Medicare A SNF Concurrent Therapy – Patient Scheduling and Caseload Mix Variables Affect Practice Patterns

On October 1, 2010, the utilization of concurrent therapy in the MDS 3.0-SNF Part A setting will change dramatically. Concurrent minutes will be assigned a 50% value once they are entered into MDS Section O. How will that change your practice patterns?

Current Practice Patterns
Has your company examined how much concurrent therapy is being delivered now? How many Part A residents are being seen together in the gym? There’s a good chance you are delivering more than you think; 40%, 50% or even 60%.

The only way to determine how much concurrent therapy is being delivered is to track it. It’s hard to use productivity as a gauge for concurrent therapy. There are too many variables involved to say, “90% department productivity = X% of concurrent therapy.” Two of the more influential variables are patient scheduling and caseload mix.

Patient scheduling – Do you have limited windows throughout the day to see the bulk of your patients? Does nursing get residents up early enough in the morning to spread treatments across the entire day? Therapy departments often see 4 or 5 residents transported to the gym at once because they were all finally bathed and dressed – and it’s 10am! Then there is Bingo, mealtimes, doctor appointments, medication administration, family visits, etc. How does a therapy department with 15-20 residents on Part A deliver care in this scenario? Answer: Lots of concurrent therapy.

Caseload Mix – If your department also has a significant Medicare Part B therapy caseload, the available windows for MCA patients get even smaller. Patients on MCB are already being treated one on one. For every hour your therapists are treating MCB, there’s an hour that MCA can’t be seen. So, the higher your MCB caseload mix, the more concurrent treatment you delivering with your MCA caseload.

In the MDS 2.0 system, concurrent therapy has allowed the flexibility to still deliver required RUGS minutes during assessment periods, even when the variables of patient scheduling and MCB caseloads reduced available treatment time.

How does your company plan to manage concurrent minutes in the new MDS 3.0 system?


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