The decision by skilled nursing organizations to outsource therapy services is done for a variety of reasons including a lack of internal expertise, a desire to save money or simply to free up management time and resources to function on other areas of the business. The process of selecting a therapy provider can be formal, with extensive criteria, or rather informal with the selection process driven by past experience or a specific referral. The completion of the RFP process should represent the beginning of an ongoing evaluation of the provider you choose, rather than the completion of an evaluation.
In our experience organizations tend to ignore any kind of regular evaluation of their contract therapy provider, until a problem or concern arises. By that point there could be problems that bring regulatory, financial and reputational ramifications. It makes more sense to take a proactive approach to evaluating your therapy provider on a more regular basis.
Here are some key areas to focus on when evaluating your therapy provider:
- Clinical Outcomes – your therapy provider should provide monthly reports illustrating outcomes but beyond these reports you should actively solicit feedback from patients, family members and the physicians who serve your patients. Ask your therapy provider for reports that compare your facility outcomes to the average outcomes of their client base.
- Reputation – talk to your hospital partners to see if your facility is meeting their expectations, particularly as it relates to their participation in value based purchasing programs. The two key metrics they are evaluating are length of stay and rehospitalization rates. Your therapy provider should have clinical protocols designed to address these key areas. Also speak to your long-term residents, short term patients, and their families. Are they satisfied with the therapy services they are receiving?
- Contract Pricing and Terms – this is particularly important for those who have not conducted an RFP in the past five years. The methodology and pricing for Medicare Part A changed dramatically since the shift to PDPM. There is significant competition within the contract therapy business which creates opportunities for skilled nursing to improve their pricing and terms. It is also important to evaluate costs versus the services being delivered, which has also changed under PDPM.
- Compliance – if your contract therapy provider engages in unethical or illegal behavior your organization will also be held liable. Beyond simply adhering to the rules, the quality of therapy oversight and documentation is critical in supporting the need for care in the event of any insurance appeals or ADR’s. Ask your therapy provider for reports that support their compliance oversight efforts.
- Ancillary Services and Support – as competition increases, contract therapy providers have added to their service offerings beyond delivering therapy. Other services include census development research and support along with MDS education and support. If your therapy provider highlighted these additional services, it is important to check in to make sure they are delivering upon them.
It is important to assign one person the responsibility for monitoring and evaluating your contract therapy provider. This person will obviously need to solicit feedback and insights from others, but by assigning the responsibility to one person, it ensures that the work will be completed.
An annual evaluation of your contract therapy provider might uncover the need for an RFP, particularly if you have had the same provider for a number of years. Rather than viewing this process as a burden it should be viewed as an opportunity to improve the quality and cost of your therapy services.
If you need assistance in evaluating your contract therapy provider, or in conducting an RFP for therapy services contact Brian MacDonald at firstname.lastname@example.org