Is a CORF designation in your facility’s future? Take the lead on rehab hospitals
Like it or not, the marketplace may demand it
Rehabilitation providers who once scoffed at the possibility of a skilled nursing facility taking patients are now giving subacute rehab providers a serious second look, which could offer a potential windfall of new patients if the facility gets accredited.
Those in the know say in the near future comprehensive outpatient rehabilitation facilities (CORFs) could be treating hundreds of patients annually who now are being treated in acute rehabilitation facilities.
Already, acute lengths of stay have been slashed to the point that many discharged patients still need the comprehensive transdisciplinary rehab services that can be provided in a CORF, says Lenore Hersh, director of planning and site development for Casa Colina Centers for Rehabilitation, with headquarters in Pomona, CA. Hersh is an advocate of CORFs, despite her company’s decision to close its three CORFs.
Nancy Beckley, MS, MBA, recalling discussions of five or six years ago, says, "I heard numerous people in the rehab field dismiss the threat of subacute facilities." Beckley is president of the Bloomingdale Consulting Group in Valrico, FL. "They laughed and said that an SNF couldn’t take their patients because it didn’t really offer rehab."
Time has proved them wrong. Now, some stroke and orthopedic patients, who previously were admitted to inpatient rehabilitation, go directly from the acute hospital to a subacute unit or home with home health services.
As states develop managed care programs for their Medicare populations, and the managed care payers push for alternatives to acute hospitalization, an increasing number of Medicare patients are likely to be moved directly from the trauma center to the outpatient setting and that’s where having a CORF could allow you to remain a player. (For tips on how to decide if a CORF will be profitable for your facility, see story, p. 75.)
CORFs are Medicare-certified facilities that provide a comprehensive range of interdisciplinary services in one location. Essentially, a CORF provides the entire gamut of services available on an inpatient rehabilitation unit but provides them on an outpatient basis for patients who do not need 24-hour-a-day nursing care.
The difference in a CORF and a typical outpatient rehab program is that the staff of a CORF treat patients as a team, with interdisciplinary team goals, rather than each discipline coming up with an individual treatment plan and working with the patient separately, Hersh says. For example, if a patient goal is to work on cognition, the physical therapist and speech therapist will include in their treatment sessions activities to improve cognition.
Medicare will reimburse a CORF for a wide variety of services, including social work, psychological services, and rehab nursing. A typical outpatient program is reimbursed only for physical therapy, occupational therapy, and speech therapy services. (For a complete list of services Medicare reimburses, see box, p. 76.)
In 1996, CORFs recorded more than 1 million patient visits. The number of Medicare-certified CORFs has increased from 318 in mid-1996 to 431 today, according to the American Rehabilitation Association in Reston, VA. (For information on the upcoming CORF conference, see story, p. 76.)
As the baby boomers age, the number of Medicare beneficiaries who will need the services of a CORF will increase.
In fact, the number of Medicare beneficiaries has increased from 19 million in 1965 to more than 38 million in 1996. It is projected that by the year 2020, 31% of the population will be over 55, and 10% will be in the age group 65 to 74.
And as the demand increases, so will your competition for these baby-boomer patients.
"Those of us who have been in rehab for a long time in traditional facilities tend to look inward and not realize that a provider down the street is really a competitor," Beckley says.
In the future, competition for medically stable rehab patients who are Medicare beneficiaries will come from:
• hospitals that don’t have separate inpatient rehab units but are now looking into developing CORFS as a way to provide a continuum of care and get Medicare cost reimbursement for their patients;
• private practice, single-therapy clinics expanding their services to include other disciplines;
• private physician practices that are looking into developing their own CORFs. Since the Stark II legislation governing self-referrals became effective in January 1995, physicians have had clearer definitions about what is allowed in financial relationships with entities to which they refer patients.
Some rehabilitation hospitals that once operated Medicare-certified CORFs gave them up because they determined the extra reimbursement was not worth the effort of complying with strict Medicare guidelines.
"We decided to simplify our lives," says Karen Bricker, MS, OTR/L, director of rehabilitation services at D.T. Watson Rehabilitation Center in Sewickley, PA.
HCFA policies require that providers have separate policies and procedures, separate charts, and specifically designate space that is not used for anything but treating CORF patients.
This posed a problem for the D.T. Watson staff because their CORF was located within the rehab facility. Therapists who worked with CORF patients and with other rehab outpatients had to mark separate time cards for their time spent with the Medicare patients.
"When we weighed the time and effort we had to put into maintaining a separate entity, it just didn’t make any sense," Bricker says.
Another rehab administrator, who asked that his name not be used, said the requirement for interdisciplinary team conferences for CORF patients spelled the death knell for a CORF at his facility, a fairly small hospital-based unit.
"We weren’t reimbursed for the team meetings. This meant that the physician and all the therapists were sitting in meetings when they could be treating other patients. It doesn’t make sense unless you have enough CORF patients so that you dedicate a group of therapists solely to your CORF," he adds.
Casa Colina Center for Rehabilitation closed three CORFs it had operated for many years when large managed care plans in Southern California began setting up their own outpatient facilities and sending patients to them, says Hersh.
"[Payers] would discharge their patients from our acute hospital and send them to their own outpatient clinics," she explains.
Despite Casa Colina’s experience with CORFs, Hersh is a firm believer in their efficacy.
"Our situation was unique to Southern California," she says.
Mimi Stachowski, administration director for ambulatory services at Bryn Mawr Rehabilitation in Malvern, PA, implemented 13 CORFs in six states for her previous employer, Dallas-based Milestone Health Care, a contract management company. Stachowski offers these tips on how to make your CORF succeed:
• Make sure your CORF is easy to find and is easily accessible by patients with a disability.
A medical office building owned by a hospital is an ideal location for a CORF, Stachowski says. The patients know where it is; it’s visible to the referring physicians; the space is free from hospital overhead; and it turns an unused space into a money generator.
• Develop your referral base, and set up a comprehensive marketing plan before you open, Stachowski advises. Contact payers, acute care hospitals, and physicians on your facility’s new service to improve the referral base.
"You cannot open a CORF and expect that patients are going to come to you. You have to have something to offer, and you have to have a good referral base to succeed," she explains.
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