You can’t have your cake and eat it too. Or can you?

The phrase “you can’t have your cake and eat it too”, is a common phrase that is often used to imply we cannot have the best of both worlds. For skilled nursing operators they have had the choice of recognizing cost savings associated with an in-house therapy program or the clinical, financial and regulatory expertise that comes with using the services of a contract therapy provider.

Many operators are now becoming aware of a third option that appears to allow them to have their cake and eat it too. This option is a hybrid or management model in which they bring the therapists in house, to realize costs savings, but use the services of a third-party management company to provide the expertise of a contract therapy company.

When presented this option it truly seems like the best of both worlds. There is the potential for a six-figure savings by moving therapists in house, yet access to the expertise that normally comes from using a contract therapy company. The monthly cost for these management services may range from $2,000 to $5,000 per month per facility depending on the level of services offered, which still represents a potentially significant savings over a contract therapy company.

I believe this is a viable option for many organizations but before proceeding here are some considerations and questions to ask the management company.

  1. Financial savings – before proceeding ask for a detailed projection of cost savings for this model. This should include projected staffing model, therapist salaries, projected therapist productivity and ancillary costs such as liability insurance, technology, EMR system costs and compare it to the last 12 months of your contract therapy charges.
  2. Staff Recruiting – will the management company recruit therapist staff and if so have them explain their process. Are they simply getting a resume and sending to your HR department or are they involved in interviewing and vetting candidates?
  3. How is the therapy department going to handle fluctuations in census or unexpected absences? How will they train and support the Therapy Director?
  4. What is the plan to share staff between our various facilities (for those who have more than one building)?
  5. How will they support the Therapy Director at ensuring staff meet the department productivity standards?
  6. How often will they meet (whether in person/phone/zoom) with the Therapy Director and what is the agenda for these meetings?
  7. What practices will be utilized to monitor documentation for compliance to regulations and to ensure documentation consistently supports the need for therapy?
  8. How do our organizational strengths, company culture and organizational goals impact our decision in making this move?
  9. What will be different for our company under this model including what specific responsibilities or actions will be required from our management team, that was not required under our contract therapy relationship?
  10. How will they support our organization if we decide we want to convert to a fully in-house model which will no longer require their management services?

These are some of the questions that will help you evaluate the potential benefits of such a move and the merits of the company that is proposing to act as your therapy management company. There are unquestionably benefits to the hybrid/management model however it is important to understand the operational impact to your company, the level of management support you will receive and how you will measure the financial impact.

If you have more specific questions about the hybrid model or are interested in an evaluation and proposal, please contact me at or 513-255-2620.