Risky business in outsourcing SNF therapy you say? A few weeks ago a news article was delivered to my inbox that might as well have been accompanied by alarm bells. Before you read the headline and consider yourself exempt, the startling aspect of the case is that it involves a SNF being held liable for actions of a contract therapy company. That’s right – just because you outsourced your therapy doesn’t mean the feds won’t come knocking on your door expecting due financial liability, and in this case it involved millions. McKnights’ writer Tim Mullaney covers this turn of events in his recent article, $3.8 million Settlement Shows Nursing Homes Must Oversee Their Therapy Providers, Feds Say, and quotes U.S. Attorney Carmen M. Ortiz:
“Settlements like this one show that, when a facility contracts with an outside rehabilitation therapy provider, the facility has a continuing responsibility to ensure that the provider is not engaged in conduct that causes the submission of false claims to Medicare.”
Risky Business: Outsourcing SNF Therapy and How to Mitigate
Up until now, many SNFs looked to their hired contract therapy company to stay current and in compliance with Medicare regulation and treatment practices, but this article is cause for a double take. The settlement between the Department of Justice and two long-term care facilities reveals that as a SNF, you are responsible to employ oversight of your contract therapy provider, and failure to do so could have devastating financial consequences. Why is this so remarkable? Because one of the reasons SNFs outsource their therapy program has been because of the assumed headaches associated with providing therapy “in-house” (i.e. staffing, managing your therapists, compliance, etc.).
Many contract therapy companies approach SNFs and sell their services by suggesting that as the SNF, you will not have to worry about anything once you bring them on board. With such a great sounding, no worries offer, “Let us take care of your therapy program” – many SNFs have done just that. They have given their therapy program over to a contractor carte blanche and the only time you are checking in with them is when the numbers are not where you expect them to be. Along with ridding yourself of the staffing and oversight problems, many SNFs also assume that you will have better control and response from the therapy team when asking that the contractor increase RUG scores, length of stay, etc… and you may, in fact, get exactly what you are asking for – but the question of whether or not those increased metrics are clinically appropriate is no longer solely on the shoulders of the therapy provider. That is the type of situation that this settlement has clarified. Gone are the days when you can just hand off your therapy program and wash your hands of it. You are actually on the hook for what the contract therapy company is doing – which means that the responsibility has now shifted back to you to assess compliance with regulations and best practices. The buck, literally, stops with you.
So what do you do now? Are you engaging in risky business of outsourcing contract therapy? The article referenced above affirms that handing over your therapy program completely is not best practice. While the SNF has always been liable for financial billing inaccuracies, billing practices, and overpayments, this announcement from the Department of Justice refines your liability to include services and practices provided in your building, including contractors.
The good news is you have nothing to fear as there are plenty of resources available so you can be proactive and protect yourself from such costly litigation and payments. When using a third-party for your therapy services (and there are several great, ethical companies out there to choose from), then the relationship needs to be one marked by the facility and therapy department collaborating to determine what is happening in the therapy program. If you want additional oversight into the services being provided in your facility by a third-party, and would like an expert audit (one-time or ongoing), Seagrove Rehab Consulting + Education can provide routine audits of your therapy program to identify where your areas of opportunity might be and where your risks are. We also offer a tailored flat-rate monthly support package for facilities who are in-house or who want to go in-house. It’s a hybrid model that allows administrators to retain control of their therapy department (staff and profits), while giving you and your team the monthly expertise and guidance to keep those headaches at bay. Whatever you decide going forward, let the McKnight article be a wake-up call to re-asses your therapy operations. Our efforts should always be marked by compliance and best practices, not just to the benefit of our facility staff and government, but also because we owe it to the patients we serve.