In the world of senior care, therapy has always played a crucial role in improving the quality of life for residents in Skilled Nursing Facilities (SNF), Continuing Care Retirement Communities (CCRCs), Assisted Living (AL), and Independent Living (IL) communities. However, recent changes in reimbursement methodologies and a growing focus on holistic wellness have transformed the landscape of therapy. To shed light on these developments and understand how therapy providers are adapting to the changing environment, I sat down with Kristy Yoskey, Senior Vice President of Clinical Strategies.
Q1: The Changing Landscape of Therapy
Julie Bringas, VP of Business Development (JB): Kristy, can you explain how therapy's role has evolved, especially in light of changing reimbursement models?
Kristy Yoskey SVP of Clinical Strategies (KY): Absolutely. Therapy has traditionally been a cornerstone of skilled nursing, with a significant portion of revenue tied to reimbursement models like the Case Mix Index (CMI) under Medicaid and RUGS under Medicare/Managed Care. However, Part A has already changed and many states are now transitioning away from these older reimbursement methodologies, which means therapy providers must adapt. We must now focus on four key areas to remain effective and impactful for our partners.
Q2: 4 Areas of Impact
JB: That's a significant shift. Could you delve into what those areas of focus are?
KY: Of course. The first key area is accurate nursing documentation and Minimum Data Set (MDS) coding. These are essential for appropriate reimbursement and resident care planning. Therapy teams must now work collaboratively with nursing staff and the IDT to ensure the MDS reflects the residents' true clinical needs. This cooperation ensures both skilled and Long-Term Care (LTC) residents receive the level of care they require. HealthPRO Heritage offers a plethora of tools/resources to support this process (PDPM Profiler, 24-Hour Report, etc…) and provides ongoing training to our Rehab Directors and staff to ask the right questions and come prepared to meetings.
The other key areas of focus from my perspective include transparency in outcomes reporting, census/occupancy support (including a wellness approach), and a strategy around market and regulatory changes, which will, of course, evolve over time.
Q3: Transparent Outcomes and Impact
JB: Transparency is crucial. Tell us more about the second area - being transparent in clinical and reimbursement outcomes.
KY: Transparency is key not only for our clinical outcomes but also for reimbursement purposes. We need to demonstrate that we're delivering what we promised to residents, communities, and organizations. By measuring and sharing our clinical and financial outcomes, we build trust and accountability. I often hear prospective partners say “I cannot get what I need from my current rehab provider as it relates to reporting and outcomes” That is disheartening to hear in today’s highly competitive market space. Many rehab providers showcase fancy tech that is flashy in the sales process, but I always ask, how is it going? Are you seeing the outcomes you were told you would see? Is your staff or residents using it and is it helping? Through our High Level Work Plan process, HealthPRO Heritage stays focused on the organizational initiatives and moving the needle to achieve the collaborative goals.
Q4: Census/Occupancy Support
JB: Maintaining census and occupancy is vital. How can therapy assist in this area?
KY: Occupancy is a key metric in senior care, and therapy can play a significant role in keeping residents engaged and active. Therapy programs should address multiple dimensions of wellness, from physical to emotional and social, and do this across the continuum of care – whether a standalone SNF or a multi-site CCRC. Engaged and active residents are more likely to stay, leading to extended length of occupancy and essentially closing the back door. HealthPRO Heritage is breaking down the silos of therapy and restorative and extending support into Fitness, Activities and Life Enrichment. Data Analytics to drive specialty programming and marketing to referral sources through clinical capabilities scorecard and success stories is just one lever to pull together.
Q5: Adapting to Market and Regulatory Changes
JB: The healthcare landscape is ever-changing. What's the fourth area, and how does therapy adapt to market and regulatory shifts?
KY: The fourth area is supporting partners in navigating market changes, regulatory updates, and payor strategy shifts, such as Dual Special Needs Plans (D-SNPs) and Institutional Special Needs Plans (I-SNPs). Therapy providers should act as true partners, offering not only exceptional rehab and outcomes but also strategic support in diversification, growth, and stability initiatives. We know the managed care penetration continues to grow at an exponential rate, what is the dialogue happening around managing this shift? How will therapy positively impact these changes – does your rehab provider share key changes or shifts in the data or regulation and understand the strategy to succeed in constant change?
In conclusion, therapy in senior care has undergone a massive transformation. While its importance remains paramount, the focus has shifted towards supporting nursing documentation, ensuring transparent outcomes, maintaining occupancy, and adapting to a dynamic healthcare landscape. As Kristy Yoskey emphasized, therapy providers must be true partners, contributing not only to residents' well-being but also to the broader success of their communities and organizations. As the industry evolves, so must the role of therapy, ensuring the best possible care for our senior population.
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