Harmony Healthcare Blog

The SNF Therapy Dilemma: In-House v. Contract

Posted by The Harmony Team on Wed, Apr 01, 2015


Edited by Kris Mastrangelo

stock-photo-18848545-gait-training-physical-therapy-051626-editedWhich is right for my building:
In-House or Contract Therapy?

This is a question that is repeatedly asked of me wherever I go.  Yet the answer is the same:   It depends.

Proponents of both contract and in-house therapy might be disappointed in my answer; however there are many factors to consider with regards to this critical decision.


Let’s consider the following:

  • Kris Mastrangelo, President and CEO of Harmony Healthcare International, taught me a long time ago that therapy is “The Business within The Business.”  This is illustrated numerically by the 2013 PEPPER report, which shows that 93.2% of all Medicare days nationally fell into a Rehab category.  While a clear focus on Rehab operations has always been a must, some key aspects have changed in the last few years.
  • In order to recover from their illness/surgery/hospitalization patients need effective therapy.
  • Medicare Part B therapy in the Skilled Nursing setting is essential to prevent decline, increase functional level, increase range of motion, improve activity tolerance, and minimize difficulty swallowing.
  • Rather than look at which type of program is “better,” let’s look at what the best programs, either in-house or contract, have in common.  

Strong leadership in the Rehab Manager position is essential.  The Rehab Manager must effectively communicate, not just within the department, to other therapists, but also with the MDS coordinator and nursing as well.

For a whole host to reasons, today’s Rehab Managers are now being asked to have a keen understanding of Medicare rules and regulations AND the ability to apply them while treating the geriatric/medically complex patient.  This is not the sort of thing therapists are learning in school.  While “on the job training” can be great, it becomes quite challenging when the differences in approaches between building-to-building and organization-to-organization become apparent.

Since the days of group and concurrent therapy are gone, program development and specialty care centers beyond orthopedics for specific conditions such as cardiac rehab, amputee rehab, and Parkinson’s care are  giving facilities an edge on their SNF competition.

Most notably, the best Medicare programs have an Administrator who is actively involved in therapy operations.  This includes having a working understanding of the operational elements, clinical systems, and business operations.  Being an active participant in the weekly Medicare meeting helps to lead and guide the team during a time of complex regulatory changes.

Here are a few more useful tips:

  • Medicare meeting and Discharge planning meeting are not the same thing.  Make sure that the purpose of each meeting is maintained.
  • OBRA regulations apply regardless of payor source (treat to highest state of practical well being).
  • Strive for consistency in Medicare Part B program year-round;  Having  peaks and valleys in utilization can be an indicator of educational needs, issues with the screening process, or staffing.
  • Staffing Patterns, utilization, and productivity should be evaluated regularly whether your department is in-house or contract.

In this era of intense governmental scrutiny, providing resources and oversight to the therapy department operations are essential.  While both the in-house and contract model have proven to be highly effective, neither can operate effectively without collaboration, communication, and support from Leadership. 

If you have questions regarding therapy services or need help maintaining therapy compliance, please click here to contact Harmony Healthcare International or call us at (800) 530-4413. 



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Tags: SNF Therapy, Contract Therapy

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