week in a 30-day stay, they’d require an additional 16 days to reach the same level of strength that they would have  attained had they received therapy on a daily basis. By not providing therapy seven days a week, essentially we are adding 16 more days to a patient’s stay. So instead of a 30-day stay, they’d be in your skilled nursing community for 46 days. Let me ask you – how many of you go to the gym? Now, how many of you go to the gym and work out for 2 1/2 hours at a time?

But that is exactly what we do in our skilled nursing communities. In order to get that high rehab category we expect an 80-year-old who is recovering from an injury or illness to have therapy for 2 1/2 hours a day, in a single session, for 5 straight days. And after that 2 1/2 hour therapy session, what do we do? We roll them back to their rooms where they lay down in the bed, completely exhausted, and sleep for the next 20 hours! It’s time for a change. So let me share the six strategies that you must hold your therapy partner accountable for to get your patients stronger faster, and to lower your Medicare ALOS.

Strategy 1:  Be Able to Provide Therapy 7 Days a Week 12 Hours a Day – 7 AM to 7 PM 

By providing patients with therapy seven days a week you won’t be setting your patients back a little bit every week because they are inactive on weekends. They will have fewer minutes in gym each day and their therapy will be divided into two sessions. Additionally, if you have therapists in your building seven days a week you can assess and treat patients the same day they are admitted so they start therapy that day. That’s important because to get patients stronger faster your therapy company must be able to assess and treat the patient on the day of admission.  

Strategy 2:  Start Providing Group Therapy (Again)  

I was recently at a hospital that had just implemented a brand new knee replacement program and they just started providing group therapy. The administrator was so excited about it and he said, “They compete with each other in the groups where they really push themselves and have a good time doing it.” The day I was there was “Golf Day” so I got to see how hard they worked playing a simulated round of golf. The reason we are not doing groups any longer is because we have to split the time up among the individual members of the group and it takes too long to document for each patient. But is that not sad?  

Strategy 3:  Avoid Discharging on Fridays

We have a policy in our skilled nursing communities that we don’t discharge on Friday because if patients leave on Friday and have a health issue on Saturday or Sunday they often can’t see a practitioner and end up in the hospital. If you explain to your prospective patients or their family members or caregivers that your ALOS is about 15 days less than what they can expect from the facility down the block, you’ll get their attention and more admissions!

Part 1:  
Skilled Nursing – Who Are Your Partners?
Part 2:
Are Your Skilled Nursing Physicians Partners or Leaches?
Part 3: 
Radical Therapy Partnerships
Part 4:
Still To Come
Part 5:
Still To Come
Part 6:
Still To Come