Therapy Program Development

Overview:

Nursing facilities have evolved over the past years to serve an increasingly clinically complex and rehabilitation intensive population.

  • Today, over half of all Medicare beneficiaries requiring care following a hospital admission are treated in nursing facilities. 
  • Individualized treatment plans devised by Therapy Professionals are an important part of this care, enabling patients to regain speech and motor function as well as master key daily activities, such as bathing and dressing.

Therapy services share a goal of helping residents to achieve and maintain the highest practicable level of functioning. In this way, therapy plays an important role in meeting the Omnibus Budget Reform Act (OBRA) of 1987 requirements, which established a minimum standard of care, including an expectation that nursing facility residents’ ability to perform activities of daily living and functional mobility would be improved or maintained, absent medical challenges.

Medicare payment during a post-hospital stay is often incorporated into the Part A prospective payment systems. The nursing facility Resource Utilization Group (RUG) payments take into account the amount of therapy a beneficiary is receiving and the payment to the nursing facility includes the therapy component.

  • Longer-stay individuals in nursing facilities may have Medicare coverage but their nursing facility stay may be paid for through Medicaid or private funds. These individuals may rely on Medicare Part B for therapy services. Hospitals, physical therapy private practices, and skilled nursing facilities are the most common sites of service for Part B therapy.
  • Often, Medicare Part A and Medicare Part B patients form two very distinct groups of patients.

While there is a great deal of focus upon the management of post acute (Medicare Part A) patients in the SNF population, many of whom will return to the community, management of long term care (Medicare Part B) patients is equally essential to the provision of services along the continuum of care.  According to CMS regulations, long-term care patients have a right to function at their highest practicable level, including the delivery of services to slow the progression of decline, as long as these services meet the definition of skilled criteria.

The goal of intervention for post-acute and long term patients is to progress the patient to highest practicable level. Often, while working with long-term patients the goal might be to slow the decline of their disease process, develop systems to maintain the patient at as high a level as possible for as long as possible, train the staff and family regarding how to elicit optimal performance from the patient, and ultimately transition the patient back to Nursing staff level of care.  Clinical objectivity by all disciplines involved is highly valuable in these processes, in order to ensure that complacency or staff bias does not interfere with patients’ rights to experience optimal health and functioning throughout their skilled nursing facility stay. Skilled interventions enhance chronic disease management patients’ quality of life, preserve their sense of independence and functionality, and reduce the burden of care on staff and caregivers.

Potential Risk to Providers:

  • Lack of specialized therapy services and expert knowledge of geriatric population can adversely affect clinical outcomes of nursing home residents. 
  • Conversely, failure to provide skilled therapy services may result in subpar standard of care and failure meeting OBRA mandated expectations to ensure patients are provided the opportunity to attain and maintain their ability to perform activities of daily living and functional mobility at the optimal level.

Do Your Medical Records Support Skilled Care?