Captains of Industry--Part 2

Proven strategies you can employ today to be your community's best return-to-work rehab clinic

This is Part 2 in a 2-part series. Part 1 is available here.

Outpatient rehabilitation clinics are penny-pinching all over the United States. From healthcare reform, to Medicare cuts and workers' compensation managed care, reimbursement is falling while rehab clinics' expenses and salaries are rising.

It's a scary trend for many rehabilitation directors and owners as they look for ways to offset the reduced reimbursement. Everyone is looking at workers' compensation patient volume and 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? There are proven strategies that work to differing degrees based on your market.

In the first installment of this series, we covered strategies 1-4, which discussed objective documentation, being a one-stop shop, marketing yourself and communicating with case managers and claims adjustors. The following are strategies 5-7.

Strategy 5: Write a Job Description

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 to get any patients. Many hospitals and physician-owned therapy practices avoid 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 increase workers' compensation referrals and also establish cash-based on-site services at local employers.

Let's say you have a physician's order that says three times per week for four weeks. Use one of those visits to take the patient to his job while you perform a job analysis. You don't need a doctor's order, nor do you need insurance approval to conduct a job analysis. All you need is permission from the employer to set foot on their property.

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The patient will not perform his job, but you and the patient will watch someone else performing the 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, contact the company representative afterward, 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 rewrite all their job descriptions.

This is a great soft-sell to the employer because it allows you to meet the decision-makers for on-site cash-based services and helps break the psychosocial barrier of return to work. But most importantly, this strategy shows local industry that you are a specialist in returning injured workers to the job and you will take the extra step to know exactly what the patient needs for full-duty return to work

Strategy 6: Involve Case Managers

When performed 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 decrease denials from the insurance company, you need to communicate proactively with 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 his job.

If your patient can only perform 73.8% of his job at discharge from outpatient rehab, then he requires work conditioning.

Strategy 7: Call the Doctor

We will call this a strategy, but it's the strategy that has the least effect on your workers' compensation referrals. This is marketing directly to doctors.

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Whether it's marketing collateral or going to visit the doctor on a marketing call, it's good to let him know you're there, and get to know him, but it's rare that these marketing efforts increase referrals long-term. Focus these marketing efforts on what you do differently from the clinic down the street. Quality documentation of return-to-work function is what doctors need to make an objective return-to-work decision.

There's no other professional who spends as much time with a workers' compensation patient as his therapist. A physician sees the patient for five minutes and must make a return-to-work decision. You see him 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 perform a 30-minute functional progress note or functional discharge summary and provide the physician with objective return-to-work information every six 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, functionally testing workers' compensation patients during outpatient therapy, and proactively communicating with all entities involved with the workers' compensation patient are key strategies to increase referrals and revenue in these ever-more challenging times for rehabilitation clinics. 

In Part 1 of this series, which appeared in the Nov. 11 issue, the author covered strategies on effective documentation, being a one-stop shop, marketing yourself and communicating with case managers and claims adjustors. Part 1 is viewable at http://www.advanceweb.com/pt%20(search for "Captains of Industry").

Jim Mecham is continuing education director for OccuPro and developer of OccuPro's return-to-work software, which features OccuPro's proprietary Functional Progress Notes and Functional Discharge Summaries. Contact http://jmecham@occupro.net or 866-470-4440.



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