Do All Medicare Part A Patients Need Therapy?
Today the answer is yes, particularly if the patient is a resident of the facility who went out with a medical problem. Not only do these patients need therapy, they need to be on caseload as long as possible. It is the only way a SNF can survive.
Years ago, what I refer to as "back in the day," we had the same scenario. We were encouraged to pick up all Part A patients. The difference was they weren't on caseload very long. Today we're pressured not only to pick them up but to keep treating them as long as possible. Doing so helps the financials.
The facility I'm working at right now is barely surviving. Several residents have developed medical problems resulting in hospitalizations. I wouldn't say the reaction is gleeful when someone goes out, but there is a sigh of relief. They might actually make budget this month.
Obviously decisions about who to put on caseload and for how long are based on clinical judgment, or should be. It's beyond troubling that our current reimbursement structure produces an environment where staying solvent is so difficult. Everything has been cut to the minimum and SNFs still lose money. It won't be too long before current employees have their salaries reduced.
It's causing a conflict of interest. I decide who is on caseload and how long. My salary is dependent on the facility not losing money. If I pick up everyone for therapy for as long as possible then I keep my salary, which might not be in the patient's best interest. If I maintain the caseload based on what's best for the patient, my salary is in danger.
I don't think the situation has gotten that severe yet, but we can't survive much longer as we are now.