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Cleaning and Disinfecting in the Era of COVID-19<p>Like the coronavirus, skilled nursing facilities (SNFs) are under the microscope. The high mortality rate among SNF residents has drawn significant attention from national health organizations and the media. The issue&#58; An estimated 42 percent of America’s 150,000 COVID-19 deaths have been associated with elder care facilities. By comparison, residents of SNFs account for less than 0.62 percent of the population, according to Forbes, on May 22.<br></p><p>To help protect this vulnerable population, the Department of Health and Human Services allocated $5 billion in July to help combat infection in nursing homes. The money included funding for an online infection control training program available to Medicare-certified long term care facilities.<br></p><p>“Education and training is the key for controlling coronavirus,” says Sam Okafor of ServiceMaster Building Services in Portland, Ore. “A facility’s infection preventionist and the environmental services team are the front line for infection prevention. They should receive thorough and frequent training. Cleaning knowledge and diligence will keep residents and staff safer.”<br></p><p>Professional cleaning companies typically have subject matter experts who are highly trained and credentialed in the science of cleaning and disinfecting. ServiceMaster Clean often shares its knowledge with facilities that seek help. Here are some of the most frequently asked questions regarding safety in the era of COVID-19.<br></p><p><em class="ms-rteForeColor-8">Has cleaning protocol changed because of the pandemic? How?</em><br>Yes, in three ways&#58; greater frequency of disinfecting, especially high-touch areas; more use of full Personal Protective Equipment (PPE); and the timing of cleanings. Before the pandemic, cleaning was often done after hours. Now, because of the greater frequency of cleaning and the need to reassure residents and guests, cleaning is being conducted throughout the day.<br></p><p><span class="ms-rteForeColor-8"><em>When do you recommend full PPE for cleaning staff? What protection should be worn for normal cleaning duties?</em></span><br>Regarding PPE requirements, we recommend following the Centers for Disease Control &amp; Prevention (CDC), U.S. Environmental Protection Agency (EPA), and any requirements set forth by state or local government. For health care personnel working around residents with Covid-19, CDC recommends a face shield or goggles, an N-95 mask or respirator, a gown or body covering, and gloves. For normal cleaning, gloves and a face mask should be worn. Refer to product labels regarding additional PPE requirements.<br></p><p><em class="ms-rteForeColor-8">Given that CDC now says COVID-19 typically spreads by respiratory droplets, is the cleaning of high-touch points still a priority for stopping the spread of the virus? </em><br>Yes, cleaning and disinfecting high-touch areas will always be important. Infected persons could cough or sneeze and contaminate surfaces with their respiratory droplets. Other persons could then touch the contaminated surface, touch their face, and become infected.<br></p><p><em class="ms-rteForeColor-8">Is fogging effective for eliminating pathogens, specifically COVID-19?</em><br>The EPA currently does not recommend fogging application as fogging is often imprecise.* That’s why most professional cleaning companies use a hands-on application method for maximum effectiveness.<br></p><p><em class="ms-rteForeColor-8">What would you recommend for a SNF that wants to create a safe space for visitors to interact with their loved ones? </em><br>We recommend following CDC guidance.<strong>**</strong> This would certainly include social distancing of six feet or more. Additionally, we would recommend interaction occur outdoors in fresh air or in an indoor space that is well ventilated with fresh air from outdoors. Furthermore, face coverings should also be worn during interaction. <br></p><p><em class="ms-rteForeColor-8">What are the most important things a facility’s infection preventionist should know about cleaning and disinfecting (priorities 1, 2, and 3)? </em><br>1. For Covid-19 purposes, a disinfectant on the EPA’s List N&#58; Disinfectants for Use Against SARS-CoV-2 (COVID-19) should be used and should be applied in a method specified on its EPA product label. <br>2. Proper disinfection cannot occur without proper cleaning. If gross soiling is present, a one-step cleaner disinfectant can be used. If you are not using a one-step product, the surface must be cleaned first, then disinfected. <br>3. Appropriate dwell time (time the product must remain wet on a surfact) must be achieved for proper disinfection to occur. The EPA product label will specify the dwell time. The EPA’s List N also will specify appropriate dwell time for each product on the list.<br></p><p><em class="ms-rteForeColor-8">What should residents know about cleaning and disinfecting that will help keep them safer? </em><br>Residents should be reminded to perform personal hygiene practices. Emphasize thorough hand washing, performed frequently. This is the No. 1 way to prevent the spread of infection. Meanwhile, avoid touching of the eyes, nose, and mouth. Also, remember that disinfection, while effective if done properly, is only for a snapshot in time. Once someone re-enters the space after disinfection, that space could be recontaminated. For this reason, residents should perform proper hand hygiene immediately after touching surfaces in common areas. </p><p><em class="ms-rteForeColor-8">If cleaning is done by an in-house team, how can one be sure they are trained properly to eliminate infection?</em><br>Facility cleaning staff should, at minimum, be knowledgeable of the following&#58; CDC guidelines for disinfection and proper use of PPE; EPA guidelines for how to apply disinfectant and each product’s prescribed dwell time; and the need for frequent cleaning of high-touch, high-traffic areas along with a detailed list of those surfaces and appropriate products to use.<em class="ms-rteForeColor-8"><br></em></p><p><em class="ms-rteForeColor-8">If a facility hires an outside contractor to help with cleaning, how do staff know they are qualified to clean and disinfect properly?</em><br>An outside contractor should be able to demonstrate the correct protocol for proper cleaning and disinfection. At minimum, their protocol should align with CDC and EPA guidelines. The contractor also should be able to reference their training for cleaning and disinfecting in the health care environment. Furthermore, if the contractor has any certifications for cleaning and disinfection in the health care environment, that would be another good indicator of their qualification. </p><p><span class="ms-rteForeColor-8"><em>Is it possible to keep common areas safe, especially dining rooms? </em></span><br>No area of any facility can be guaranteed to be disinfected 100 percent of the time. However, with high-frequency cleaning and disinfection it is possible to greatly reduce the risk of spreading infection. <br>For dining rooms specifically, here’s a recommended cleaning protocol&#58;<br>1. Clean and disinfect prior to the first meal of the day. <br>2. Clean and disinfect after first meal. <br>3. Clean and disinfect after second meal. <br>4. Clean and disinfect after third meal. <br>5. Clean and disinfect after any other events in the dining rooms such as an activity or a facility meeting. <br>6. Limit access to the dining area at all other times. Have a designated area for residents to obtain snacks and beverages between meals. Ensure surfaces in this area are frequently cleaned and disinfected in addition to full dining room cleaning and disinfection. <br></p><p><em class="ms-rteForeColor-8">If one cleans to eliminate COVID-19, is she also preventing other infectious diseases and irritants such as Methicillin-resistant Staphylococcus aureus (MRSA), influenza, and Clostridium difficile (C. diff)? </em><br>Many of the disinfectants on the EPA’s List N that are approved for use against Covid-19 are effective in disinfecting against MRSA and influenza. These disinfectants are acceptable for daily use against most pathogens commonly found in health care facilities. The disinfectant’s EPA product label will list its kill claims and required dwell times. <br></p><p>C. diff requires a sporicidal disinfectant. The EPA has List K, which contains sporicidal disinfectants that are approved for use against C. diff. Not all disinfectants on List N are on List K. In cases of C. diff, the facility should ensure that an EPA-registered sporicidal disinfectant on List K is used. <br><br><em>Daniel Gravatt is business operations manager for ServiceMaster Clean, which has more than 900 franchised and licensed locations around the world. He is a licensed nursing home administrator and a trainer of the Certified Surgical Cleaning Technician program. He can be reached at <a href="mailto&#58;dgravatt@smclean.com" target="_blank">dgravatt@smclean.com</a>.​</em></p><p><br></p><p><strong>*www.epa.gov/coronavirus/can-i-use-fumigation-or-electrostatic-spraying-help-control-covid-19</strong><br><strong>**www.cdc.gov/coronavirus/2019-ncov/community/retirement/index.html</strong><br></p>2020-10-01T04:00:00Z<img alt="" src="/Monthly-Issue/2020/October/PublishingImages/cleaning.jpg" style="BORDER&#58;0px solid;" />Management;COVID-19Daniel GravattProfessional cleaning companies typically have subject matter experts who are highly trained and credentialed in the science of cleaning and disinfecting.
Clinical Partnerships with a Local TouchIn serving the long term and post-acute care pharmacy needs of its clients, PharMerica employs a three-pronged approach to achieving optimal outcomes by tapping into the company’s expertise in the medical, consultant pharmacist, and nursing fields. <br><div><br></div><div>At a time of a flurry of regulatory and clinical activity around the COVID-19 pandemic, it makes even more sense for long term care and senior living communities to have a pharmacy partner capable of seeing what risks lie ahead and then being able to implement solutions to answer these challenges.</div><h2>Mission Bound</h2>In undertaking this multi-pronged strategy, PharMerica is furthering its mission&#58; to help people live their best life and at the same time advance the success of its clients by providing the capabilities and trusted expertise to help facilities stay ahead. <br><div><br></div><div><img src="/Monthly-Issue/2020/October/PublishingImages/WilliamMills.jpg" alt="William Mills" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;205px;height&#58;256px;" />To understand better how PharMerica brings its strengths to bear for each client, it is important to realize that the company, while being a national leader in the pharmacy space, is also intensely focused on the local delivery of its services. And, it keeps this philosophy when meshing the three-pronged approach, says William Mills, MD, senior vice president, medical affairs, at PharMerica.</div><br>“PharMerica prides itself on being a partner with the long term care and senior living communities it serves,” he says.<br><div><br></div><div>“We have really seen this work&#58; being a large company with scale with a local presence. It has proven to be the key to our high-quality medical management, exceptionally high medication adherence, and also our robust consulting program,” Mills continues. </div><br>“For example, every prescription sent by prescribers helps our pharmacists flag potential adverse drug interactions, realize opportunities for e-prescribing, and play a role as some of the ways that long term care and senior living can minimize avoidable hospitalizations and decrease readmissions.”<h2>Flu Season Like No Other</h2>In practical terms, Mills points to PharMerica’s efforts this pending flu season as a prime example of how the company puts its clients in a position to succeed in what may prove to be an especially harsh combined flu–COVID-19 time period.<br><div><br></div><div>“The COVID-19 pandemic makes now the perfect time to not only continue to work to protect our clients’ residents from the coronavirus, but also to plan for the rapidly approaching flu season,” he says. “It’s critically important for senior living leadership to start planning flu shot/vaccine strategies while everything is fresh in our minds with respect to infection control and appropriate precautions.”</div><br><div>There is a dual threat out there, Mills says, noting the role PharMerica pharmacists can take in helping to procure and deliver the flu vaccine, which may be a sign of things to come with a COVID-19 vaccine sometime later this year or early in 2021.</div><br><div>“On the long term care side we have the ability to procure and administer a vaccine with our pharmacist team while working with nursing staff, and on the senior living side, our Value Med service line actively promotes and convenes onsite flu vaccine clinics,” he says.</div><br>On a potential COVID-19 vaccine, PharMerica is also front and center with its Chief Pharmacy Officer T.J. Griffin a part of the federal Operation Warp Speed effort to bring a vaccine to bear as quickly and safely as possible. “PharMerica is looking to play a leading role by using our abilities to get vaccines out widely to long term care and senior living. We have more than 225 local consultant pharmacists experienced in vaccination strategies,” Mills stresses.<br><div><br></div><div>And, notably, since the pandemic began, PharMerica has focused on implementing best practices in infection control, visitor management, employee screening, and streamlined reporting and triage protocols to optimally support communities. </div><br>“Our approach, including our pharmacist-led outbreak mitigation approach in long term care, has been published in four peer-reviewed medical journals, and the work has been cited by the World Health Organization and the International Long Term Care Policy Network, among others,” he says.<h2>Consulting and Nursing Strategies</h2>Prongs two and three in the PharMerica effort to bring clinical excellence to its clients are the consultant pharmacist and nursing operations. For starters, Marti Wdowicki, director of clinical operations – South, PharMerica, says the company’s 225 local consultant pharmacists throughout the country are a valued member of every client facility’s interdisciplinary team.<br><div><br></div><div><img src="/Monthly-Issue/2020/October/PublishingImages/MarthaWdowicki.jpg" class="ms-rtePosition-1" alt="Marti Wdowicki" style="margin&#58;50px;width&#58;205px;height&#58;256px;" />She says these pharmacists help long term care and senior living communities achieve optimal outcomes for their residents and their bottom line. </div><br>Armed with thorough understanding of the facility’s unique needs, the consultant provides a tailored program that encompasses the educational, regulatory, and cost-containment concerns of the facility while assuring appropriate medication therapy for each resident. Some examples include&#58;<br><ul><ul><ul><ul><ul><ul><li>iMRR New Move Ins (Senior Living and Skilled)<br></li><li>iMMR Falls Review<br></li><li>E-Prescribing Strategy<br></li><li>Reporting and Education to Improve Outcomes<br></li><li>Education and Training<br></li></ul></ul></ul></ul></ul></ul><div>Wdowicki, a 23-year veteran of PharMerica, says the fundamental role of the consultant pharmacist is to review the medication of every nursing home resident and offer clinical services to assisted living and other senior living settings.</div><br>“In addition to meeting the regulatory compliance needs of clients in the skilled nursing environment, there is the work required to mitigate risk by providing clinical oversight and also the work to make sure the right medications are being used at the best price point,” she says.<h2>Personal Touch</h2><div>The pharmacists typically are in their jobs for the duration, Wdowicki says, allowing PharMerica to offer a personal touch with its customers, residents, and administrators alike.</div><br><div>“Normally, you will see a pharmacist sitting down [in non-COVID times] at a nursing station, talking to a director of nursing or nurse about their husband having trouble with some medication, or a family member’s blood pressure being up or down, or how to safely destroy a resident’s unused medications,” she says.<br></div><br><div>“We get personally involved with the individuals who staff our client facilities, and we are reviewing the same residents month after month and they really get to know everyone, building strong bonds over the years,” Wdowicki says.<br></div><h2>Nursing’s Role </h2><div>Elena Hart, senior nurse consultant, PharMerica, represents a dedicated team of over 140 local field nurses who consult with facilities and community staff and provide education, as well as support through state requirements and regulations.</div><br><div><img src="/Monthly-Issue/2020/October/PublishingImages/ElenaHart.jpg" alt="Elena Hart" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;205px;height&#58;256px;" />This job is more than just filling orders, considering long term care facilities today need a partner who can help them stay ahead of risks and opportunities. <br></div><div><br></div><div>Hart says PharMerica in turn backs up its pharmacy capabilities with clinical consulting services to help clients improve the quality of care and their operations for optimal outcomes and revenue, rounding out the three-pronged approach to excellence. <br></div><div><br></div>PharMerica’s specially trained consultant pharmacists and nurse consultants provide an added layer of safety, delivering expert advice through&#58;<br><ul><ul><ul><ul><ul><ul><ul><li>Medication regimen reviews to ensure appropriate therapy, reduce errors, and minimize polypharmacy;</li><li>Staff education to advance knowledge and reduce risk;</li><li>Field support for state requirements and regulations; and</li><li>Survey audit, preparation, and support.</li></ul></ul></ul></ul></ul></ul></ul><div>Hart notes that “our interview process is quite extensive as we are looking for someone who has long term care experience, is able to work autonomously, and has a desire to travel.”<br></div><br><div>As a proactive service, Nurse Consulting Services offers PharMerica clients a variety of audits and education, including mock surveys, which help communities stay in compliance with state and federal regulations. <br></div><div><br></div><div>“We are looking for reliable and trustworthy people that are seeking a long-term career with PharMerica,” Hart says. <br></div><div><br></div><div>“Building a solid relationship with our clients is vital to a successful partnership. Establishing trust and dependability aids in our efforts to keep the facility in compliance and when making recommendations for areas of improvement to the director of nursing.</div><div><br></div>“As a liaison for our customers, our goal is to assist in providing quality care, while remaining compliant with ever-changing regulations,” Hart says. “Accomplishing this aspect follows the consistent efforts of PharMerica to keep the partner’s best interest at heart.” <br>2020-10-01T04:00:00Z<img alt="" src="/Monthly-Issue/2020/October/PublishingImages/pharmerica.jpg" style="BORDER&#58;0px solid;" />Patrick ConnoleAt a time of a flurry of regulatory and clinical activity around the COVID-19 pandemic, it makes even more sense for long term care and senior living communities to have a pharmacy partner capable of seeing what risks lie ahead and then being able to implement solutions to answer these challenges.
COVID-19: Where We Are Now and What Must Be Done <p>Caregivers in nursing homes and assisted living communities have done everything in their power to protect our most vulnerable from COVID-19. Despite unprecedented challenges and delayed support early on, they have bravely answered the call of duty and have saved thousands of lives. </p><p>COVID-19 was a new virus that the health care sector had never seen before. Older Americans and those with underlying health conditions were among the most susceptible, and the virus could rapidly spread through people who showed no symptoms. For these reasons, I called the virus early on “the perfect killing machine” for the elderly. </p><h2>Initial Oversight Tragic</h2><p>Long term care facilities were not made a priority at the outset. Critical resources, namely personal protective equipment (PPE), testing, and additional workers, were directed to overburdened hospitals. Lack of priority left long term care providers feeling forgotten and pleading for help.&#160; </p><p>This led to nursing homes and assisted living communities bearing the brunt of the tragedy. COVID-related cases in long term care facilities account for 8 percent of total cases yet over 40 percent of deaths nationwide. Independent research from some of the top experts in the country has found that a facility’s quality ratings or for-profit or nonprofit status has little correlation with the presence of the virus, but rather its location. Facilities located within areas with a high percentage of community spread are more likely to have more positive cases.</p><p>But the disproportionate effect the virus has had on long term care brings two immediate needs into focus. The first is ensuring that nursing homes and assisted living communities receive top priority for resources to continue fighting the crisis at hand. The second is implementing long-awaited reforms that will help secure the future of our sector. </p><h2>A Continuing Threat</h2><p>Temporary federal funding has helped us turn the tide on the virus, but as long as COVID-19 is a threat to the general population, it’s a threat to our most vulnerable. Even though positive cases have stabilized throughout the country, we must be prepared for a resurgence in the fall. At minimum, long term care providers must have the PPE and testing needed to prevent outbreaks. This requires ongoing support from federal and state governments.</p><p>The Associated Press reported that one in five long term care facilities lacked PPE in the early part of the summer. This equipment—gloves, gowns, eye protection, and N95 masks—are the most basic necessities that residents and staff need to protect themselves, yet months after the pandemic commenced are still in short supply for many facilities. </p><p>Surveillance testing is critical, especially for workers who regularly come in and out of facilities and have close contact with residents. The Centers for Disease Control and Prevention (CDC) Director Robert Redfield said rapid and widescale testing is the best way to limit transmission. However, cost and supply continue to be prohibitive to implementation. Long wait times for lab results have made some testing counterproductive. In certain cases, providers have to wait five days or more to receive results, giving asymptomatic carriers ample time to unknowingly spread the virus.</p><p>Testing, PPE, and hiring of additional staff have caused expenses to skyrocket, while occupancy rates in long term care facilities have declined. In fact, one study found that occupancy rates dipped below 75 percent at the end of June. The combination of these factors has left many facilities teetering on the edge of collapse. Some have already closed their doors permanently, leaving vulnerable residents displaced without the care they need.</p><h2>Reimbursement Reform Critical to Future</h2><p>There must be a monumental shift in the way we think about long term care. We have an opportunity to make pivotal changes that will shape the future of millions of seniors who will rely on our services. As a recent New York Times editorial noted, “In the longer term, federal officials need to consider revising Medicaid reimbursement rates for long term care so they support higher than minimum-wage salaries, and shifting reimbursement policies so at least some long term care can be reimbursed with Medicare dollars.”</p><p>Current Medicaid reimbursement rates fall short of the actual cost of the high-quality care we provide. A fully funded Medicaid program will enable us to offer competitive wages to hardworking staff. We can invest in our physical structures and bolster infection control processes.</p><p>We need to think creatively about how we recruit and retain the next generation of workers to our field. We have long advocated for tuition reimbursement and loan forgiveness as incentives to attract new talent. We are committed to working collaboratively with Congress to make these reforms for the sake of the millions of residents in our care. </p><p>The same editorial noted, “Lawmakers and nursing home operators also would do well to consider a national initiative, perhaps involving student volunteers and internship programs, to recruit future workers to nursing home care. That work, which can be deeply rewarding, will remain urgently needed long after this crisis passes.”</p><p>We must be vigilant and forward-thinking. We cannot sit idly by and wait for the next pandemic to make the changes necessary to strengthen our sector. With a growing senior population, we need viable options to meet demand. Federal and state governments must put their full weight behind supporting long term care. We must take action today so we can confidently continue to fight COVID-19 and prepare for our future. </p><p><em>Mark Parkinson is the president and chief executive officer of the American Health Care Association and National Center for Assisted Living and former governor of Kansas.</em></p><p>​</p>2020-09-22T04:00:00Z<img alt="" src="/PublishingImages/Headshots/MarkParkinson.jpg" style="BORDER&#58;0px solid;" />COVID-19;Infection ControlMark ParkinsonCOVID-19 was a new virus that the health care sector had never seen before. Older Americans and those with underlying health conditions were among the most susceptible, and the virus could rapidly spread through people who showed no symptoms. For these reasons, I called the virus early on “the perfect killing machine” for the elderly.
Therapy Shouldn’t Be DIY<span style="background-color&#58;initial;font-size&#58;13.6px;"></span><p>Skilled nursing facility (SNF) providers are reeling after all the changes with PDPM and COVID-19. While providers surface after a challenging year, the truth is that skilled nursing has turned upside down in many communities. Providers are seeking for answers that will lead to a win for the residents and a win for their operations. </p><p>As providers scratch their heads over the undeniable shortcomings of the federal and state governments to support their needs during the pandemic, they are left to search for ways to fund their unexpected extra costs and balance their budgets. </p><p>In a recent presentation by LeadingAge, Ruth Katz noted that a provider who only needed 6 gowns per month prior to COVID-19 was now purchasing hundreds per month. She equated this to the average person’s consumption of toilet paper, which costs about $8/month for 8 rolls. The exponential costs and numbers of personal protective equipment (PPE) required for providers is similar to raising this cost to over $1,600/month per person in toilet paper. These costs would be unsustainable for us as individuals, and they have been disastrous for the senior living continuum as well. </p><p>Providers have begun to consider therapy as an opportunity to recoup some of their losses by bringing therapy in house, either with or without a management agreement. Gravity Healthcare Consulting recently conducted research on behalf of Reliant Rehabilitation, one of the largest nationwide contract therapy providers. The goal of the research was to uncover the actual provider operational costs and margins associated with contract rehab versus management agreement models and in-house therapy. </p><p>Life plan communities, in the same geographical area with the same wage index, were compared. They were very closely matched for census and case mix. The results were enlightening – in-house therapy programs, either with or without a management agreement, yielded lower reimbursement and higher provider costs than contract rehab. The study spanned Q1 of 2020 and examined the data of multiple real sites. Let’s break down the numbers&#58; </p><ul><li>Minutes&#58; Advocates all over the senior care industry were campaigning to have accountability for therapy minutes, since PDPM no longer tied reimbursement directly to the number of minutes provided. The Centers for Medicare &amp; Medicaid Services listened, and they have stated that they will be watching closely to make sure that providers continue to supply each resident with individualized and medically indicated services. </li></ul><p></p><p>However, this new risk has made some providers begin to consider bringing their programs in-house, so they can internalize therapy oversight and ensure that resident needs continue to be met within the framework of the new payment system. The fear is that contract therapy companies will inappropriately slash therapy minutes in an effort to increase margins. </p><p>The study showed that overall the majority of therapy partners have only made 10-20% cuts in the average delivery of therapy minutes. Most residents receive around 450-550 minutes, a Rehab Very High (RV) level of services. However, research conducted by <a href="https&#58;//www.ncbi.nlm.nih.gov/pmc/articles/PMC4706596/" target="_blank">Hye-Young Jung about therapy dosing</a> showed that residents at the RV level achieved the same outcomes as those who were elevated to a Rehab Ultra High, or RU level of therapy at 720 minutes per week. </p><p></p><p>Additionally, residents in the RV therapy range are 3.1% more likely to return to home versus those who received less minutes. Managed Medicare companies have been pushing this evidence-based range of therapy treatment for over 5 years. While there have been growing pains, this model has forced therapists to reinvent their approach. It has proven therapists can do more with less. Shorter lengths of stay with moderately reduced therapy minutes yield the same functional outcomes and discharges to home when governed by a clinically strong therapy team. </p><p></p><ul><li>Labor costs&#58; Contract therapy only cost $1,557 more than the staffing costs for therapy under a management model (excluding the actual management agreement fees) and was actually less than the salary costs for the in-house programs. Therapist salaries are the largest for in-house programs, at the 75th percentile and beyond. Departments overseen by a management agreement see some cost control through salaries in the 60th percentile. Contract rehab is able to manage their costs best on behalf of the provider, and they generally pay around the median salary. </li></ul><p></p><p>While it may appear that staffing for a contract rehab arrangement would be more difficult with lower salaries, because of the plethora of therapy-specific benefits and the opportunity to advance within the company, contract therapy companies usually excel at fulfilling the staffing needs. </p><p></p><p>Providers who partner with a proven contract rehab vendor, such as Reliant, reap all the included benefits that the therapy company offers for virtually no additional expense, or even a cost savings! </p><p></p><ul><li>Margins&#58; As may be expected, contract therapy partners obtain and maintain the highest productivity levels. And while there can be concerns with unrealistic productivity expectations over 100% with the new model, generally speaking, contract therapy targets a reasonable productivity expectation of between 80-90%. Most jobs have some sort of productivity requirement, such as a certain number of widgets, reports, or sales that are due each week. </li></ul><p></p><p>The secret sauce, however, was not the focus on productivity. Rather, contract rehab was armed with clinical expertise and research, and the therapy champions from a contract rehab </p><p>management team empowered the therapists to function at the top of their game. By focusing on the clinical needs and medical necessity of each individual resident, contract therapy showed an increased number of residents who were evaluated and appropriately treated in long term care. Additionally, the average therapy dose per day (number of minutes) for long term care residents was actually higher with contract therapy than with management agreement or in-house models. </p><p></p><p>This focus on productivity and clinically appropriate service delivery yielded the largest provider margins with contract rehab in the Gravity study. SNF margins for in-house programs were on average 71% less than with contract rehab. Management agreements didn’t fare much better, with an average SNF margin of 61% less than contact rehab. This is both due to cost and reduced revenue consistently seen with both the in-house and management agreements. </p><p></p><ul><li>Compliance&#58; The study showed significant difference in compliance between the various therapy models. In-house models scored 50% or less on therapy compliance audits. Management agreement models fared a little better, averaging between 75-85%. Contract rehab got the win with compliance audits usually at 95% or greater. </li></ul><p></p><p>Stephanie Parks, MBA, MS, CCC-SLP, Chief Development Officer with Reliant Rehabilitation, sums it up well, saying, “Clinical and documentation quality assurance and performance improvement are best achieved when the reviewers are reputationally and financially accountable for potential claim losses and litigation risks related to poor performance, as is the case with full-service therapy partners.” </p><p></p><p>When collaborating with the right therapy partner, the interests of both parties are closely aligned, and drive compliance upward. While it may be tempting to bring therapy in house or to a management agreement to reduce the provider’s liability, the results show that compliance is best left up to the contract therapy experts. </p><p>Many early projections for a transition to in-house or management anticipate improved provider margins with the transition away from contract rehab. However, the research shows that the actual costs are greater, and revenue tends to decline. Some of these additional, often unforeseen costs include the cost of a management agreement, the cost of the therapy electronic medical record, the human resources costs (which include some additional costs unique to therapy), and the compliance and denials management costs. </p><p>The uncertain times surrounding COVID-19 make the decision to insource therapy even more risky. The Gravity study showed there are increased liabilities, potential losses, and reduced outcomes for residents of in-house or management agreement models. If you would like to have a complete, unbiased third-party analysis of your current therapy program, please contact us today. </p><p>Reliant Rehabilitation is a national provider of rehabilitation services. The Company utilizes a proprietary care model that emphasizes early intervention and assessment and properly designed clinical care plans, as well as pathways to improve patients’ functional levels. Reliant differentiates itself by providing proven program performance management, customer marketing support, and industry-leading compliance systems. Our Mission is &quot;Care Matters.” We are completely committed to our employees, patients, and the customers we serve. At Reliant, we strive for optimal patient outcomes in the most efficient matter. <a href="http&#58;//www.reliant-rehab.com/" target="_blank">www.reliant-rehab.com</a>.</p><p>For more information, please contact Stephanie Parks at <a href="mailto&#58;sparks@reliant-rehab.com" target="_blank">sparks@reliant-rehab.com</a>. </p><p></p><p>Melissa (Sabo) Brown, OTR/L, CSRS, CDP, is the Chief Operating Officer of Gravity Healthcare Consulting. She is an Occupational Therapist with over 15 years of experience in skilled nursing, continuing care retirement communities, and home health. </p><p>Reference </p><p><em>1. Jung, H.-Y., Trivedi, A. N., Grabowski, D. C., &amp; Mor, V. (2016, January). Does More Therapy in Skilled Nursing Facilities Lead to Better Outcomes in Patients with Hip Fracture? Retrieved May 21, 2020, from <a href="https&#58;//www.ncbi.nlm.nih.gov/pmc/articles/PMC4706596/" target="_blank">https&#58;//www.ncbi.nlm.nih.gov/pmc/articles/PMC4706596/</a>. </em></p>2020-09-08T04:00:00Z<img alt="" src="/Topics/Special-Features/PublishingImages/2020/MelissaBrown.jpg" style="BORDER&#58;0px solid;" />COVID-19;CaregivingMelissa BrownSNF providers are reeling after all the changes with PDPM and COVID-19. While providers surface after a challenging year, the truth is that skilled nursing has turned upside down in many communities.