This article is in partnership with RehabCare. In this Voices interview, Skilled Nursing News sits down with Glenda Mack, Senior Vice President of Operations and Chief Operating Officer of RehabCare, to learn how RehabCare prepped clients for Patient-Driven Payment Model (PDPM) a year in advance, and how the company views its responsibilities as not just a therapy provider, but a skilled nursing facility (SNF) partner.
Skilled Nursing News: You’ve been with RehabCare since 1997, overseeing operations since 2017. Describe your role. What are your most important responsibilities here in 2020?
Glenda Mack: As the chief operating officer for RehabCare, I oversee the operations across approximately 1,400 partnerships across the country, which includes our management services.
The most important things I have to think about in 2020 is keeping our teams focused on the patient and on outcomes with our partners. The one thing that is guaranteed in post-acute care, especially in skilled nursing, is change. We had PDPM on October 1, and we will see proposed rules for skilled nursing coming in the next 60 to 90 days. We expect if CMS doesn’t outright propose changes to PDPM, they will at least start hinting at changes.
Therefore, my most important responsibility is keeping our eyes on the ball, with a focus on patient outcomes. As a leader in post-acute care, we’re going to have to keep asking ourselves how we can continue driving toward better outcomes.
Give us some background on RehabCare.
Mack: Kindred Healthcare is our parent company, and RehabCare is one line of business that sits under that umbrella. Kindred is an approximately $3.2 billion health care company that provides services in multiple post-acute settings, and under that we have two rehabilitation businesses. Kindred Hospital Rehabilitation Services provides joint-venture and contract therapy management services to hospital systems across the country. RehabCare provides the contract therapy services to the skilled nursing facilities, assisted living and independent living spaces.
If you think of Kindred as a whole, we provide services in about 1,700 sites across the country and RehabCare comprises about 1,400 of those sites.
You talked about this concept of change, so from your view, what does the PDPM landscape look like?
Mack: Initially everybody was very anxious and worried about what would happen when the switch flipped with PDPM. This was the largest revamping of SNF payment systems in 20-plus years. Everything changed on October 1, and that brought tremendous anxiety. “What is my revenue going to look like? Am I going to be able to bill?” That anxiety is for the most part gone.
Over the past 60 days or so, skilled nursing facilities have started to better understand the details of PDPM. The software systems have started to play out. Everybody understands how to use the systems that have been built around PDPM.
Now skilled nursing facilities have identified what questions they need to ask CMS (Centers for Medicare & Medicaid Services). They’re starting to feel comfortable in what they need to improve under PDPM and are developing process enhancement pieces.
They understand how many gaps they had in their ICD-10 coding, prior to PDPM. They kind of understood it before PDPM was implemented, but now that it’s here, they really see the knowledge gaps that existed from a coding and MDS (minimum data set) perspective, specifically ICD-10 coding.
What does success look like under PDPM?
Mack: Success under PDPM means different things to different people. It’s multifaceted. From the beneficiary standpoint, it hasn’t really changed. It’s about safe and efficacious care that gives them a successful discharge at the highest independence level.
From the skilled nursing facility’s perspective, it’s about reengineering care and process so they can effectively meet CMS demands, while also receiving payment that compensates for the services. I don’t think you can have one without the other.
I think CMS is anticipating a decline in payment-per-beneficiary from an episodic standpoint while experiencing the same or equal outcome. They also anticipated a budget-neutral payment system.
This is a multifaceted success story. I’m not sure how all those are going to come out in the long run. At a minimum, it is not a budget neutral payment system, at least from what we see at this point.
When a nursing facility or senior living community is evaluating a provider of rehab services, what do you think are the key qualities they should look for?
Mack: The number one thing I see in the marketplace is that there’s difference between a staffing company and a partner. Sometimes it’s difficult for a skilled nursing facility to tease out the difference. Every single therapy company out there can generally staff your building, but who will be a partner? Who will actually invest in making you a better facility? Who’s going to actually build programs and support systems and structures around your facility?
Another piece that a lot of skilled nursing facilities overlook: Is the company that you’re putting in your department transparent with what’s going on in the department? Do you have clarity in who’s providing the services and how those services are being provided? Are they good at communicating that to you? We often see flash over substance.
I know some of this sounds like soft skills, and they very much are. There are a lot of therapy companies that can handle the technical pieces of having a therapist in the building who works 8 a.m. to 4 p.m., 9 a.m. to 5 p.m., or whatever the hours are. It’s the quality of the care delivery and the structures and systems around to support that therapist delivering care every day that really become the differentiators in who you want to be partnered with.
How did RehabCare help clients prepare for PDPM?
Mack: We were very proud of our work. We created a detailed roadmap that allowed each of our partners to assess their readiness, with a task list of black-and-white objectives that needed to be accomplished. We made the roadmap available to our clients about a year before PDPM took effect, and we walked hand-in-hand with them along the strategic plan to help them prepare for October 1.
Additionally, we created customizable templates for clients, so that none of them had to start from scratch for any of the processes and systems that were going to change under PDPM. They could make adjustments to the templates based on how their particular EMR (electronic medical record) worked, so it could be uniquely theirs.
How does RehabCare develop customized solutions for individual facilities?
Mack: Six or seven years ago we moved away from creating therapy-focused programs, like a therapy falls program or a therapy restraint program. While those are wonderful for training a therapist, what we found is if we trained therapists in isolation, it rarely ever changed the overall outcomes for the facility in these critical areas.
We moved to a data-driven interdisciplinary approach. Our Right Path programs use the facility data and the data of the partners — both upstream and downstream — to help make decisions about where our partners should focus on clinical programs that are actually going to meet the needs of patients, residents and the community for that particular market.
We’ve moved away from just doing training for the sake of training. It’s really fun to talk to clients and sit down with them as an interdisciplinary team, because it’s a process. It’s not a one-time only, “We go and train you, we leave and we’re done.” We’re building something with our partner, and working through it upstream and downstream for them.
We’ve talked a lot about changes. What hasn’t changed?
Mack: This is still a resident population that deserves and needs rehabilitative care. They’re still expecting a certain outcome at the end of the day. There is still a long-term care population that needs to have rehabilitative care, and we still have skilled nursing facility and long-term care facility groups that are plagued by Medicaid, managed care and bad debt challenges.
There is a lot of noise and turmoil. We tend to focus on PDPM because it’s a complete overhaul of the system, but we still have skilled nursing facilities closing at an alarming rate. We have a lot of consolidation in the industry. There’s a lot of moving parts. We can’t stick our heads in the sand and pretend that the changes with PDPM or PDGM (Patient-Driven Groupings Model, for home health care) are the only changes that require us to review our care process and care delivery.
In one word, describe the impacts you believe PDPM will have.
Editor’s note: This interview has been edited for length and clarity.
RehabCare provides contract therapy services across multiple settings including SNFs, ALs/ILs, Life Plan Communities and Outpatient Facilities. For more information about how RehabCare can help your facility reach even greater success, visit rehabcare.com.
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