The therapy director of an extended care center was concerned that the center’s therapy operations were not functioning at an optimal level and turned to AdvantageCare Consulting to conduct an audit. The goal of the audit was to identify the areas and practices undermining the center’s financial performance, which would overtime threaten the viability of the center’s therapy offerings.
AdvantageCare Consulting conducted a comprehensive audit of the center’s rehabilitation program, which consists of physical, occupational, and speech-language pathology services. The audit included a full day of on-site observations, reviews and interviews. Following was an extensive off-site review of the center’s therapy medical records, billing volume indicators, clinician productivity tools, and MDS submissions.
The audit concluded that the center’s therapy operations were indeed underperforming across a number of key measurement categories. AdvantageCare Consulting performed a detailed, comparative analysis of regional, state and national data reports – such as RUGs distribution reports against the center’s data and identified areas in which the center’s performance was well below recommended levels. Likewise, the audit revealed that weak PPS practices and low financial awareness were having a significant and negative impact on clinical reimbursement levels. Below are some excerpts from the audit’s findings:
“Analysis of MDS submissions, Therapy Billing Records, RUG Tracking tools, and clinical documentation demonstrated a failure to incorporate an awareness of clinical reimbursement into clinical decision-making and clinical service delivery.”
“The brevity of PT and OT treatments posed the greatest clinical concern during this audit…the low RUG scores yielded by the abbreviated minutes suggests under-utilization…”
“A review of Therapy labor hour and charge submissions yielded a billable productivity of only 52% for PT and 38% for OT. This is well below the contract rehabilitation industry average of 75-80%.”
“The system employed for therapy billing and clinical documentation does not appear to provide adequate safeguards to insure compliance with Medicare documentation requirements, or facilitate accurate reporting of MDS treatment days and minutes.”
“The financial impact of greater RUGs maximization will be significant. Enhanced annual revenues of\nearly $360,000 could be appreciated…”
A detailed listing of recommendations was included in the AdvantageCare Consulting’s final report to the center. The overriding recommendation was to secure additional training and education for staff in order to improve: awareness of clinical tracking and reimbursement methods; MDS accuracy; functional outcomes; and therapy staffing levels. In addition, a new billing system was recommended to help improve the accuracy of tracking data and more effectively monitor RUGs overage and shortages, as well as clinician productivity and utilization rates. In addition, a variety of new reviews, reports and evaluations were recommended to align the delivery of therapy services with the center’s compliance reporting and performance tracking.
AdvantageCare Consulting delivered an on-site presentation of the audit’s results, findings and recommendations to the center’s therapy management team. In addition, AdvantageCare Consulting provided a detailed report that included a review of existing therapy practices and the audit’s findings and recommendations. The audit report included comparative analyses, tables and charts.
The center’s therapy director now has a clear understanding of the issues and practices that are threatening the long-term viability of its therapy services – and has a set of clear recommendations on how to improve its therapy management operations. In addition, an objective baseline of performance benchmarks has been established, so the center can measure its progress overtime.
AdvantageCare Consulting helps facility administrators and therapy directors evaluate current therapy operations and identify practices that are undermining the facility’s ability to deliver consistently high quality care overtime. Once the problems are identified, AdvantageCare Consulting provides recommendations and a customized plan of action for improving the facility’s therapy operations, which in turn strengthens the long term financial health and therapy services of the facility.
We can help your therapy operations get back on track to improved clinical outcomes and strong financial health.
For more information, please call: (412) 440-0142