The changes we anticipate coming from Medicare in October 2010 are approaching fast and challenging us to think out of the box. At Park View Gardens we have decided to get busy practicing some strategies that will help us bring fresh treatment ideas into our practice while maintaining the department’s financial stability. We believe regularly scheduled groups will help us achieve this goal. We expect that group treatments will help us manage our productivity in light of billing changes when treating concurrently. We also think our groups will enrich the treatments our patients receive, and will be advantageous to us in highlighting the many skills of our therapy staff. We would like to share our experience in making this transition to group treatments with the hope that you can learn from some of our experiences.
Facility Profile:
We have 114 beds and are well staffed in rehab with a stable and devoted team of therapists. We typically run 25-35 skilled patients at any given time, with a 20-25% HMO caseload. We have a newly remodeled rehab gym, which is very busy during much of the day and can be loud and crowded. We have 1 full-time and 1 part-time rehab aide. In the past, we have used group as a treatment enhancement around holiday times and based on the interests of given patients or therapists (usually OTs).
Our Challenges (aka excuses):
1. We were hesitant to make a big change. Frankly, the task of changing our method of delivering our therapy services felt a little daunting. The planned implementation date came at a time when facility census was high. It was a real challenge to think about creating changes when we were so busy.
2. How can we fit a group into our crowded gym? We felt we had space issues.
3. We felt disorganized. We usually found that when we did groups, the amount of time saved in the group was somewhat offset by the time needed to gather materials and sufficiently plan.
Our assets (what we have going for us):
A stable and devoted team. Our team is always up for a challenge and generally has a can-do attitude when presented with a challenge. We also have a devoted rehab aide who helps our well-oiled operation run.
Facility support. The department head team was open to trying something new and helped me find solutions to our space and scheduling needs.
Time. Because we are getting a headstart on this, we feel we have time to prepare ourselves and the facility so we don’t set ourselves up for failure.
Planning. Goals and an implementation schedule help to keep us on track.
Communication. Staff meetings to give and receive feedback are vital.
A large enough caseload and varied case mix that allows us to easily group patients with like needs together.
The Planning Phase:
I was pleasantly surprised by the positive and upbeat response of the therapy team. They were initially given a task to brainstorm group treatment ideas and come up with a group they would like to lead as well as the material they needed to do the group. We had some great ideas generated and there was a lot of buzz in the department!
I met with the activities director to discuss the use of the activity rooms during times when they are not in use. We outlined the times available for therapy groups throughout the week, and I had the beginnings of a schedule. I also met with our nursing scheduler who was gracious in taking on the task of communicating to the CNAs regarding the daily therapy group schedules.
Implementation:
We were looking for ways to more efficiently run a group. One of the issues identified was that the gathering of materials was time-consuming. We decided to create kits for our groups. As an example, our lower body dressing group kit includes oversized clothing that patients are able to don over their clothing as well as adaptive equipment. (We decided to keep this separate from the other department supplies to avoid the need to hunt for equipment right before the group.) The kit also includes patient handouts on hip precautions and other adaptive dressing techniques. It is kept together and labeled as a dressing group kit. This way, the therapist can just grab it and go.
Another important part of making groups run smoothly is to schedule them out in advance with the time, location, and patient names. This information is completed for the next week on Friday, with a copy given to the therapists and nursing. This helps the CNAs and therapists plan their day with the patients.
We decided to use our “caught in the act” program to thank CNAs who bring patients to group in a timely manner. When a patient is brought to the group on time, the CNA who assisted the patient is given a card that is later entered into a drawing. It is also important that all therapists in the department have a copy of the weekly list so they can plan their treatment times around the group schedule for the day.
Future Goals:
We are currently running 3 groups per week for OT and three groups per week for PT. SLP has also added one dining group per week. We plan to hold steady with this schedule for the next month while we complete our supply kits and while the facility acclimates to our new group schedules. After this period of adjustment is complete, we will add one more group for OT and PT per week as census allows.