Guest guest Posted November 11, 1998 Report Share Posted November 11, 1998 I have clients who are negotiating rates based upon the PPS rates that the facility will recieve. They are getting a percentage of the therapy component of the rate. The percentage varies between 65-90% based on the services provided by the therapy contractor. This is a % of the facility specific rate after it has been adjusted for the geographic wage index. The rates are per RUG category. They are being paid only for the days they provide treatment. I do not recommend a per minute rate, but you have to know your costs per minute in order to negotiate. Some facilities are agreeing to contracts that will be reviewed after the first 90 days to compare the difference between salary equivalency and the agreed %. Then they will split the loss or gain. A much bigger issue is the type of patients that will be admitted based on the therapists ability to treat the higher acuity patients based on the costs. You have to get a copy of the facility rates before you agree to a percentage of any rate. ------------------------------------------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 1998 Report Share Posted November 11, 1998 Subj: Re: Per diem rates Date: 11/11/98 12:34:38 PM Central Daylight Time From: KShie31054 To: ptmanageregroups I've heard the gamut out there: * per diem for the top 5 RUGS categories (Ultra, Very, High, Medium, Low) * flat out per diem rate * per hour for the top 5 RUGS categories * per minute for the top 5 RUGS categories * percentage of the facility rate for the top 5 RUGS categories * percentage of blended rate (facility + federal) of the top 5 RUGS categories * salary equivalency or a percentage of salary equivalency * plus a per diem for the " other " RUGS classifications * per hour for Part B * salary equivalency for Part B * per unit for Part B The two I now hear the most about (out here in the middle of the country) are per diem (RUGS) or per minute (RUGS). We looked at our fixed cost + variable costs + profit margin for each RUGS classification and developed a per diem rate. Or, I guess we could take it one step further and develop a " per minute " rate. Seems to me " per minute " rates are more a way to catch someone's eye (marketing), but when I think about the billing aspect or tracking for documenation purposes -- (yikes -- i have enough headaches!!). On some of the RUGS classifications -- Ultra and Very High -- you are more than likely going to have to assume some of the " risk " (i.e., a loss), but should be able to make up for it within the High and Medium classifications (where a majority of the residents should fall). Good luck, Rolando -- Been no picnic for us!! Kathy Shields Professional Therapy Providers St. Louis, Missouri ------------------------------------------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 12, 1998 Report Share Posted November 12, 1998 I have worked with PPS in New York for several years. You have touched upon a key point often overlooked. In order to be successful under PPS you need to be very selective in the patients admitted. I suggest any rehab manager under PPS make the admissions coordinator their new " best friend " . When I was in LTC I spoke frequently with the admissions coordinator who spent her days out " shopping " for patients in the local hospitals. I would frequently visit potential patients personally if the coordinator could not be confident in determining the patient's rehab. potential. As the number of local nursing home beds rose, there was increased competition for Med A, rehab potential patients.There was then more pressure from the facility to put on the rose colored glasses regarding rehab potential and admit patients with poor potential just to keep beds filled. The more fragile the patients (physically, medically, cognitively,emotionally, and socially supported) the more risk that they will fall off Med A or miss treatments or minutes during critical assessment periods thereby limiting your ability to capture the category and get paid. I suggest that anyone considering a risk sharing contract include provision for the rehab manager to play an integral part in admissions decisions. I would also advise being thoroughly informed as to the availabilty of patients and competition for good short term rehab candidates and the likelihood of your facility being able to admit sufficient solid rehab candidates for you to be financially successful. A facility with primarily Med B type admissions and true long term care would not be able to offer much incentive for a contract based on per centage of RUGS . In my experience the most risk was associated with higher functioning community dwelling " old, old " (i.e. age >90), iffy cognstatus or motivation,energy (high risk of patient refusing rx and thereby falling out of targeted RUGS category) and patients already high functioning with weak discharge plan who may quickly fail to qualify for continued SNF stay yet be unable to leave. Hope this helps! Pat Walaszek,PT ------------------------------------------------------------------------ Quote Link to comment Share on other sites More sharing options...
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