| 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: 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: 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 & 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: 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: 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:<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: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:0px solid;" /> | Management;COVID-19 | Daniel Gravatt | Professional 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 Touch | In 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: 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:5px;width:205px;height: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: 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:50px;width:205px;height: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:<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:5px;width:205px;height: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:<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:0px solid;" /> | | Patrick Connole | 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. |
| 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.  </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:0px solid;" /> | COVID-19;Infection Control | Mark Parkinson | 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. |
| Therapy Shouldn’t Be DIY | <span style="background-color:initial;font-size: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: </p><ul><li>Minutes: 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 & 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://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: 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: 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: 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 "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://www.reliant-rehab.com/" target="_blank">www.reliant-rehab.com</a>.</p><p>For more
information, please contact Stephanie Parks at <a href="mailto: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., & 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://www.ncbi.nlm.nih.gov/pmc/articles/PMC4706596/" target="_blank">https://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:0px solid;" /> | COVID-19;Caregiving | Melissa Brown | 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. |