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 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? Here are proven strategies that work to differing degrees based on your market.
Strategy 1: Document Objectively
Train your staff to understand that there's 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 patient's 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 doctor has given you the OK to perform strengthening activities, you should be providing all entities involved in the case with functional progress notes and functional discharge summaries.
There is very little value in 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 his job. Then, six to 10 visits later, he can perform 63.6% of his job, which would suggest he's had an 18.4% improvement specifically in returning to the essential functions of his full-duty job.
Then, when someone discharges the patient, whether the treating physician, case manager, claims adjustor, managed care organization or other party, and the client can only perform 73.8% of his job, you have the objective information suggesting that yes, the patient can be discharged from skilled outpatient rehab but requires 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 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 six 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: Be a One-stop Shop
If you're 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?
When an employer is looking to work with an occupational medicine doctor, do they choose the doctor who only performs drug screens and physicals? No, they choose the doctor that has a full menu of occupational medicine services.
The same thing holds true for when a doctor, 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, even if you're the best therapist around, it doesn't matter. Referrers 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 patient to a practice that has this full menu of services.
Strategy 3: Market Yourself
Putting together marketing collateral can have some nice benefits, but any marketing material must talk about your full menu of return-to-work services as well as your on-site preventive and reactive services. Also, make sure your marketing collateral talks about your specialization in treating the injured worker and getting him back to work as soon as functionally possible. You need to promote how your return-to-work rehab clinic is different from the clinic down the road from you.
Everyone performs functional capacity evaluations and work conditioning, so this will not differentiate your business. Separate yourself from your competition by showing off your return-to-work functional documentation and the progress notes you complete 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 his job, and yes, you can communicate with the employer.
Strategy 4: Go to the Source
You communicate with the treating physician proactively - why not communicate verbally with the case manager, claims adjustor and employer?
Many 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. The clinic receives a referral from a physician's office or a patient.
2. The clinic contacts insurance to verify it is an open and active workers' compensation claim.
3. Obtains verbal authorization for therapy.
4. Following verbal approval, the clinic informs the person on the phone that it will be contacting the employer to obtain the job description.
5. The same person contacts the employer, introducing herself in the following way: "Good morning, this is Barb and I am calling from ABC Therapy. We are an outpatient rehabilitation practice that specializes in getting the injured worker back to work as quickly and 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, this could be your opportunity to go on site, perform a job analysis, and write up a job description.
In Part 2 of this series, read about strategies on writing proper job descriptions, involving case managers, and informing the referring physician.
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 email@example.com or 866-470-4440.