National Physiatry to Attend HealthTAC West 2019 in San Diego August 18-20
CORAL GABLES, FL–The Patient-Driven Payment Model (PDPM), the new Medicare payment rule for skilled nursing facilities (SNF) with an October 2019 implementation date, will surely be a topic of discussion among senior living and healthcare executives at the upcoming HealthTAC West 2019 to be held at Rancho Bernardo Inn in San Diego, August 18-20.
“Skilled nursing facility administrators everywhere have been wrestling with how to keep readmission percentages low for short term sub-acute rehab patients while simultaneously complying with shorter lengths of stay, and this has been a dilemma.” said Glen Rundell, CEO, National Physiatry.
Rundell will make a presentation at HealthTAC West 2019 regarding his prediction for PDPM, reimbursements and risk adjustment, and the increased need for telerehab—a branch off the larger telemedicine movement.
People continue to enter assisted living at a later age and with higher acuity and one or more chronic conditions. High-acuity residents often present challenging medical conditions and have more complex health care needs, which are often significant and unpredictable. Just a few years ago, those residents would have been at a SNF.
SNF administrators are looking at various methods to lower costs, improve patient outcomes, augment revenue sources and optimize reimbursements. They’re implementing protocols to manage the higher-care needs of many residents to help lower the community’s liability risk and increase their capacity to retain residents.
“Technology is transforming lives. Health care reform is transforming medicine. Telerehab can help achieve the triple aim by harnessing technology to deliver new models of healthcare,” said Rundell, whose National Physiatry firm currently provides physiatrists—medical doctors specializing in physical medicine and rehabilitation (PM&R)—at no cost to skilled nursing facilities, often within Continuing Care Retirement Communities (CCRCs) or Life Plan Communities.
Physiatrists diagnose and treat pain; restore maximum function lost through injury, illness or disabling conditions; treat the whole person rather than just the problem area; lead a team of medical professionals; provide non-surgical treatments; and explain a patient’s medical problems and treatment/prevention plan.
“Now we’re looking at how to serve rural areas with the same need and usually a higher census number, because they’re out in the middle of nowhere, doctors don’t want to go there, and there are not enough residents for a full-time physician,” said Rundell.
“A telerehab model would have one of our physiatrists living and working in New York City, for example, and driving to a CCRC, assisted living or SNF facility an hour and a half away in Newton, NJ. They’d like to go up there, and it takes a lot longer the first time, but maybe they go once a week after that and do follow-ups by telemedicine,” Rundell explained. “Via telemedicine technology, they can sit in on utilization review meetings with multidisciplinary groups at a facility, then measure patient progress or decline and make adjustments.”
It is estimated that about one-third of disabled adults over the age of 65 would benefit from physical rehabilitation and can be divided into two group. Those who have been disabled throughout their lives and need continuous rehabilitation, which is provided by trained professional therapists involved in evaluating the patient and designing a plan of care. And those who have become disabled as a result of an accident or illness and need restorative care where the evaluation and care plan is performed by the nursing staff.
“Telemedicine has huge implications for both groups, but with PDPM comes increased opportunities for restorative care,” said Rundell. “Outpatient is another part—creating outpatient services within the skilled nursing environment. Patients needing restorative care have to go someplace, and there are always barriers. This could be another revenue stream. Why not keep the continuum of care with the same team instead of starting over again?
“This is the beginning of a whole new dialogue as we explore the possibility of telerehab for rural areas that desperately need service, and provide a way for physicians to practice medicine more efficiently with more volume,” Rundell added. “They can see more patients, facilities benefit, and there’s a model where perhaps we provide a physiatrist with a small office, and they only do telerehab. There are a lot of possibilities, but I predict those facilities who have a doctor there, have telerehab there, will see an amazing increase in their census within a year.”
National Physiatry has already made huge inroads but is looking at some of the biggest challenges with implementing telerehab including how it’s done on the patient end. The hope is for implementation by the end of the year.
“It’s exciting to be offering these services that no other physiatry company is offering—their own EMR, telerehab. We have to be able to provide it, have to be able to give them what we’re promising. We want to test it, get feedback and tweak it so it works for each specific facility.”
Originally formed in order to improve the rehab process for sub-acute post-op patients, National Physiatry has grown from physician providers with a single purpose into an organization with many services that improve patient care, doctor life/work balance and the overall improvement of SNF effectiveness, patient outcomes and referrals through marketing. Happy and satisfied patients, primary care physicians and hospitals promote increased referrals.
Rundell believes SNFs will be able to increase some lengths of stay with the implementation of PDPM based on higher acuity levels so they can focus on increased quality of life and help prevent rehospitalization. Some patients will be able to go home earlier like those in short-term rehab for knee replacements. Many of those are already going straight home, depending on age and condition. That is expected to offset the increased stay by those with more complicated conditions.
“National Physiatry provides physiatrists—rehabilitation physicians—as consultants at no cost to the facilities,” Rundell emphasized. “We hire the doctors; they’re not independent contractors. When we present a physiatrist for final approval, that doctor is ready to come aboard and has already met with the rehab team, director of nursing, executive director and primary care physicians prior to the physiatrist’s start date.
“We are a full service practice management company and take care of all the day-to-day administration and operations that a SNF would have to do—and many can’t afford a full-time physiatrist. The interviewing process with extensive background checks and credentialing, payroll, compliance review, physician medical documentation, physician/team education, and timely patient outcome reports are all included with our management program, allowing the physiatrist to focus on rehab plans and improved patient care,” Rundell added. “Our physiatrists can really focus on exclusive customer service with each patient, re-hospitalization reduction, help with marketing and census building, and it becomes a differentiation of services offered by the SNF.”
Based in Coral Gables, FL, National Physiatry’s mission is to consistently provide high-quality patient care through their Physician Led Rehab Program® throughout the nation. National Physiatry’s vision is to consistently improve patient care by providing physiatry physician services for short-term sub-acute rehab units, at no cost to the facility.