Guest guest Posted October 21, 2004 Report Share Posted October 21, 2004 Here's an age old topic! I would like to hear how others are meeting the 3 hour rule on an inpatient rehab unit. Our FI (Michigan)defines it as 3 hours a day, 5 out of 7 days. This means that it's based on a rolling calendar. It wasn't so difficult when we used Mon-Fri as our five days but as you know patients are admitted and discharged on any day of the week. We are struggling with the shorter stay (5-7 days) patients who are admitted late in the week so two of their days are Sat and Sun. What kind of schedule do you create for these patients? How different does your weekend schedules look for all patients? Staffing and programmatically? The other struggle is with patients who arrive late in the afternoon on day of admission. Many times, they do not receive 3 hours of therapy so we are now down to meeting intensity 5 out of 6 days. Any suggestions, clarification, ideas, etc. would be much appreciated. Thanks! Lori Stoddart Inpatient Therapy Manager Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 21, 2004 Report Share Posted October 21, 2004 Lori: We work with rehab units all over the country. Your FI is not unusual in their definition and, under the stricter enforcement of Medical Necessity Guidelines (one of which is intensive therapy ie. The three hour rule) your organization is much more likely to get denials for services. There are a number of strategies we use for our clients: 1. Modified therapy schedules to allow patients to receive full therapy services on the day of admission and on the day of discharge. (A therapy shift that ends later in the day, etc.) 2. Education about how to use " concurrent therapy " to provide services to rehab patients. 3. Therapeutic groups (not to exceed 25% of a patient's care) 4. A focus on recording all time spent in therapy (our reviews have shown that therapists under-estimate the time actually spent in patient care activities by about 15%. 5. Weekend scheduling of therapies to assure more intensity. I would be glad to talk with you by phone about these and other strategies -- just call or email direct. Angie , PT President/CEO Images & Associates 407 South Shore Drive Amarillo, TX 79118 Phone- Fax- Mobile- Web: www.ptconsultant.com Email: images@... Home of The Desktop Consultant: The Rehab Department's Guide to JCAHO NOTICE: This message and its attachments may contain confidential information that is intended only for the use of the ADDRESSEE(s)named above. If you are not the named addressee or if this message has been addressed to you in error, you are directed not to read, disclose, reproduce, distribute, disseminate or otherwise use this transmission. Please notify the sender immediately by e-mail and delete and destroy this message and its attachments. 3 hour rule Here's an age old topic! I would like to hear how others are meeting the 3 hour rule on an inpatient rehab unit. Our FI (Michigan)defines it as 3 hours a day, 5 out of 7 days. This means that it's based on a rolling calendar. It wasn't so difficult when we used Mon-Fri as our five days but as you know patients are admitted and discharged on any day of the week. We are struggling with the shorter stay (5-7 days) patients who are admitted late in the week so two of their days are Sat and Sun. What kind of schedule do you create for these patients? How different does your weekend schedules look for all patients? Staffing and programmatically? The other struggle is with patients who arrive late in the afternoon on day of admission. Many times, they do not receive 3 hours of therapy so we are now down to meeting intensity 5 out of 6 days. Any suggestions, clarification, ideas, etc. would be much appreciated. Thanks! Lori Stoddart Inpatient Therapy Manager Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2004 Report Share Posted October 22, 2004 Hi Lori, We approach it as a revolving calendar. In response to the ambiguity of the language, we decided that we would error on the side of caution. For each patient admitted to the unit, beginning with the day of admission, for any chosen 7 day period, our patient will have received 3 hours of therapy 5/7 days. We too have encountered problems with late admits. While we strive to have all of our patients here by 11:00 am, we all know that this, at times, is not possible. Because of the aforementioned issues, we have noted an increase in weekend therapy provided. As far as the short stays, we have a policy that all patients who have an ELOS of less than 7 days are seen daily (including weekends). This does not occur often, however, due to the 75/25 (50/50) rule. We are typically seeing more medically complex patients to meet the medical necessity criteria. Kim , MPT Manager, Physical Medicine & Rehabilitation North Oakland Medical Centers 461 W. Huron Pontiac, MI 48341 Phone: Pager: 3 hour rule Here's an age old topic! I would like to hear how others are meeting the 3 hour rule on an inpatient rehab unit. Our FI (Michigan)defines it as 3 hours a day, 5 out of 7 days. This means that it's based on a rolling calendar. It wasn't so difficult when we used Mon-Fri as our five days but as you know patients are admitted and discharged on any day of the week. We are struggling with the shorter stay (5-7 days) patients who are admitted late in the week so two of their days are Sat and Sun. What kind of schedule do you create for these patients? How different does your weekend schedules look for all patients? Staffing and programmatically? The other struggle is with patients who arrive late in the afternoon on day of admission. Many times, they do not receive 3 hours of therapy so we are now down to meeting intensity 5 out of 6 days. Any suggestions, clarification, ideas, etc. would be much appreciated. Thanks! Lori Stoddart Inpatient Therapy Manager Quote Link to comment Share on other sites More sharing options...
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