Harmony Healthcare International (HHI) Blog

AHCA Provider Lounge Series: What RCS-1 Means for Therapy in the SNF



Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency

Interview with Fred Benjamin, President of Skilled Nursing at Lexington Health Network

Kris Mastrangelo, President of Harmony Healthcare International (HHI) interviews Fred Benjamin, the President of Skilled Nursing at Lexington Health Network, in the 2017 AHCA Provider Lounge.  Fred discusses how the new Resident Classifcation System (RCS-1) will affect the continuing role of therapy and rehabilitation in his organization. At the end of the day, his goal is to provide his patients with the rehab services they need and expect from his facilities.  (Audio transcription below).


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Transcribed Audio:

Kris Mastrangelo: Good afternoon and welcome to the 68th Annual American Health Care Convention. Today we with Fred Benjamin from Lexington Health Network. He's the President of the Skilled Nursing Division. Welcome Fred.

Fred Benjamin: Good to see you Kris.

Kris: Good to see you as well. Wow, what a year. Lots going on. We have a lot of regulatory and reimbursement changes, but you know one of the things that I haven't spoken about today is the RCS, the resident classification system. Can you tell me a little bit about what's going on in your organization and how you perceive this will affect you?

Fred: Sure, well rehabilitation obviously is a primary reason that people come to skilled care facilities and when you change the reimbursement system surrounding rehabilitation it causes a lot of people to be concerned about what does this mean. So, we've been trying to answer that question internally for ourselves and some of the early thoughts that that we've had: first of all, to do some financial modeling and to see what the financial effect would be based on completing the MDS form that that we have right now and looking at RUGs pricing, if you will, compared with the proposed pricing under an RCS system. But that's the least important part for right now. I think the most important part is what is going to change in the way that we provide services to our residents and so in my mind's eye one of the potentially good things about RCS is that it will take into account a lot of the other kinds of comorbid conditions and will but hopefully better track more medical/surgical kinds of diagnostic elements for us. So, we're right now trying to figure out how our programmatic planning will be effected at our facilities and therefore if we need to develop some new kinds of programs that we don't offer now and also to try to figure out what the continuing role of therapy and rehabilitation will be inside of our company. But one thing is for sure though, when we try to see this through the lens of our patients we need to provide the rehab services that they need and that they expect of us. What has been changing of course has been the length of stay and what we're finding is that the trajectory of people's improvement can be can be speeded up a little bit but the changes in going from you know a couple of years back 30-day length to stay to some of our facilities and some of our diagnostic elements of 13/14 days for some of the some of the orthopedic conditions, looking at those and seeing that skilled care is being bypassed and in many instances and what's left we're still being asked to get people in and out sometimes in seven days or less.

Kris: How many properties do you have?

Fred: Lexington has ten skilled facilities, two assisted living facilities, one independent living facilities. All larger buildings, all in the Chicago Suburban market.

Kris: And that's different when you have multi facilities, handling all the change versus having one. The pressures are there either way but do you have any insight or recommendations on how to handle that in multiple facilities?

Fred: Sure. Well I don't think that anybody can predict exactly what the response would be because every market is a little bit different of course, but one thing that that does stick out to me is the presence, particularly in large urban markets, of large hospital systems that are geographically distributed, multiple hospitals. We have a couple of those in the Chicago market, so we have the opportunity at the system level to work with health system partners which is different than working with individual Hospital partners because they're trying to achieve a little bit broader kind of mission and they're a little bit more focused on population health as opposed to specific clinical diagnostic entities. So, we're trying to partner up with the larger systems and find out what clinical programs they need in what specific locations and how we can figure out a way to better to partner with them.

Kris: That's brilliant and so with regards clinical programming, have any of your created a niche for the respiratory therapy or are you there yet or you on your way with that niche?

Fred: We've had specialty clinical programs for a long time. Those aren't new. What is different is the willingness of physicians and hospitals and hospital systems and their post-acute networks to have discussions with us about the handoffs and as we continue forward with penalties in reimbursement for people being readmitted to the hospital 30, 60, 90 days out, Lexington is well-positioned because we have home health and hospice and some of the other services and hopefully we can tie those up in ways that allow us to design a clinical program that begins before people get to our facility and ends significantly afterwards so that we can achieve optimal outcomes without people going back to the hospital.

Kris: The Mark Parkinson keynote. He brought up a slide that talks about the best deal in town.

Fred: We are. The low-cost provider, low-cost, high quality provider. Without a question.

Kris: Well I'm a hundred percent with you. And you talk about length of stay and so the national average per the PEPPER Report is 21.3 days but I know that I have clients that have orthopedic patients 11.6 days. So, having said that though, if we’re looking at readmissions, we're looking at length of stay also. Thinking about the best deal in town, do you think that as this evolves, the length of stay will be the same, smaller or maybe get a little bit longer when they start tracking hospital readmissions or ER visits.

Fred: Wow that's a loaded question, but that's it's the real world that we live in. Of course, because the payers want to pay less and the pressures on the insurance industry and created demographically and within the Medicare system and Medicaid system, every governmental entity has its own financial pressures and the insurance companies have their financial pressures as well and consequently I think that in the short-term the length of stay will continue to be to be pushed down a little bit. As we as we continue forward if people continue or if life expectancy continues to grow then the kinds of illnesses that we see and the trajectory of treatment is going to change as well, but it's all it's all under the under the veil of who can afford to pay for the care.

Kris: Exactly. Thank you so much that was a wonderful answer. Our time is up. Thank you, Fred Benjamin. Wonderful discussion and we'll see you soon.

Fred: Thank you.

harmony20 October 29-30 2020 Encore Boston Harbor

Topics: RCS-1

Kris Mastrangelo, OTR/L, LNHA, MBA


Kris Mastrangelo, OTR/L, LNHA, MBA

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