“Remember, it’s not the questions you ask, but the questions you fail to ask, that shape your destiny.” Anthony Robbins
In-House Therapy or Contract labor? A topic that always generates debate and indecision. Some SNF providers oscillate back and forth while others are adamant one way. There is no perfect solution or simple formula to decide. Why? Because the results are directly dependent on people. To be more specific, the therapists caring for the patients, the managers running the department along with one very key player….the facility Administrator. One may see a contracted therapy company provide extraordinary services in Connecticut while the same company produces ineffective services in Maine. While some in-house therapy programs flourish, others lack systems and outcomes.
Either way, one thing is for sure, Administrators need to be apprised of how to operate a Rehabilitation Department. Regardless if the therapy is on staff or contracted out, this department can significantly impact the reputation of the facility and the patient outcomes necessary for quality care. The Rehabilitation Department is one that I affectionately refer to as “The Business Within the Business.”
It may appear to be overwhelming, but in the whole scheme of things, Administrators are licensed and trained in operating a healthcare facility. The principles that apply to operating a successful nursing facility (maintain occupancy, give great care and collect payments), can be useful to therapy department management.
Rehabilitation Department oversight has three categories:
- Operational Elements: Staffing, Space, Signage, Equipment, Supplies, Marketing.
- Clinical Systems: Restorative Feeding, Functional Maintenance, Restorative Nursing, Contracture Prevention, Wound Care, Restraint Reduction, Positioning.
- Standards of Operation: Productivity, Efficiency, Revenue, Payor Mix and Expenses.
While the above three categories are not all inclusive, they do provide a road map to success. However, of all the above subcategories, Staffing always seems to be the most difficult and the most important. In order to provide services accordingly, it is imperative that the facility identifies the amount of therapists required to properly service the facility census. Simultaneously, deriving the staffing mix between Registered and Assistant level clinicians poses discussion and contemplation. The determining factors include staff availability, cost, state specific practice acts along with therapist experience.
Definitions: Registered Clinicians (OTR, RPT, SLP), Licensed Assistants (COTA, LPTA)
When determining staffing, the first thing required is a six-month collection of patient days by payer category (Medicare Part A, Managed Care, Hospice, Private, etc.). From this census, determine what the expected percent of each payer source receives therapy. For example, if there is an ADC of 10 for Medicare Part A, one may expect that 75% are receiving therapy. Then, calculate the number of patients on caseload each day. From there, one can determine the total hours of therapy staff required to meet the patient's clinical needs.
- 120 bed facility
- 89% occupied
- 12 Medicare Part A’s
- 15 privates
- 10 other
Staffing/Caseload Calculation: Part A
- (12 ADC) (75%) = 9 Rehab patients
Staffing/Caseload Calculation: Part B
- Total Census 106.8 Minus:
- 12 Medicare A’s
- 15 (private)
- 10 (other)
- = 69.8 Part B pool
- (69.8) (.05) = 3.49 anticipated caseload (Conservative measure)
- 9 Part A
- 3.49 Part B
- 12.49 Total Caseload
Therapy Caseload: FTE Calculation: This calculation infers that each therapist will treat 8 patients per day, in an 8 hour day.
Total 12.49 Residents
OT: ÷ By 8 = 1.56 FTE OT = 62.45 hrs/week
PT: ÷ By 8 = 1.56 FTE PT = 62.45 hrs/week
ST: 10% PT = ST 1.56 = 6.25 hrs/week (SLP most often ranges from 10-50% of hours required by Physical/Occupational Therapy).
- OT: 62.45 hrs/week
- PT: 62.45 hrs/week
- SLP: 6.25 hrs/week*
Total: 131.15 hrs/week
= 3.28 FTE’s
*SLP hours are dependent upon diagnoses within a facility. SLP hours generally run between 10% - 50% of total OT/PT hours.
Staffing Mix: Registered Clinicians are required to complete all evaluations and supervise assistant level staff. As stated above, this is where the facility has flexibility but must rely on state specific practice acts, costs and staff availability.
- COTA: 40 hrs/week
- OTR: 22.25 hrs/week
Total OT: 62.45 hours/week
The above calculation should be a helpful guide to successfully calculating therapy staffing. Please continue to send in requests for topics that you desire more insight. More articles to come from “The Business Within the Business.”
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