What has your therapy department done for you lately? Six value-added components to look for...

You've heard it many times: Two heads are better than one. That's why smart skilled nursing facilities are looking at their therapy departments in a new light when it comes to the task of building census. "Therapy is the right arm of the nursing home," says Patrick Sulzberger, managing consultant

Since the start of PPS in 1998, many skilled nursing facilities around the country have seen a 10% drop in census, according to Leo LaCroix, vice-president of sales for Aegis Therapies. "The trend affects the entire industry," he says. "It demands proactive solutions."

A skilled facility's rehab department can play a big role in those solutions by offering a variety of value-added services to expand the facility's market. "Therapy can't own a skilled facility's census development," says LaCroix, "but it can help facilitate it and support it."

"The value-added side of therapy is important," adds Faith Lessig Ott, marketing consultant at LW Consulting, Inc. "More than simply specifically providing rehab, we have to think outside the box. A really great rehab partner has to be creative."

If your therapy department isn't offering its expertise to help fill those empty beds, the big question is: Why not? "You need the expertise of the therapy team to grow your business," says Vickie Shoopman, RN, CRRN, CCM, owner of Rx Healthcare Management and Consulting, LLC. "If the therapy department says it can't do it because it's not billable time, that's a problem."

"Look for a rehab company that provides more than therapy," advises Fran Fowler, president of Fowler Healthcare Affiliates, Inc. "The rehab company can bring market development expertise to the table."

Here are six ways in which your therapy department can reach out to help your SNF build census.

1. Boost marketing skills. Mark Tellier, healthcare consultant and principal with Tellier & Associates, LLC, recalls his experience when he was involved with Covenant Health Network, a group of some of the largest not-for-profit long-term care facilities in Arizona: "Leo LaCroix from Aegis Therapies provided an in-service on how to grow census by involving rehab. It was excellent. The feedback was very good, and it increased awareness among administrators."

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LaCroix's popular sales-referral program, "Unlocking the Mysteries of Census Development," is geared toward marketing departments and executive directors. "It's important that the organization speaks the same language as it relates to sales so they can understand why they are getting admissions and why they are losing admissions to the competition," explains LaCroix. "We talk about identifying need and matching services to need, building relationships, validating our promises, working out obstacles, and closing the sale."

2. Ramp up relationships with referrals. "We have found that facilities with Medicare censuses below their target levels oftentimes are not proactive about going to the hospital discharge planning team and identifying candidates for skilled care," says Sulzberger. He suggests that the therapy director meet with the hospital to identify Medicare skilled criteria and talk about the outcomes the skilled facility can provide.

Relationships that therapists forge with physicians can lead to customized care for the physicians' patients. "Therapists understand physicians," says Fowler. "Long-term care providers don't. So therapists could work with physicians in the community to build a rehab program that is tailored to physicians' specific protocols. The rehab component is the number one issue most orthopods are concerned with. Using a seasoned team of therapists and a company that can point to outcomes, with a mechanism for training and updating therapists, gives a facility an advantage in obtaining referrals."

3. Manage care for maximum census. The 2005 work plan for the HHS Office of Inspector General includes a focus on recidivism and concern about how effectively patient care is being managed. Because therapists are familiar with the intricacies of the Medicare program and are experts at managing therapy minutes, they can be a valuable source of information for the facility. "Rehab can educate both the facility and the hospital staff so they can build a coalition that moves the patient through the continuum of care at the right time," says Sulzberger. "When length of stay is managed effectively, a facility might be able to increase its Medicare patients by 10% or more."

4. Generate business and outcomes information. The rehab company that can deliver knowledge about its business gives the facility an advantage over its competition. Useful outcomes data, denials tracking, documentation procedures, e-billing, and technology to capture, analyze, and report data in a variety of ways all make the rehab company an invaluable asset. For example, Aegis offers a state-of-the-art program that demonstrates the benefits of therapy. "Our information system helps the facility understand its business," says Mike Beckwith, Aegis's senior sales manager. "We can tell the facility where its discharges are coming from, the length of patients' stays, where they are discharged, and exactly how much progress they made. That's money in the bank for the facility."

5. Create a market niche. Creating a rehab specialty is an effective method of building census. By analyzing market data and tracking referrals and discharges, a good rehab company can identify a niche in the marketplace and help the facility fill that unmet community need. "If we see a lot of stroke discharges, for example, then we can put together a stroke recovery program that is unique to the facility to capture those patients," says Beckwith. "The rehab company can be a leader in positioning the facility in a specialty."

Tellier suggests that specialty programs are an excellent way for skilled facilities to differentiate themselves from their competition. "I'm a big believer in marketing by product line. You're not marketing a nursing home, you're marketing a stroke rehab program or an orthopedic rehab program," he explains. "This positions the SNF as an expert in the area. It becomes more than a generic rehab provider--in essence it has a new identity."

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Tellier cites the case of Springdale West, in Mesa, Arizona, where he helped develop a vent unit. "Our successes with the vent program changed the image of Springdale West in the community," he says. "Rehab brought a lot of life to a traditional nursing home setting by marketing a specialty."

6. Reach out to educate the facility and the community. One of the key value-added contributions from rehab is outreach education. "We have an obligation to educate the community in how to prevent injury or disease," says Violet Parker, director of customer care and account management for Aegis Therapies. "Our therapists take part in health fairs and speak at assisted living facilities and other senior centers about fall prevention, how to prevent back pain, and other wellness topics." When the need for rehab or skilled services arises, the facility has already generated goodwill and name recognition.

The rehab department can strengthen the awareness of the rehab component within the facility itself, according to Dolores Reidenbach, senior director of LW Consulting. She advocates including therapy goals in care planning at all levels, not simply among RNs and therapists. "For example, if the CNA understands that Mr. Jones doesn't only need help to get to the bathroom, but needs to ambulate 150 feet, then the CNA might include a walk down to the nurses' station." That kind of knowledge fosters faster resident improvement and increases patient and family satisfaction--which enhances the buzz about good therapy in the facility.

In addition, such integrated care is a selling point for referral sources. "It shows that the facility is focused on the total outcome after the patient leaves the therapy room," says LW Consulting's Lessig Ott.

If your therapists are stuck in the gym, it may be time to ask for a helping hand in taking your message to the outside world. Rehab is more than a group of therapists who treat patients; it is your partner in building census. "Rehab can strengthen the market position of a nursing home," says Fowler. "It improves reimbursement, enhances reputation, and aligns facilities better with physicians. For a skilled facility, that's a significant step up in the community."

RELATED ARTICLE: The Case for Demographics

Rehab/facility partnership success story

A rehab company that can collect demographic information is a valuable partner. Leo LaCroix, vice-president of sales for Aegis Therapies, tells of a facility in Wisconsin that was worried about low census, although it was located within a six-mile radius of three hospitals--one two miles away, one four miles, and one six. "The facility only called on the hospital two miles away," reports LaCroix. "They had no demographic information."

When Aegis began working with the facility to obtain demographic information, it turned out that the hospital the facility used for referral had 420 discharges to a SNF a year. The big surprise was that the hospital four miles away had 860, and the hospital six miles away had 1,000.

The demographics opened up a whole new market for the facility. "To be successful, you have to have demographic information so you know the number of discharges from a hospital, the number of discharges to a SNF, the diagnosis at discharge, and who the referring physicians are," says LaCroix. "A rehab company with the capability to collect such information can be a big help."