How to Tell if Your Rehab Provider is a Good Pandemic Partner

Jun 2

“Prosperity makes friends, adversity tries them.”
- Latin scholar Publilius Syrus

History of Prosperity in the SNF Rehab Space

For the last several decades, contract therapy providers have been integral to operations within skilled nursing facilities (SNFs). Most of that time SNFs operated under the RUGs payment system for Medicare Part A patients. You may recall that under the RUGs system, the volume of therapy minutes provided was the primary driver of payment for your Part A patients. All of that changed on October 1, 2019 when Medicare implemented the new Patient Driven Payment Model* (*PDPM side note: feel free to peruse and download our whitepaper to understand the ins and outs of PDPM and learn how payment is now generated.)

Under PDPM, many SNF operators began to see their therapy department as a cost center rather than a revenue generator. While that isn’t entirely true, I do understand that thought since therapy minutes are no longer the driver of revenue for Part A patients. (For Part B patients and some other non-Medicare payors, those services are still billed at a fee-for-service rate that ultimately generates revenue.)

Understanding the RUGs payment model and having managed multiple contract therapy locations over the years, I would say that the contract therapy provider was often the master of their own fate, with an ability to create prosperity for themselves and their SNF clients. Now that we are in changing times experiencing adversity, how is that partnership holding up?

Pandemic Adversity

We have heard from many colleagues who run contract therapy companies or are SNF administrators, and the contractors have responded to the pandemic in varied ways. Two examples of their diverse response in regards to PPE and Staff Compensation:

PPE - Some contractors have voluntarily purchased hundreds of thousands of dollars worth of PPE (which in most cases is not required per the therapy contract) and have distributed it to their teams in different states as a proactive measure. While others did not provide anything proactively and instead relied on the SNF client to provide PPE for the contractor’s staff. And others, in the middle of both extremes, have come together to discuss how to handle the PPE situation.

Staff Compensation - We are seeing some SNFs pay “hero” pay to their own staff while contract therapy companies are cutting pay to their therapists due to decreased revenue. If you are in a facility where this has happened, it ultimately puts your contract therapist team members and your own employees, who work side-by-side, in some precarious conversations and situations.

I can tell you that many contract therapy providers I know are hurting (as evident by the pay wage reductions) as many of them calculated a percentage of group and concurrent into their fee structure and that was one way that they were going to handle the decreased reimbursement under PDPM (and how they likely gave you a reduced therapy bid for PDPM). However, based on the CMS limitation of group activities in the SNF setting during this pandemic, group and concurrent shouldn’t be happening. And many contractors move therapists from building to building as caseloads fluctuate, and in many cases, that movement should no longer be an option due to the limitations on staff going from one building to another during the pandemic. I heard from a prospective client the other day, “I have [contract] therapists coming and going from my building and have no idea where they have been.” Because the therapists are not technically his staff, he feels he has had little control over the movement of the contract therapy company’s therapists going from one facility to another and then to his SNF.

This all made me think of Syrus’ quote, “Prosperity makes friends, adversity tries them.”

Sometimes contract therapy companies are still the right fit for a SNF depending on their size, location, and other attributes. Both rehab models, contract and in-house, have their place in the long-term care industry. However for some, the type of therapy partner who was a great fit last year for your SNF during a time of prosperity, may not be working out well for you today during the reality of a global pandemic and in the post-PDPM landscape.

Questions to Ask Yourself:
• In this time of pandemic, how is your therapy partner performing?
• Has group and concurrent therapy been eliminated during this health crisis?
• How are therapists being treated - Is PPE being provided? Are they being compensated similarly to other staff in the facility?
• Looking back would you rather have been in-house so you could have control over the therapy team staff and their movements?
• Would you rather have kept the revenue that goes to the contract provider so you could use the profit to benefit your patients, your physical plant, and/or your employees?
• Would you rather have had ultimate control over the policies and procedures happening in the rehab department so you could enforce or enact changes to benefit your residents during such a unique time?

Our next post will be Part 2: Five Ways the In-House Therapy Alliance™ Can Benefit Your SNF. Our clients have had a different experience altogether this year. Through our alliance, our clients are either already in-house or we previously led them through a conversion to an in-house model. The post will cover the many benefits they have experienced, especially during times of adversity.

To learn more you can also click here to view our two-minute explainer video.

Best regards to you, the residents in your care, and your teams,