Are Groups the Answer?
One of the take-home messages from the APTA Combined Sections Meeting last month was that more therapy is better. I think everyone agrees with that. What we can't agree on, or even figure out for that matter, is how to squeeze more therapy into an already overcrowded day. One suggestion was to utilize group therapy in addition to what we're already doing.
On the surface that sounds like a great idea. You can work with more patients with less staff. Group is even billable, although not for very much. When performed in addition to regular therapy, there would be a net increase in revenue. At least that's how it sounds. If a couple of groups were incorporated into the weekly schedule, we'd have more therapy.
I see two problems with the idea. First, who is going to staff the group? Generally everyone will have a full caseload. I don't know of one facility that allows overtime. Nobody has time in their schedule for extra therapy. Bringing in an extra person probably isn't feasible. Even with some revenue generated, the influx will not cover the salary of the staff needed to have the group.
The second problem is reimbursement, as in who will pay for it? Even if you somehow find the time and the staff, someone still has to pay for it. One suggestion was to have patients private pay for the group when provided on an outpatient basis. I don't know about everyone else, but at any given time at least one-third of my patients are non-funded. Many others are on a fixed income. Even if they want the therapy, they can't afford it.
You would need to have the group meet at least three times a week for it to have any meaningful impact. Multiply that by a few weeks and the cost rises quickly. If the cost is kept low, larger groups will be needed to offset expenses. Larger groups mean more staff. If you limit the number in the group, the cost will need to be higher. Many patients grumble about outpatient therapy copays. I can't see this going over any better on a large scale.
So we have a reasonable suggestion but no feasible way to implement it at this time. Obviously increasing the amount of reimbursement for our services would be a big help, but that isn't going to happen.
Until someone on the payer side realizes all the benefits of therapy on keeping costs down and decreasing length of stay, nothing will change. The same studies that say more is better also show how increasing the therapy actually decreases the bill and length of stay. Maybe they don't want to see it. Maybe they don't believe it. One reason our system is dysfunctional is because of the numerous groups and entities invested in keeping it the way it is.