Outpatient rehabilitation clinics are penny pinching all over the United
States. From healthcare reform, Medicare cuts, and workers’ compensation managed
care, reimbursement is falling while a rehab clinics expenses and salaries are
rising. It is a scary trend for many rehabilitation directors/owners as they are
looking for ways to offset the reduced reimbursement. Everyone is looking at
workers’ compensation patient volume/revenue and on-site cash based revenue as
the means to offset this trend.
Rehabilitation clinics throughout the country have workers’ compensation
initiatives in full force. They are looking at opportunities to enhance revenue
with improved clinic based workers’ compensation services and providing cash
based on-site services at local employers.
How are you going to accomplish the goal of increasing workers’ compensation
outpatient rehab volume which in turn can increase clinic and on-site based
revenue streams? Here are seven strategies that work to differing degrees based
on your market.
Strategy 1
Train your staff to understand there is a difference between rehabbing a patient
and rehabbing an injured worker. The professionals involved in getting an
injured worker back to work, including case managers, physicians, claims
adjustors, patients, and employers, rarely care what your patients muscle
strength and range of motion is. All of these professionals are concerned with
how close to return to work your patient is. When you send progress notes on a
workers’ compensation patient, and the Dr. has given you the okay to perform
strengthening activities, you should be providing all of the entities involved
in the case with functional progress notes and functional discharge summaries.
There is very little value in regards to documenting that your workers’
compensation patient has 4+/5 strength and 47 degrees of active range of motion.
What the employer, case manager and physician care about is that the patient can
perform 45.2% of their job. Then 6-10 visits later they can now perform 63.6% of
their job which would suggest they’ve had an 18.4% improvement specifically in
regards to returning to the essential functions of their full duty job.
Then when someone is discharging the patient, either the treating physician,
case manager, claims adjustor, managed care organization, or whoever, and the
client can only perform 73.8% of their job, you have the objective information
that suggests that yes, the patient can be discharged from skilled outpatient
rehab but they require work hardening, work conditioning, or advanced work
rehabilitation.
This strategy turns you into a practice that specializes in the return to work
of the injured worker and separates you from the practices that continue to
treat injured workers just like any other patient.
Functional progress notes and functional discharge summaries are 15 to 30 minute
functional re-evaluations that can be performed every 6 to 10 visits and do not
require a physician’s order nor do they require insurance authorization. These
testing methods are easy to perform and tend to be performed by all the
therapists within an outpatient rehab practice. They are not Functional Capacity
Evaluations and most rehabilitation professionals are willing to perform them
secondary to their understanding of how important function is.
Strategy 2
If you are looking to rehab your house, would you go to 10 different hardware
stores to find the material you need or would you go to one hardware store that
has a full menu of material you need to complete the project. When an employer
is looking to work with an occupational medicine Dr. do they choose the doctor
that just does drug screens and physicals, no they choose the Dr that has a full
menu of occupational medicine services
Same thing holds true for when a Dr., case manager, claims adjustor, or employer
directs care for rehabilitation. They want the injured worker to go to a rehab
practice that has a full menu of return to work services.
If you only provide outpatient rehab and even if you are the best therapist it
does not matter, they are going to send the patient to the return to work
specialty practice that focuses on return to work function and provides
Functional Capacity Evaluations, Functional Progress Notes, Functional Discharge
Summaries, Work Conditioning, Job Analysis, On-Site Rehab, On-Site Injury
Prevention, Ergonomic Consultation, Back School classes, Post Offer Employment
Testing or other return-to-work/stay-at-work/injury prevention services. Why,
because they will choose to send the clinician to a practice that has a full
menu of services.
Strategy 3
Putting together marketing collateral can have some nice benefits but any
marketing material needs to talk about your full menu of return-to-work services
as well as your on-site preventative/reactive services. Also make sure that your
marketing collateral talks about your specialty in treating the injured worker
and getting them back to work as soon as functionally possible. You need to
promote how your return to work rehab clinic is different than the clinic down
the road from you.
Everyone does Functional Capacity Evaluations and work conditioning so this will
not separate you. Separate yourself from your competition by showing off your
return-to-work functional documentation and the progress notes you perform
during outpatient therapy. Make sure your marketing strategies point out that
you will send this documentation directly to the employer while their employee
is in rehab. What about HIPAA? HIPAA is slightly pushed to the side as long as
your documentation is prudent and focuses on your patient’s ability to perform,
or not perform, the essential functions of their job and yes you can communicate
with the employer.
Strategy 4
You communicate with the treating physician pro activity, why not communicate
verbally with the case manager, claims adjustor and employer. Many of the
leading return-to-work rehab clinics throughout the United States perform the
following steps upon getting a referral for rehab from a workers’ compensation
patient.
1) Receives referral from physician office or patient
2) Contacts insurance to verify if it is an open and active workers’
compensation claim
3) Obtains verbal authorization for therapy
4) Once verbally approved, informs person on phone that they will next be
contacting the employer to obtain the job description
5) Same person contacts the employer and introduces themselves and the practice
in the following way, “Good morning, this is Barb and I am calling for ABC
Therapy. We are an outpatient rehabilitation practice that specializes in
getting the injured worker back to work as quickly and as safely as possible. I
was hoping you could fax me Mr. Smith’s job description so we can set long term
goals that directly focus on the essential functions of Mr. Smith’s job?”
This is a great soft sell to employers every time one of their employees enters
your rehabilitation practice. If there is no job description maybe this is your
opportunity to go on-site and perform a Job Analysis and write up a job
description.
Strategy 5
Workers Compensation managed care is taking over the landscape of workers
compensation rehabilitation. If you sign a contract with managed care you are
not guaranteed you will get any patients. Many hospitals and physician owned
therapy practice avoid the workers’ compensation managed care contracts because
they have a direct referral source in-house. Either way they are also
implementing strategies to offset reimbursement decreases from other insurance
avenues through workers’ compensation initiatives.
No matter how you get your referrals, this strategy helps to increase workers’
compensation referrals and also helps to establish cash based on-site services
at local employers.
You have a physician’s order that says 3 times per week for four weeks. Take one
of those visits and take the patient to their job while you perform a Job
Analysis. You do not need a doctor’s order nor do you need insurance approval to
do a Job Analysis. All you need is permission from the employer to step foot on
their property. The patient will not perform their job but you and the patient
will watch someone else doing their job while you take notes on the physical
demands required for full duty return to work. The cpt code you use is 97537 for
each 15 minutes you are on-site with the patient. Use this data to perform
improved functional return-to-work rehab, establish long term goals that are
functionally based, and test the person using functional progress notes and
functional discharge summaries. After this visit to the company, write up a job
description whether the company wanted it or not and contact the company
representative afterwards and offer to come in to show them the job description
you wrote up. This strategy more often than not lands you a contract to re-write
all of their job descriptions.
This is a great soft sell to the employer, allows you to meet the decision
makers for on-site cash based services, helps to break the psychosocial barrier
of return to work, but most importantly tells local industry that you are that
markets specialist in return to work of the injured worker because you take the
extra step to know exactly what the patient needs to do for full duty return to
work.
Strategy 6
When done correctly, work conditioning, work hardening or advanced work rehab
continues to be one of the best reimbursed services in 80% of the United States.
Case managers consistently direct care to these programs. However, they direct
care to programs that successfully get the injured worker back to full duty
work.
To increase referrals into your work conditioning program and to decrease
denials from the insurance company, you need to communicate proactively to the
case manager during outpatient rehab. This includes proactively letting the case
manager know that you feel the patient may need work conditioning. Make sure
your communication outlines the exact return to work function the client can and
cannot perform related to the physical demands of their job. If your patient can
only perform 73.8% of their job at discharge from outpatient rehab then they
require work conditioning.
Strategy 7
We will call this a strategy but it is the strategy that has the least effect on
your workers’ compensation referrals. This is marketing directly to the Doctors.
Whether it is marketing collateral or going to visit the Doctor on a marketing
call. It is good to let them know you are there, and get to know them, but it is
rare that these marketing efforts increase referrals long term. Focus these
marketing efforts on what you do different from the clinic down the street.
Quality documentation in regards to return to work function is what the Dr’s
need to make an objective return-to-work decision
There is no other professional that spends as much time with a workers’
compensation patient as compared to the therapists. A physician sees the patient
for 5 minutes and needs to make a return to work decision. You see them for 60
minutes three times a week and have the skills and equipment to make return to
work recommendations. It does not require a 4 hour Functional Capacity
Evaluation to make return-to-work decisions. An outpatient therapist can do a 30
minute functional progress note or functional discharge summary and provide the
physician with objective return to work information every 6 to 10 visits, bill
97750 for this time, and greatly assist the physician with objective return to
work information.
Improving workers’ compensation services, offering a full menu of return to work
services, functional testing workers’ compensation patients during outpatient
therapy, and proactively communicating with all entities involved in the
workers’ compensation patient are key strategies to increase referrals and
revenue in ever more challenging times for rehabilitation clinics.
Last revised: May 21, 2014
By Jim Mecham, MSIE, OTR/L,
CPE
