​MDS 3.0 and the new RUG-IV system will prompt an increase in demand for therapists. Therefore, facilities should immediately begin thinking in terms of staffing and retention for these positions.

For many facilities, adding staff will not be an option. In that case, creative scheduling solutions like staggered shifts and nights and weekend coverage must be investigated. At a minimum, leadership should recognize that this change will place extraordinary pressure on therapists to increase productivity and, therefore, should consider the following proactive steps:

• Review current utilization patterns with the therapy provider;
• Review Medicare assessment types and assessment reference dates that impact reimbursement, and establish communication systems necessary to manage their use;
• Consider and evaluate any changes to scheduling and staff;
• Closely monitor all therapy minutes to ensure no persistent deviations, over or under, from the minutes that are allowed in each RUG-IV level; and
• Determine the right balance between concurrent, individual, and group therapy given available staffing and resident needs.