NRH Medical Rehabilitation Network
Paul R. Rao Ph.D. CCC CPHQ
FACHE
Vice President, Clinical Services, Quality & Compliance
National Rehabilitation Hospital 102 Irving Street NW Washington D.C. 20010 Office 202-877-1438 Cell 410-591-3021 Fax 202-829-5180 Paul.r.rao@medstar.net
NRH, within the nation’s capital, is licensed for 137 rehab beds, is the largest freestanding rehabilitation
inpatient facility in the region & one of the 10 largest in the nation.
Largest outpatient rehabilitation network on the east coast.
NRH has been ranked as one of the top hospitals for medical rehabilitation in the nation by U.S. News & World
Report for 14 consecutive years.
Identified as “World Class” since 2006, based on Watson/Wyatt Employee
Satisfaction Index-73 ESI.
Employer of Physical Therapists
Number of NRH Team Member PTs out of
1000 NRH employees…nearly 20% of staff
– Acute Care @ the Washington Hospital Center n=20/20
– In-Patient Acute Rehab @ NRH n=24/24
– Out-Patient Medical Rehab Network n=155
Labor Shortage: Physical
Therapy-
A Rehab Hospital Perspective
Historical Context: Reimbursement and Compliance of
the Centers for Medicare & Medicaid Services (CMS) and Managed Care requirements drive the employment market in acute rehabilitation. The inpatient acute rehabilitation industry consists of 240 free standing rehabilitation
facilities and over 1000 rehab units within acute care hospitals.
PT labor pipeline has been saw toothed. The most recent radical shifts occurred following the BBA of ’97 followed by the CMS Prospective Payment System in 2002.
Acute Care Rehab Drivers
DRG Model of payment since 1983- shorter stay,
greater pay and PTs are key to determining if
patients can go home or be discharged to another level of care. PTs often asked to evaluate the
acute care patient within 24 hours of admission including the ICU to determine viability of safe
discharge. Acute Care hospitals are not paid per se for the PT intervention but must have PT
expertise and adequate staffing for PT Evaluations and treatment and reduce length of stay- hence
Acute Inpatient Rehab Drivers
Medicare Requirements: Medicare
statute-beneficiary is entitled to coverage of
reasonable and necessary inpatient hospital
care, including inpatient rehab services
– PT one of 3 required disciplines for each in-patient rehab admission;
– Acute inpatient rehab patients must receive 3 hours of therapy from PT/OT/SLP for 5 of every 7 days
Recovery Audit Contractors: 2009
“The greatest recoveries, net of appeals, for
inpatient hospital services included claims
for excisional debridement, inpatient
rehabilitation services following joint
replacement surgery, surgical procedures
in the wrong setting, cardiac defibrillator
implant in the wrong setting, treatment for
heart failure and shock and respiratory
RAC Audits thus…
Push for more intense and concurrent
compliance with 3 hour rule intervention
e.g., PTs, OTs, and SLPs as facilities can
receive retrospective denials as far back as
Oct. 2007 and receive 9-12% of
recoverables for all denied stays that are
upheld.
Out-Patient Rehab Drivers
Therapy Caps
CPT code complexities
Not able to bill for unsupervised services
No allowance for co-treatment with other disciplines Reduction in allowance for group therapy- more 1:1
The expectation is that the rehab services require the skills of a therapist which include:
– Experience
– Knowledge
– Clinical judgment
– Decision making abilities
New Drivers
Economy
Healthcare Reform
Age Wave
Prevention
Technology
Vacancy Rate Reduction Using a
Marketing Strategy
Year Acute Care Acute Rehab
OP Rehab
2007 17% 15% 13%
Recruitment/Marketing Strategies
Scholarship Reduction/Sign-On Bonus
Relocation Assistance
Reputation as a Magnet Hospital
Recruit Your Best & Brightest Students
Pay @ 75% of Market
Consider International Market esp. England and Philippines
Retention Strategies
Merit Raises & Market Adjustments
Mentorship
Career Ladder: Director, Manager, Supervisor, Senior, Resource Clinician, staff PT
Reward for Specialty Certifications
Fund Courses/Classes
Research Opportunities & Faculty Appointments
Expand Career Learning/Career Options e.g., transfer to a different program or level of care
Recognition & Rewards e.g., pay for APTA membership, campus parking, internet access
Other Quality of Life Retention
Strategies
Day Care On Site
Flexible Hours e.g. 4 ten hour days
Job Share
Collaborative work culture: New
Value
Transfer to flexipool
Competition from Other PT
Practice Venues
Direct Access in over 40 states
School Systems
Home Care
Long Term Care
Private Practice
Future “Scape”
Evidenced Based Practice
Outcomes as a Foundation of Evidence for Efficacy and Effectiveness
Medicare Direct Access to Physical Therapists
Electronic Medical Record and Tech approaches to work e.g., performance appraisal, scheduling
Increased use of PTAs as a lower cost alternative Decrease variability of Practice Act Laws by state
DPT as norm by 2020…currently 75% of PT grads have a DPT…92% of PT Programs offer DPT.
CMS Bundling Plan by 2015- could have a sea change on all post acute care, including prospects for PT & other
allied health…fewer Medicare beneficiaries qualifying for post acute care…and thus less of a need for PTs.
