Guest guest Posted October 14, 2005 Report Share Posted October 14, 2005 Marty - Two questions for you (and your administrator and insurance company): Is there evidence that 7-day therapy for this particular population results in improved outcomes over 5 or 6-day? If so, is the benefit worth the cost? Regards, Trager, PT Rehabilitation Services Manager Kaweah Delta Health Care District Visalia, CA. rtrager@... Sunday Therapy I am the Rehab Director at a 130 bed SNF/LTC facility with 35 beds dedicated to sub-acute patients with an average length of stay of 14 days. We currently see most inpatients a minimum of Monday-Friday. Some patients, who need 6x/week, do receive treatment Monday-Saturday. We recently became a provider for a certain insurance company that says they will pay us more money per day, if we see their patients seven days per week. Our current system seems to be working for the patients benefit, the therapists job satisfaction, and the facility from a revenue standpoint. I fear that if seven day a week therapy is instituted, then I will loose therapists. I can not afford to do this because it took us over a year to fill a full time PT position. Is anyone else facing this issue? And if so, how are you handling it. I have tried to educate administration that we are not an acute rehab hospital, but are only a sub-acute SNF. Thanks in advance for any responses to this topic! Marty Koehler, PT, MPT Rehab Director Ohio Valley Manor Ripley, OH Looking to start and own 100% of your own Practice? Visit www.InHomeRehab.com. PTManager encourages participation in your professional association. Join and participate now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 14, 2005 Report Share Posted October 14, 2005 Marty - Two questions for you (and your administrator and insurance company): Is there evidence that 7-day therapy for this particular population results in improved outcomes over 5 or 6-day? If so, is the benefit worth the cost? Regards, Trager, PT Rehabilitation Services Manager Kaweah Delta Health Care District Visalia, CA. rtrager@... Sunday Therapy I am the Rehab Director at a 130 bed SNF/LTC facility with 35 beds dedicated to sub-acute patients with an average length of stay of 14 days. We currently see most inpatients a minimum of Monday-Friday. Some patients, who need 6x/week, do receive treatment Monday-Saturday. We recently became a provider for a certain insurance company that says they will pay us more money per day, if we see their patients seven days per week. Our current system seems to be working for the patients benefit, the therapists job satisfaction, and the facility from a revenue standpoint. I fear that if seven day a week therapy is instituted, then I will loose therapists. I can not afford to do this because it took us over a year to fill a full time PT position. Is anyone else facing this issue? And if so, how are you handling it. I have tried to educate administration that we are not an acute rehab hospital, but are only a sub-acute SNF. Thanks in advance for any responses to this topic! Marty Koehler, PT, MPT Rehab Director Ohio Valley Manor Ripley, OH Looking to start and own 100% of your own Practice? Visit www.InHomeRehab.com. PTManager encourages participation in your professional association. Join and participate now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 14, 2005 Report Share Posted October 14, 2005 ; To play Devil's Advocate however; if a payer wants something from us in exchange for their reimbursement to us, are we really in a strong position to " tell " them whether they are getting their money's worth, or the " benefit " for the cost? Isn't that a decision for the payer/buyer to make, rather than the seller/provider? Don't get me wrong; I am not saying that I agree with this payer, but is that really relevant in the big picture? I firmly believe, and our professional standards would support me in this, that our decisions must be based on the need in our patients; not our wishes, or those our employers, administrators or payers. Ken Mailly, PT Mailly & Inglett Consulting, LLC Tel. 973 692-0033 Fax 973 633-9557 68 Seneca Trail Wayne, NJ, 07470 www.NJPTAid.biz Bridging the Gap! Sunday Therapy I am the Rehab Director at a 130 bed SNF/LTC facility with 35 beds dedicated to sub-acute patients with an average length of stay of 14 days. We currently see most inpatients a minimum of Monday-Friday. Some patients, who need 6x/week, do receive treatment Monday-Saturday. We recently became a provider for a certain insurance company that says they will pay us more money per day, if we see their patients seven days per week. Our current system seems to be working for the patients benefit, the therapists job satisfaction, and the facility from a revenue standpoint. I fear that if seven day a week therapy is instituted, then I will loose therapists. I can not afford to do this because it took us over a year to fill a full time PT position. Is anyone else facing this issue? And if so, how are you handling it. I have tried to educate administration that we are not an acute rehab hospital, but are only a sub-acute SNF. Thanks in advance for any responses to this topic! Marty Koehler, PT, MPT Rehab Director Ohio Valley Manor Ripley, OH Looking to start and own 100% of your own Practice? Visit www.InHomeRehab.com. PTManager encourages participation in your professional association. Join and participate now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 14, 2005 Report Share Posted October 14, 2005 ; To play Devil's Advocate however; if a payer wants something from us in exchange for their reimbursement to us, are we really in a strong position to " tell " them whether they are getting their money's worth, or the " benefit " for the cost? Isn't that a decision for the payer/buyer to make, rather than the seller/provider? Don't get me wrong; I am not saying that I agree with this payer, but is that really relevant in the big picture? I firmly believe, and our professional standards would support me in this, that our decisions must be based on the need in our patients; not our wishes, or those our employers, administrators or payers. Ken Mailly, PT Mailly & Inglett Consulting, LLC Tel. 973 692-0033 Fax 973 633-9557 68 Seneca Trail Wayne, NJ, 07470 www.NJPTAid.biz Bridging the Gap! Sunday Therapy I am the Rehab Director at a 130 bed SNF/LTC facility with 35 beds dedicated to sub-acute patients with an average length of stay of 14 days. We currently see most inpatients a minimum of Monday-Friday. Some patients, who need 6x/week, do receive treatment Monday-Saturday. We recently became a provider for a certain insurance company that says they will pay us more money per day, if we see their patients seven days per week. Our current system seems to be working for the patients benefit, the therapists job satisfaction, and the facility from a revenue standpoint. I fear that if seven day a week therapy is instituted, then I will loose therapists. I can not afford to do this because it took us over a year to fill a full time PT position. Is anyone else facing this issue? And if so, how are you handling it. I have tried to educate administration that we are not an acute rehab hospital, but are only a sub-acute SNF. Thanks in advance for any responses to this topic! Marty Koehler, PT, MPT Rehab Director Ohio Valley Manor Ripley, OH Looking to start and own 100% of your own Practice? Visit www.InHomeRehab.com. PTManager encourages participation in your professional association. Join and participate now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 14, 2005 Report Share Posted October 14, 2005 Ken - No argument. Asking " What does the evidence support? " is our professional responsiblity - and providing services accordingly is in the best interest of the patient. Once that's determined, (most of us) need to be fiscally, as well as professionally, responsible. Regards, Trager, PT Rehabilitation Services Manager Kaweah Delta Health Care District Visalia, CA. rtrager@... Sunday Therapy I am the Rehab Director at a 130 bed SNF/LTC facility with 35 beds dedicated to sub-acute patients with an average length of stay of 14 days. We currently see most inpatients a minimum of Monday-Friday. Some patients, who need 6x/week, do receive treatment Monday-Saturday. We recently became a provider for a certain insurance company that says they will pay us more money per day, if we see their patients seven days per week. Our current system seems to be working for the patients benefit, the therapists job satisfaction, and the facility from a revenue standpoint. I fear that if seven day a week therapy is instituted, then I will loose therapists. I can not afford to do this because it took us over a year to fill a full time PT position. Is anyone else facing this issue? And if so, how are you handling it. I have tried to educate administration that we are not an acute rehab hospital, but are only a sub-acute SNF. Thanks in advance for any responses to this topic! Marty Koehler, PT, MPT Rehab Director Ohio Valley Manor Ripley, OH Looking to start and own 100% of your own Practice? Visit www.InHomeRehab.com. PTManager encourages participation in your professional association. Join and participate now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 14, 2005 Report Share Posted October 14, 2005 Ken - No argument. Asking " What does the evidence support? " is our professional responsiblity - and providing services accordingly is in the best interest of the patient. Once that's determined, (most of us) need to be fiscally, as well as professionally, responsible. Regards, Trager, PT Rehabilitation Services Manager Kaweah Delta Health Care District Visalia, CA. rtrager@... Sunday Therapy I am the Rehab Director at a 130 bed SNF/LTC facility with 35 beds dedicated to sub-acute patients with an average length of stay of 14 days. We currently see most inpatients a minimum of Monday-Friday. Some patients, who need 6x/week, do receive treatment Monday-Saturday. We recently became a provider for a certain insurance company that says they will pay us more money per day, if we see their patients seven days per week. Our current system seems to be working for the patients benefit, the therapists job satisfaction, and the facility from a revenue standpoint. I fear that if seven day a week therapy is instituted, then I will loose therapists. I can not afford to do this because it took us over a year to fill a full time PT position. Is anyone else facing this issue? And if so, how are you handling it. I have tried to educate administration that we are not an acute rehab hospital, but are only a sub-acute SNF. Thanks in advance for any responses to this topic! Marty Koehler, PT, MPT Rehab Director Ohio Valley Manor Ripley, OH Looking to start and own 100% of your own Practice? Visit www.InHomeRehab.com. PTManager encourages participation in your professional association. Join and participate now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 14, 2005 Report Share Posted October 14, 2005 Ken hit the nail on the head. I would add that there would be no problem here if the consumer (i.e. the patient) were the payer. Unfortunately, with our sort of third-party payer system, someone distant from the needs of the patient and the service is making the decision as to what is needed and what the service is worth. How else could a decision be made that ALL short-term SNF patients need therapy 5, 6, or 7 days per week? Determination of cost/benefit should be the responsibility of the patient, not a far-away bureaucrat whose primary interest is financial. Support Healthcare Savings Accounts! Dave Milano, PT, Director of Rehab Services Laurel Health System 32-36 Central Ave. Wellsboro, PA 16901 dmilano@... Sunday Therapy I am the Rehab Director at a 130 bed SNF/LTC facility with 35 beds dedicated to sub-acute patients with an average length of stay of 14 days. We currently see most inpatients a minimum of Monday-Friday. Some patients, who need 6x/week, do receive treatment Monday-Saturday. We recently became a provider for a certain insurance company that says they will pay us more money per day, if we see their patients seven days per week. Our current system seems to be working for the patients benefit, the therapists job satisfaction, and the facility from a revenue standpoint. I fear that if seven day a week therapy is instituted, then I will loose therapists. I can not afford to do this because it took us over a year to fill a full time PT position. Is anyone else facing this issue? And if so, how are you handling it. I have tried to educate administration that we are not an acute rehab hospital, but are only a sub-acute SNF. Thanks in advance for any responses to this topic! Marty Koehler, PT, MPT Rehab Director Ohio Valley Manor Ripley, OH Looking to start and own 100% of your own Practice? Visit www.InHomeRehab.com. PTManager encourages participation in your professional association. Join and participate now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 14, 2005 Report Share Posted October 14, 2005 Ken hit the nail on the head. I would add that there would be no problem here if the consumer (i.e. the patient) were the payer. Unfortunately, with our sort of third-party payer system, someone distant from the needs of the patient and the service is making the decision as to what is needed and what the service is worth. How else could a decision be made that ALL short-term SNF patients need therapy 5, 6, or 7 days per week? Determination of cost/benefit should be the responsibility of the patient, not a far-away bureaucrat whose primary interest is financial. Support Healthcare Savings Accounts! Dave Milano, PT, Director of Rehab Services Laurel Health System 32-36 Central Ave. Wellsboro, PA 16901 dmilano@... Sunday Therapy I am the Rehab Director at a 130 bed SNF/LTC facility with 35 beds dedicated to sub-acute patients with an average length of stay of 14 days. We currently see most inpatients a minimum of Monday-Friday. Some patients, who need 6x/week, do receive treatment Monday-Saturday. We recently became a provider for a certain insurance company that says they will pay us more money per day, if we see their patients seven days per week. Our current system seems to be working for the patients benefit, the therapists job satisfaction, and the facility from a revenue standpoint. I fear that if seven day a week therapy is instituted, then I will loose therapists. I can not afford to do this because it took us over a year to fill a full time PT position. Is anyone else facing this issue? And if so, how are you handling it. I have tried to educate administration that we are not an acute rehab hospital, but are only a sub-acute SNF. Thanks in advance for any responses to this topic! Marty Koehler, PT, MPT Rehab Director Ohio Valley Manor Ripley, OH Looking to start and own 100% of your own Practice? Visit www.InHomeRehab.com. PTManager encourages participation in your professional association. Join and participate now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 14, 2005 Report Share Posted October 14, 2005 Ken hit the nail on the head. I would add that there would be no problem here if the consumer (i.e. the patient) were the payer. Unfortunately, with our sort of third-party payer system, someone distant from the needs of the patient and the service is making the decision as to what is needed and what the service is worth. How else could a decision be made that ALL short-term SNF patients need therapy 5, 6, or 7 days per week? Determination of cost/benefit should be the responsibility of the patient, not a far-away bureaucrat whose primary interest is financial. Support Healthcare Savings Accounts! Dave Milano, PT, Director of Rehab Services Laurel Health System 32-36 Central Ave. Wellsboro, PA 16901 dmilano@... Sunday Therapy I am the Rehab Director at a 130 bed SNF/LTC facility with 35 beds dedicated to sub-acute patients with an average length of stay of 14 days. We currently see most inpatients a minimum of Monday-Friday. Some patients, who need 6x/week, do receive treatment Monday-Saturday. We recently became a provider for a certain insurance company that says they will pay us more money per day, if we see their patients seven days per week. Our current system seems to be working for the patients benefit, the therapists job satisfaction, and the facility from a revenue standpoint. I fear that if seven day a week therapy is instituted, then I will loose therapists. I can not afford to do this because it took us over a year to fill a full time PT position. Is anyone else facing this issue? And if so, how are you handling it. I have tried to educate administration that we are not an acute rehab hospital, but are only a sub-acute SNF. Thanks in advance for any responses to this topic! Marty Koehler, PT, MPT Rehab Director Ohio Valley Manor Ripley, OH Looking to start and own 100% of your own Practice? Visit www.InHomeRehab.com. PTManager encourages participation in your professional association. Join and participate now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 14, 2005 Report Share Posted October 14, 2005 Marty, Obviously all treatment plans should be based on medical necessity and have the patient's best interest in mind. However, I suppose it would be hard to argue against the assumption by your payer that an extra day of therapy per week would move their beneficiary more quickly to the next level of care. I'm sure their goal is not to have some corporate suit control your practice patterns. Somehow they have determined it is worth it to pay more per day and possibly decrease the total number of days required in your facility. On the other hand, as a manger you understand the value of having a stable staff. Turnover could run down your quality faster than anything else and may not be worth the extra payment. Perhaps the increased reimbursement could allow you to offer an attractive shift differential for weekend work. In my experience shift differentials for weekend work have kept the grumbling to a minimum and helped stabilize staffing. I would think seriously about not staffing weekends if you do not have sufficient staffing resources. As a multiple site manager I have gone both ways on this issue depending on staff. Darrell Messersmith, MSPT Director of Physical Medicine Platte Valley Medical Center > > I am the Rehab Director at a 130 bed SNF/LTC facility with 35 beds dedicated > to sub-acute patients with an average length of stay of 14 days. We > currently see most inpatients a minimum of Monday-Friday. Some patients, > who need 6x/week, do receive treatment Monday-Saturday. We recently became > a provider for a certain insurance company that says they will pay us more > money per day, if we see their patients seven days per week. Our current > system seems to be working for the patients benefit, the therapists job > satisfaction, and the facility from a revenue standpoint. I fear that if > seven day a week therapy is instituted, then I will loose therapists. I can > not afford to do this because it took us over a year to fill a full time PT > position. Is anyone else facing this issue? And if so, how are you > handling it. I have tried to educate administration that we are not an > acute rehab hospital, but are only a sub-acute SNF. Thanks in advance for > any responses to this topic! > > Marty Koehler, PT, MPT > Rehab Director > Ohio Valley Manor > Ripley, OH > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 14, 2005 Report Share Posted October 14, 2005 Marty, Obviously all treatment plans should be based on medical necessity and have the patient's best interest in mind. However, I suppose it would be hard to argue against the assumption by your payer that an extra day of therapy per week would move their beneficiary more quickly to the next level of care. I'm sure their goal is not to have some corporate suit control your practice patterns. Somehow they have determined it is worth it to pay more per day and possibly decrease the total number of days required in your facility. On the other hand, as a manger you understand the value of having a stable staff. Turnover could run down your quality faster than anything else and may not be worth the extra payment. Perhaps the increased reimbursement could allow you to offer an attractive shift differential for weekend work. In my experience shift differentials for weekend work have kept the grumbling to a minimum and helped stabilize staffing. I would think seriously about not staffing weekends if you do not have sufficient staffing resources. As a multiple site manager I have gone both ways on this issue depending on staff. Darrell Messersmith, MSPT Director of Physical Medicine Platte Valley Medical Center > > I am the Rehab Director at a 130 bed SNF/LTC facility with 35 beds dedicated > to sub-acute patients with an average length of stay of 14 days. We > currently see most inpatients a minimum of Monday-Friday. Some patients, > who need 6x/week, do receive treatment Monday-Saturday. We recently became > a provider for a certain insurance company that says they will pay us more > money per day, if we see their patients seven days per week. Our current > system seems to be working for the patients benefit, the therapists job > satisfaction, and the facility from a revenue standpoint. I fear that if > seven day a week therapy is instituted, then I will loose therapists. I can > not afford to do this because it took us over a year to fill a full time PT > position. Is anyone else facing this issue? And if so, how are you > handling it. I have tried to educate administration that we are not an > acute rehab hospital, but are only a sub-acute SNF. Thanks in advance for > any responses to this topic! > > Marty Koehler, PT, MPT > Rehab Director > Ohio Valley Manor > Ripley, OH > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2005 Report Share Posted October 17, 2005 I recently had a family member admitted in a SNF with a great M-F program. She was admitted on a Saturday and except for when I was there and helped, stayed in bed Saturday and Sunday. After an 8 day hospital stay where she was in bed 90% of the time not having therapy on Saturday and Sunday extended her bed rest time 2 days which is a 25% increase. Certainly this is not in the best interest of the patient. I would think the concern is not providing individual patients 7 day/week of therapy but having 7 days / week of therapy available for those who come in on Thursday, Friday and over the weekend. Different perspective. Marc Lacroix Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2005 Report Share Posted October 17, 2005 As a director in an acute care setting, I always answer the " 7 day per week " question by keeping the patient at the center of the answer. The plan of care dictates the treatment intervention as well as frequency. That may very well be 7 days a week or 2. Until I see evidence that supports disregarding the evaluating therapist professional opinion in preference to the payers, I will hold my ground. Ron Barbato P.T. Corporate Director , Rehabilitation Ephraim McDowell Health Voice (859 )239-1515 Fax (859 )936-7249 rbarbato@... " PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that is privileged, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient, then please do not read it and be aware that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. If you received this transmission in error, please immediately advise me, by reply e-mail, and delete this message and any attachments without retaining a copy in any form. Thank you. " Sunday Therapy I am the Rehab Director at a 130 bed SNF/LTC facility with 35 beds dedicated to sub-acute patients with an average length of stay of 14 days. We currently see most inpatients a minimum of Monday-Friday. Some patients, who need 6x/week, do receive treatment Monday-Saturday. We recently became a provider for a certain insurance company that says they will pay us more money per day, if we see their patients seven days per week. Our current system seems to be working for the patients benefit, the therapists job satisfaction, and the facility from a revenue standpoint. I fear that if seven day a week therapy is instituted, then I will loose therapists. I can not afford to do this because it took us over a year to fill a full time PT position. Is anyone else facing this issue? And if so, how are you handling it. I have tried to educate administration that we are not an acute rehab hospital, but are only a sub-acute SNF. Thanks in advance for any responses to this topic! Marty Koehler, PT, MPT Rehab Director Ohio Valley Manor Ripley, OH Looking to start and own 100% of your own Practice? Visit www.InHomeRehab.com. PTManager encourages participation in your professional association. Join and participate now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2005 Report Share Posted October 17, 2005 As a director in an acute care setting, I always answer the " 7 day per week " question by keeping the patient at the center of the answer. The plan of care dictates the treatment intervention as well as frequency. That may very well be 7 days a week or 2. Until I see evidence that supports disregarding the evaluating therapist professional opinion in preference to the payers, I will hold my ground. Ron Barbato P.T. Corporate Director , Rehabilitation Ephraim McDowell Health Voice (859 )239-1515 Fax (859 )936-7249 rbarbato@... " PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that is privileged, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient, then please do not read it and be aware that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. If you received this transmission in error, please immediately advise me, by reply e-mail, and delete this message and any attachments without retaining a copy in any form. Thank you. " Sunday Therapy I am the Rehab Director at a 130 bed SNF/LTC facility with 35 beds dedicated to sub-acute patients with an average length of stay of 14 days. We currently see most inpatients a minimum of Monday-Friday. Some patients, who need 6x/week, do receive treatment Monday-Saturday. We recently became a provider for a certain insurance company that says they will pay us more money per day, if we see their patients seven days per week. Our current system seems to be working for the patients benefit, the therapists job satisfaction, and the facility from a revenue standpoint. I fear that if seven day a week therapy is instituted, then I will loose therapists. I can not afford to do this because it took us over a year to fill a full time PT position. Is anyone else facing this issue? And if so, how are you handling it. I have tried to educate administration that we are not an acute rehab hospital, but are only a sub-acute SNF. Thanks in advance for any responses to this topic! Marty Koehler, PT, MPT Rehab Director Ohio Valley Manor Ripley, OH Looking to start and own 100% of your own Practice? Visit www.InHomeRehab.com. PTManager encourages participation in your professional association. Join and participate now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2005 Report Share Posted October 17, 2005 Marty, I work in a SNF that is a little larger than the facility that you are working in. At this time we are not dealing with insurance for 7 days a week. However, if you would like to talk further please call. Pruitt, BSM, PTA Therapy Manager >>> marty_mpt@... 10/14/05 01:50PM >>> I am the Rehab Director at a 130 bed SNF/LTC facility with 35 beds dedicated to sub-acute patients with an average length of stay of 14 days. We currently see most inpatients a minimum of Monday-Friday. Some patients, who need 6x/week, do receive treatment Monday-Saturday. We recently became a provider for a certain insurance company that says they will pay us more money per day, if we see their patients seven days per week. Our current system seems to be working for the patients benefit, the therapists job satisfaction, and the facility from a revenue standpoint. I fear that if seven day a week therapy is instituted, then I will loose therapists. I can not afford to do this because it took us over a year to fill a full time PT position. Is anyone else facing this issue? And if so, how are you handling it. I have tried to educate administration that we are not an acute rehab hospital, but are only a sub-acute SNF. Thanks in advance for any responses to this topic! Marty Koehler, PT, MPT Rehab Director Ohio Valley Manor Ripley, OH Looking to start and own 100% of your own Practice? Visit www.InHomeRehab.com. PTManager encourages participation in your professional association. Join and participate now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2005 Report Share Posted October 17, 2005 Please keep in mind that not getting out of bed and " not having therapy " are two different issues. I, too, had a family member in the hospital (not the one where I work) and he was not gotten out of bed by nursing on several occasions. The reasons: " therapy didn't make him a daily patient " , " he's too difficult to get up " (he weighted about 100 lbs) and " we don't have special chairs on this unit " . When he went to SNF his upright tolerance was terrible. They did, however, get him up every day, even on non therapy days of Saturday and Sunday. Since when do nursing staff members arbitrarily decide who gets up and who doesn't? Interestingly enough, it took two staff members to help him on a bed pan, same as it would have taken to get him up to a commode. Remember that therapy must be skilled services but too often nursing staff interpret that as therapists " get the patients up " . There are so many opportunities for improvements in health care.... Bonnie Swafford, PT Manager of Physical Therapy University of Kansas Hospital >>> Malacroix@... 10/17/2005 9:54:21 AM >>> I recently had a family member admitted in a SNF with a great M-F program. She was admitted on a Saturday and except for when I was there and helped, stayed in bed Saturday and Sunday. After an 8 day hospital stay where she was in bed 90% of the time not having therapy on Saturday and Sunday extended her bed rest time 2 days which is a 25% increase. Certainly this is not in the best interest of the patient. I would think the concern is not providing individual patients 7 day/week of therapy but having 7 days / week of therapy available for those who come in on Thursday, Friday and over the weekend. Different perspective. Marc Lacroix Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2005 Report Share Posted October 17, 2005 Bonnie; Your points are excellent and along the same vein; ambulation and gait are also not the same thing. As obvious as this point may appear, it appears to continually confuse some. Training a gait pattern, and remediation of a gait pattern should likewise be differentiated, yet often are not. We can't " train " someone to do something they are not physically capable of, so the skill lies in making the determination of whether one can BE trained, not the training itself. Ken Mailly, PT Coordinator, PTA Program Bergen Community College Partner Mailly & Inglett Consulting, LLC Tel. 973 692-0033 Fax 973 633-9557 68 Seneca Trail Wayne, NJ, 07470 www.NJPTAid.biz " First he wrought, and afterwards he taught. " Chaucer Bridging the Gap! Re: Sunday Therapy Please keep in mind that not getting out of bed and " not having therapy " are two different issues. I, too, had a family member in the hospital (not the one where I work) and he was not gotten out of bed by nursing on several occasions. The reasons: " therapy didn't make him a daily patient " , " he's too difficult to get up " (he weighted about 100 lbs) and " we don't have special chairs on this unit " . When he went to SNF his upright tolerance was terrible. They did, however, get him up every day, even on non therapy days of Saturday and Sunday. Since when do nursing staff members arbitrarily decide who gets up and who doesn't? Interestingly enough, it took two staff members to help him on a bed pan, same as it would have taken to get him up to a commode. Remember that therapy must be skilled services but too often nursing staff interpret that as therapists " get the patients up " . There are so many opportunities for improvements in health care.... Bonnie Swafford, PT Manager of Physical Therapy University of Kansas Hospital >>> Malacroix@... 10/17/2005 9:54:21 AM >>> I recently had a family member admitted in a SNF with a great M-F program. She was admitted on a Saturday and except for when I was there and helped, stayed in bed Saturday and Sunday. After an 8 day hospital stay where she was in bed 90% of the time not having therapy on Saturday and Sunday extended her bed rest time 2 days which is a 25% increase. Certainly this is not in the best interest of the patient. I would think the concern is not providing individual patients 7 day/week of therapy but having 7 days / week of therapy available for those who come in on Thursday, Friday and over the weekend. Different perspective. Marc Lacroix Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2005 Report Share Posted October 17, 2005 Bonnie; Your points are excellent and along the same vein; ambulation and gait are also not the same thing. As obvious as this point may appear, it appears to continually confuse some. Training a gait pattern, and remediation of a gait pattern should likewise be differentiated, yet often are not. We can't " train " someone to do something they are not physically capable of, so the skill lies in making the determination of whether one can BE trained, not the training itself. Ken Mailly, PT Coordinator, PTA Program Bergen Community College Partner Mailly & Inglett Consulting, LLC Tel. 973 692-0033 Fax 973 633-9557 68 Seneca Trail Wayne, NJ, 07470 www.NJPTAid.biz " First he wrought, and afterwards he taught. " Chaucer Bridging the Gap! Re: Sunday Therapy Please keep in mind that not getting out of bed and " not having therapy " are two different issues. I, too, had a family member in the hospital (not the one where I work) and he was not gotten out of bed by nursing on several occasions. The reasons: " therapy didn't make him a daily patient " , " he's too difficult to get up " (he weighted about 100 lbs) and " we don't have special chairs on this unit " . When he went to SNF his upright tolerance was terrible. They did, however, get him up every day, even on non therapy days of Saturday and Sunday. Since when do nursing staff members arbitrarily decide who gets up and who doesn't? Interestingly enough, it took two staff members to help him on a bed pan, same as it would have taken to get him up to a commode. Remember that therapy must be skilled services but too often nursing staff interpret that as therapists " get the patients up " . There are so many opportunities for improvements in health care.... Bonnie Swafford, PT Manager of Physical Therapy University of Kansas Hospital >>> Malacroix@... 10/17/2005 9:54:21 AM >>> I recently had a family member admitted in a SNF with a great M-F program. She was admitted on a Saturday and except for when I was there and helped, stayed in bed Saturday and Sunday. After an 8 day hospital stay where she was in bed 90% of the time not having therapy on Saturday and Sunday extended her bed rest time 2 days which is a 25% increase. Certainly this is not in the best interest of the patient. I would think the concern is not providing individual patients 7 day/week of therapy but having 7 days / week of therapy available for those who come in on Thursday, Friday and over the weekend. Different perspective. Marc Lacroix Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2005 Report Share Posted October 17, 2005 Bonnie, how right you are. This has been a sore subject with almost every PT department that I have belonged to. I just recently had a go around about this with our nursing staff and it required INTENSIVE education with them, but I think they finally got the point that we are not a walking service. Keep the faith. McLoughlin, PT Director of Rehab Services Cushing Memorial Hospital Leavenworth, KS Re: Sunday Therapy Please keep in mind that not getting out of bed and " not having therapy " are two different issues. I, too, had a family member in the hospital (not the one where I work) and he was not gotten out of bed by nursing on several occasions. The reasons: " therapy didn't make him a daily patient " , " he's too difficult to get up " (he weighted about 100 lbs) and " we don't have special chairs on this unit " . When he went to SNF his upright tolerance was terrible. They did, however, get him up every day, even on non therapy days of Saturday and Sunday. Since when do nursing staff members arbitrarily decide who gets up and who doesn't? Interestingly enough, it took two staff members to help him on a bed pan, same as it would have taken to get him up to a commode. Remember that therapy must be skilled services but too often nursing staff interpret that as therapists " get the patients up " . There are so many opportunities for improvements in health care.... Bonnie Swafford, PT Manager of Physical Therapy University of Kansas Hospital >>> Malacroix@... 10/17/2005 9:54:21 AM >>> I recently had a family member admitted in a SNF with a great M-F program. She was admitted on a Saturday and except for when I was there and helped, stayed in bed Saturday and Sunday. After an 8 day hospital stay where she was in bed 90% of the time not having therapy on Saturday and Sunday extended her bed rest time 2 days which is a 25% increase. Certainly this is not in the best interest of the patient. I would think the concern is not providing individual patients 7 day/week of therapy but having 7 days / week of therapy available for those who come in on Thursday, Friday and over the weekend. Different perspective. Marc Lacroix Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 18, 2005 Report Share Posted October 18, 2005 Ron: That is a good point. Please follow this example: Patient A has a TKA on Tuesday, the CPM installed that day, with PT and OT on Wed, Thurs, and Fri when he is discharged. Patient B has a TKR on Friday, the CPM installed that day, with PT on Sat, and OT on Sun due to weekend schedule... he sees both on Mon and is discharged. The question that is likely to be asked within insurance exec's circles: if patients get less therapy on the weekend due to staffing and the patient's outcomes do not suffer, then the patients are being over-treated Mon-Fri. > > As a director in an acute care setting, I always answer the " 7 day per > week " question by keeping the patient at the center of the answer. The > plan of care dictates the treatment intervention as well as frequency. > That may very well be 7 days a week or 2. Until I see evidence that > supports disregarding the evaluating therapist professional opinion in > preference to the payers, I will hold my ground. > > Ron Barbato P.T. > Corporate Director , Rehabilitation > Ephraim McDowell Health > Voice (859 )239-1515 > Fax (859 )936-7249 > rbarbato@e... > > " PRIVILEGED AND CONFIDENTIAL: This transmission may contain information > that is privileged, confidential and/or exempt from disclosure under > applicable law. If you are not the intended recipient, then please do > not read it and be aware that any disclosure, copying, distribution, or > use of the information contained herein (including any reliance thereon) > is STRICTLY PROHIBITED. If you received this transmission in error, > please immediately advise me, by reply e-mail, and delete this message > and any attachments without retaining a copy in any form. Thank you. " > > > > Sunday Therapy > > > I am the Rehab Director at a 130 bed SNF/LTC facility with 35 beds > dedicated > to sub-acute patients with an average length of stay of 14 days. We > currently see most inpatients a minimum of Monday-Friday. Some > patients, > who need 6x/week, do receive treatment Monday-Saturday. We recently > became > a provider for a certain insurance company that says they will pay us > more > money per day, if we see their patients seven days per week. Our > current > system seems to be working for the patients benefit, the therapists job > satisfaction, and the facility from a revenue standpoint. I fear that > if > seven day a week therapy is instituted, then I will loose therapists. I > can > not afford to do this because it took us over a year to fill a full time > PT > position. Is anyone else facing this issue? And if so, how are you > handling it. I have tried to educate administration that we are not an > acute rehab hospital, but are only a sub-acute SNF. Thanks in advance > for > any responses to this topic! > > Marty Koehler, PT, MPT > Rehab Director > Ohio Valley Manor > Ripley, OH > > > > > > > Looking to start and own 100% of your own Practice? > Visit www.InHomeRehab.com. > PTManager encourages participation in your professional association. > Join and participate now! > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 18, 2005 Report Share Posted October 18, 2005 Ron: That is a good point. Please follow this example: Patient A has a TKA on Tuesday, the CPM installed that day, with PT and OT on Wed, Thurs, and Fri when he is discharged. Patient B has a TKR on Friday, the CPM installed that day, with PT on Sat, and OT on Sun due to weekend schedule... he sees both on Mon and is discharged. The question that is likely to be asked within insurance exec's circles: if patients get less therapy on the weekend due to staffing and the patient's outcomes do not suffer, then the patients are being over-treated Mon-Fri. > > As a director in an acute care setting, I always answer the " 7 day per > week " question by keeping the patient at the center of the answer. The > plan of care dictates the treatment intervention as well as frequency. > That may very well be 7 days a week or 2. Until I see evidence that > supports disregarding the evaluating therapist professional opinion in > preference to the payers, I will hold my ground. > > Ron Barbato P.T. > Corporate Director , Rehabilitation > Ephraim McDowell Health > Voice (859 )239-1515 > Fax (859 )936-7249 > rbarbato@e... > > " PRIVILEGED AND CONFIDENTIAL: This transmission may contain information > that is privileged, confidential and/or exempt from disclosure under > applicable law. If you are not the intended recipient, then please do > not read it and be aware that any disclosure, copying, distribution, or > use of the information contained herein (including any reliance thereon) > is STRICTLY PROHIBITED. If you received this transmission in error, > please immediately advise me, by reply e-mail, and delete this message > and any attachments without retaining a copy in any form. Thank you. " > > > > Sunday Therapy > > > I am the Rehab Director at a 130 bed SNF/LTC facility with 35 beds > dedicated > to sub-acute patients with an average length of stay of 14 days. We > currently see most inpatients a minimum of Monday-Friday. Some > patients, > who need 6x/week, do receive treatment Monday-Saturday. We recently > became > a provider for a certain insurance company that says they will pay us > more > money per day, if we see their patients seven days per week. Our > current > system seems to be working for the patients benefit, the therapists job > satisfaction, and the facility from a revenue standpoint. I fear that > if > seven day a week therapy is instituted, then I will loose therapists. I > can > not afford to do this because it took us over a year to fill a full time > PT > position. Is anyone else facing this issue? And if so, how are you > handling it. I have tried to educate administration that we are not an > acute rehab hospital, but are only a sub-acute SNF. Thanks in advance > for > any responses to this topic! > > Marty Koehler, PT, MPT > Rehab Director > Ohio Valley Manor > Ripley, OH > > > > > > > Looking to start and own 100% of your own Practice? > Visit www.InHomeRehab.com. > PTManager encourages participation in your professional association. > Join and participate now! > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 18, 2005 Report Share Posted October 18, 2005 Ron: That is a good point. Please follow this example: Patient A has a TKA on Tuesday, the CPM installed that day, with PT and OT on Wed, Thurs, and Fri when he is discharged. Patient B has a TKR on Friday, the CPM installed that day, with PT on Sat, and OT on Sun due to weekend schedule... he sees both on Mon and is discharged. The question that is likely to be asked within insurance exec's circles: if patients get less therapy on the weekend due to staffing and the patient's outcomes do not suffer, then the patients are being over-treated Mon-Fri. > > As a director in an acute care setting, I always answer the " 7 day per > week " question by keeping the patient at the center of the answer. The > plan of care dictates the treatment intervention as well as frequency. > That may very well be 7 days a week or 2. Until I see evidence that > supports disregarding the evaluating therapist professional opinion in > preference to the payers, I will hold my ground. > > Ron Barbato P.T. > Corporate Director , Rehabilitation > Ephraim McDowell Health > Voice (859 )239-1515 > Fax (859 )936-7249 > rbarbato@e... > > " PRIVILEGED AND CONFIDENTIAL: This transmission may contain information > that is privileged, confidential and/or exempt from disclosure under > applicable law. If you are not the intended recipient, then please do > not read it and be aware that any disclosure, copying, distribution, or > use of the information contained herein (including any reliance thereon) > is STRICTLY PROHIBITED. If you received this transmission in error, > please immediately advise me, by reply e-mail, and delete this message > and any attachments without retaining a copy in any form. Thank you. " > > > > Sunday Therapy > > > I am the Rehab Director at a 130 bed SNF/LTC facility with 35 beds > dedicated > to sub-acute patients with an average length of stay of 14 days. We > currently see most inpatients a minimum of Monday-Friday. Some > patients, > who need 6x/week, do receive treatment Monday-Saturday. We recently > became > a provider for a certain insurance company that says they will pay us > more > money per day, if we see their patients seven days per week. Our > current > system seems to be working for the patients benefit, the therapists job > satisfaction, and the facility from a revenue standpoint. I fear that > if > seven day a week therapy is instituted, then I will loose therapists. I > can > not afford to do this because it took us over a year to fill a full time > PT > position. Is anyone else facing this issue? And if so, how are you > handling it. I have tried to educate administration that we are not an > acute rehab hospital, but are only a sub-acute SNF. Thanks in advance > for > any responses to this topic! > > Marty Koehler, PT, MPT > Rehab Director > Ohio Valley Manor > Ripley, OH > > > > > > > Looking to start and own 100% of your own Practice? > Visit www.InHomeRehab.com. > PTManager encourages participation in your professional association. > Join and participate now! > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 18, 2005 Report Share Posted October 18, 2005 It really boils down to a " mobility issue " . In most cases and in most places I have managed , it was assumed that PT owned mobility. Discussion and training is needed to " enlighten " other health care providers that " mobility " is everyone's responsibility. Ron Barbato P.T. Corporate Director , Rehabilitation Ephraim McDowell Health Voice (859 )239-1515 Fax (859 )936-7249 rbarbato@... " PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that is privileged, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient, then please do not read it and be aware that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. If you received this transmission in error, please immediately advise me, by reply e-mail, and delete this message and any attachments without retaining a copy in any form. Thank you. " Re: Sunday Therapy Please keep in mind that not getting out of bed and " not having therapy " are two different issues. I, too, had a family member in the hospital (not the one where I work) and he was not gotten out of bed by nursing on several occasions. The reasons: " therapy didn't make him a daily patient " , " he's too difficult to get up " (he weighted about 100 lbs) and " we don't have special chairs on this unit " . When he went to SNF his upright tolerance was terrible. They did, however, get him up every day, even on non therapy days of Saturday and Sunday. Since when do nursing staff members arbitrarily decide who gets up and who doesn't? Interestingly enough, it took two staff members to help him on a bed pan, same as it would have taken to get him up to a commode. Remember that therapy must be skilled services but too often nursing staff interpret that as therapists " get the patients up " . There are so many opportunities for improvements in health care.... Bonnie Swafford, PT Manager of Physical Therapy University of Kansas Hospital >>> Malacroix@... 10/17/2005 9:54:21 AM >>> I recently had a family member admitted in a SNF with a great M-F program. She was admitted on a Saturday and except for when I was there and helped, stayed in bed Saturday and Sunday. After an 8 day hospital stay where she was in bed 90% of the time not having therapy on Saturday and Sunday extended her bed rest time 2 days which is a 25% increase. Certainly this is not in the best interest of the patient. I would think the concern is not providing individual patients 7 day/week of therapy but having 7 days / week of therapy available for those who come in on Thursday, Friday and over the weekend. Different perspective. Marc Lacroix Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 18, 2005 Report Share Posted October 18, 2005 It really boils down to a " mobility issue " . In most cases and in most places I have managed , it was assumed that PT owned mobility. Discussion and training is needed to " enlighten " other health care providers that " mobility " is everyone's responsibility. Ron Barbato P.T. Corporate Director , Rehabilitation Ephraim McDowell Health Voice (859 )239-1515 Fax (859 )936-7249 rbarbato@... " PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that is privileged, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient, then please do not read it and be aware that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. If you received this transmission in error, please immediately advise me, by reply e-mail, and delete this message and any attachments without retaining a copy in any form. Thank you. " Re: Sunday Therapy Please keep in mind that not getting out of bed and " not having therapy " are two different issues. I, too, had a family member in the hospital (not the one where I work) and he was not gotten out of bed by nursing on several occasions. The reasons: " therapy didn't make him a daily patient " , " he's too difficult to get up " (he weighted about 100 lbs) and " we don't have special chairs on this unit " . When he went to SNF his upright tolerance was terrible. They did, however, get him up every day, even on non therapy days of Saturday and Sunday. Since when do nursing staff members arbitrarily decide who gets up and who doesn't? Interestingly enough, it took two staff members to help him on a bed pan, same as it would have taken to get him up to a commode. Remember that therapy must be skilled services but too often nursing staff interpret that as therapists " get the patients up " . There are so many opportunities for improvements in health care.... Bonnie Swafford, PT Manager of Physical Therapy University of Kansas Hospital >>> Malacroix@... 10/17/2005 9:54:21 AM >>> I recently had a family member admitted in a SNF with a great M-F program. She was admitted on a Saturday and except for when I was there and helped, stayed in bed Saturday and Sunday. After an 8 day hospital stay where she was in bed 90% of the time not having therapy on Saturday and Sunday extended her bed rest time 2 days which is a 25% increase. Certainly this is not in the best interest of the patient. I would think the concern is not providing individual patients 7 day/week of therapy but having 7 days / week of therapy available for those who come in on Thursday, Friday and over the weekend. Different perspective. Marc Lacroix Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 18, 2005 Report Share Posted October 18, 2005 It really boils down to a " mobility issue " . In most cases and in most places I have managed , it was assumed that PT owned mobility. Discussion and training is needed to " enlighten " other health care providers that " mobility " is everyone's responsibility. Ron Barbato P.T. Corporate Director , Rehabilitation Ephraim McDowell Health Voice (859 )239-1515 Fax (859 )936-7249 rbarbato@... " PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that is privileged, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient, then please do not read it and be aware that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. If you received this transmission in error, please immediately advise me, by reply e-mail, and delete this message and any attachments without retaining a copy in any form. Thank you. " Re: Sunday Therapy Please keep in mind that not getting out of bed and " not having therapy " are two different issues. I, too, had a family member in the hospital (not the one where I work) and he was not gotten out of bed by nursing on several occasions. The reasons: " therapy didn't make him a daily patient " , " he's too difficult to get up " (he weighted about 100 lbs) and " we don't have special chairs on this unit " . When he went to SNF his upright tolerance was terrible. They did, however, get him up every day, even on non therapy days of Saturday and Sunday. Since when do nursing staff members arbitrarily decide who gets up and who doesn't? Interestingly enough, it took two staff members to help him on a bed pan, same as it would have taken to get him up to a commode. Remember that therapy must be skilled services but too often nursing staff interpret that as therapists " get the patients up " . There are so many opportunities for improvements in health care.... Bonnie Swafford, PT Manager of Physical Therapy University of Kansas Hospital >>> Malacroix@... 10/17/2005 9:54:21 AM >>> I recently had a family member admitted in a SNF with a great M-F program. She was admitted on a Saturday and except for when I was there and helped, stayed in bed Saturday and Sunday. After an 8 day hospital stay where she was in bed 90% of the time not having therapy on Saturday and Sunday extended her bed rest time 2 days which is a 25% increase. Certainly this is not in the best interest of the patient. I would think the concern is not providing individual patients 7 day/week of therapy but having 7 days / week of therapy available for those who come in on Thursday, Friday and over the weekend. Different perspective. Marc Lacroix Quote Link to comment Share on other sites More sharing options...
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