Voices: Freda Mowad, CEO and Founder, QRM

This article is sponsored by QRM. In this Voices interview, Skilled Nursing News sits down with Freda Mowad, founder and CEO of Quality Rehab Management [QRM], to learn how in one year, she anticipated the challenges and opportunities of the Patient-Driven Payment Model [PDPM] and built a therapy consulting and management company — operating in 10 states and partnering with more than 160 facilities — to help them transition their therapy from third party vendors to an in-house model.

Skilled Nursing News: You founded QRM last year. Describe your vision for the company. What are your most important goals here in 2020?

Freda Mowad: Our vision has always been to create an environment where our operators are truly supported. In my opinion, operators are the backbone of our industry and they bear the majority of the risk. As the CEO of this rehab management company, and as a therapist, I do feel a responsibility to contribute to the success of health care providers so they can properly care for this very vulnerable population.


Our 2020 goals are to provide customers with purposeful PDPM analytics and overall outcome reporting. It helps them achieve what CMS has been mandating. Our goal is to reinforce the patient-centered culture in rehab departments, so that the therapists can perform at the top of their skill set.

We’re also launching QRM-Continuum, referred to as QRM-C, another division of our company. It will further support operators by giving them the platform to engage in population health management. It also provides an opportunity to create a new revenue stream while driving down costs. 2020 should prove to be a very monumental year for our partners.

Give us the background on QRM. How did PDPM shape your peer-to-peer business model and how has the rollout of PDPM impacted your business model since then?


Mowad: I used to be the president of a third-party rehab company. As PDPM approached, I felt strongly that an in-house rehab model was the way to go, and that based on my beliefs about rehab, I felt it made the most sense financially and culturally. I was really concerned about what I was hearing regarding clients dramatically cutting rehab minutes and even rehab provisions once PDPM went into effect. I felt the best way that I could preserve the integrity of rehab was to move therapists from an outsourced contract model to an in-house rehab program.

If we eliminated the middleman, we would eliminate the markup, and that would significantly reduce costs for the operators, protect therapists and fuel patient-centered care, allowing our team to use their expertise to manage rehab programs. I left that third-party rehab company at the end of 2018 and I started working on what would become QRM.

What we’ve created today is an individualized, patient-centered company. Not only did PDPM shape our peer-to-peer business model, it inspired it. Each of us at QRM is hands-on. There is no red tape or opposing agendas with our model. We work directly on the client’s behalf, which ensures our goals are aligned. And because our clients have had overwhelming success, they are spreading the word. Our rehab management model works — plain and simple. That’s why I named the company “QRM” — Quality Rehab Management. We hardly ever say it in full, but that word ”quality” is really important to me. 

Do you feel your preparation for PDPM was effective?

Mowad: I absolutely do. For the last year, QRM has been working with our clients on individualized facility and corporate-level PDPM training. We developed purposeful analytics tools and all levels of PDPM training modules. We hosted webinars, recorded podcasts. We trained therapy teams. We collaborated with health care leaders around the country. We partnered with industry innovators to improve analytics and provide clients with ongoing feedback and data. We wanted to make a real impact on behavior and outcomes, and we’ve done just that. Our clients have some of the strongest trending results in the business and their understanding of PDPM’s nuances get stronger every month.

Explain QRM-C. What role will that play in your business in 2020?

Mowad: QRM is Quality Rehab Management, and that’s the core of our business. We bring facilities in-house and we manage those rehab departments. Many operators are feeling the pinch of less and less admissions. Census has globally decreased, as has length of stay. There is only so much you can do as far as cutting costs. Operators are saving a great amount going in-house, and our model has been very financially successful for them, but what we wanted to do next was help them continue to follow those patients outside of their facility walls.

So we’re working with them on being able to truly manage that patient from the hospital to their facilities to home health to outpatient to home. The operator is now able to, again, keep their hands on that patient and truly manage their care because they have an in-house rehab team, and can utilize their own therapists to treat patients outside their facility. It is population health management that is real and tangible.

A lot of operators don’t know that it’s something that they can do, so we’re excited to share this with them. It’s something that we’re focusing on pretty heavily here in 2020.

You’ve noted in the past that reimbursement rates are low in Texas. What lessons have you taken away from working in Texas that can be applied nationwide?

Mowad: QRM is based in Dallas, Texas, but we do have a satellite office in Brooklyn, New York. We work coast to coast, currently operating in 10 states. I can tell you that operating in Texas is not for the faint of heart. Our Medicaid rate is absolutely one of the lowest in the country.

That means you have to truly know your business. You have to understand Medicare, you have to understand Medicaid, managed care, the whole system. You must be on top of your game at monitoring costs and using your resources wisely. This is what we practice at QRM. It doesn’t matter the state that we’re in. This is the way we’ve had to survive in Texas, so It is the way we practice no matter where we are. We’re tasked with being stewards of federal monies as well as our client’s dollars, so we really do work hard to establish efficient and effective programs.

Have there been any surprise lessons learned from PDPM, or surprise areas of opportunity?

Mowad: I would say that much of what was anticipated with PDPM has come to fruition, so no major surprises. But on a small scale, I am surprised when I’m working with somebody who may not be our client yet, and I’m reviewing their data and it’s apparent they’re missing significant opportunities under PDPM. I’m surprised that there are still so many people out there who need training, guidance and support. 

As far as surprise areas of opportunity, I would say absolutely. Right now, we’re partnering with clients to hire therapists and therapy assistants in new roles. A therapist’s skillset is very valuable, and while you may not need as many therapists in traditional rehab roles, you can still use their skills and hire therapists for a variety of other important positions, including case management, restorative trainers and MDS [Minimum Data Set] managers. We have a population of people who are getting laid off, and our clients are looking to utilize these people and put them in other roles where they can contribute.

To what do you attribute your rapid growth, and how is the PDPM transition impacted your ability to build your client base?

Mowad: I would say that QRM definitely has had very good fortune. We’ve been able to grow tremendously in a year. I would attribute that to our amazing team members, their talent and the results that they generate. Our clients call their friends and their peers to recommend us every day. They’re amazing partners. They’re really excited to share their experiences. Every month we onboard more and more facilities. PDPM has opened the door for operators to seriously consider in-house rehab and actually do it.

What is the most important way that you support your clients now that we’re in the age of PDPM?

Mowad: There are a lot of nuances and intricacies with PDPM. Our clients come to us to help them connect the dots. We’re really great at training all levels of the facility staff. We don’t just train the rehab staff. We’re training every member of the entire IDT [interdisciplinary team], which is crucial. We have a global perspective and approach. We have started some pretty exciting analytics. We’ve partnered with some innovative people in the market and created reporting which we review with our clients every month.

That has been tremendous because every time you sit down with them, they start seeing the bigger picture. PDPM can be overwhelming. It is a lot of data to gather and a completely new process to implement. I think organizations that tried to prepare on their own by simply sending their MDS nurse to a PDPM course in July, those organizations are feeling the impact of missed opportunities. You must have supportive partners and accountability, and everybody has to be working for the greater good.

In one word, describe the impact you think PDPM will have and will say the impact it will have in 2020.

Mowad: That’s a hard one. I will go with “transformative.”

Editor’s note: This interview has been edited for length and clarity.

Quality Rehab Management (QRM) is a privately owned, Dallas-based company that provides therapy support, consulting and management services to skilled nursing home operators. To learn more about how QRM can help you, visit QRMHealth.com.

The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact sales@agingmedia.com.

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