What is the “75% Rule”?
The “75% Rule” is a CMS regulation that requires a defined percentage of all discharges from the physical rehabilitation unit to fall into one of 13 diagnostic categories. The “75% Rule” is being phased in over time and is currently scheduled to be fully implemented for cost report periods beginning on or after July 1, 2008. When fully implemented 75% of all patients admitted to the unit must fall into one of the 13 CMS categories. For more information on the “75% Rule” contact us.
What happens if we fail to meet the 75% Rule?
If a unit fails to meet the “75% Rule” CMS can retroactively pay by DRG in lieu of CMGs for the existing cost report year. The following year would also be paid under DRG until qualification can be re-established and the unit could lose its DRG exemption.
How can Horizon assist us meet the 75% Rule?
Through our customized, strategic marketing and business plan that is submitted annually, you will have a detailed and specific procedure that Horizon will follow in order to meet the 75% Rule. Most importantly, we will make sure that a comprehensive educational effort is launched throughout your service area; and it will be directed to all potential referral sources - physicians, discharge planners, other hospitals, LTACs, etc. Only those patients who are appropriate for rehab will be admitted to the unit.
Can you help us recruit a medical director?
Yes. When you contract with Horizon to manage your physical rehabilitation program one of our responsibilities will be to recruit and contract directly with a medical director for the program. Horizon has several full-time physician recruiters whose responsibility it is to identify physicians who may be interested in working with our programs.
If we contract with Horizon to manage our physical rehabilitation program is it still the hospitals program?
Yes. While Horizon manages the details of the operation the hospital maintains ultimate decision making authority in all instances. The program is branded and operated as a hospital service and the Horizon employed staff function as agents of the hospital.
What are the benefits of contracting with Horizon?
Contracting with Horizon for the management of your acute physical rehabilitation program offers several advantages. It provides you and your staff the ability to focus on your core competencies. It helps maintain compliance in an ever-changing regulatory environment. You will have access to best practices and benchmark data compiled as a result of Horizon’s experience with programs across the country. You can be assured you are offering excellent clinical programs and Horizon’s referral development system helps assure a fiscally viable program. Contact us today to find out more about the many benefits of partnering with Horizon.
What types of fee models does Horizon offer?
Horizon works with hospitals through a variety of fee structures from fixed fee through full risk. For more information please call us or complete the form on the “Contact Us” page.
What is the average contribution margin generated by the addition of an acute inpatient rehabilitation program?
The contribution margin, net of all direct and most indirect expenses, is unique to each hospital. It is influenced by staff salaries, the Case Mixed Group (CMG) payment per Medicare discharge, rates paid by other types of insurance payors, ADC, number of discharges, the number of Horizon management employees, the Horizon management fee, and a few other miscellaneous factors. For more specific information on a projected contribution margin for your facility, please call us or complete the form on the “Contact Us” page.
Can Horizon assist us in enhancing our existing rehabilitation unit’s operational performance?
Yes. Because managing physical rehabilitation programs is what we do, all day … every day and because of our access to best practices and benchmarking data from working with hospitals across the country we are often able to improve the performance of existing programs. To request a meeting to determine how we might be able to assist you with the operations of your current program, call us or complete the form on the “Contact Us” page.
What resources does Horizon bring?
The vast resources Horizon brings to client hospitals include our national and regional support team consisting of a Regional Vice President of Operations, a Regional Clinical Services Director, a Regional Director of Community Education, Financial Analysts and Recruitment Specialists. In addition, your hospital-based team will consist of staff experienced in the operation of physical rehabilitation units including a Program Director, Nurse Manager, CMG Coordinator, Assessment Coordinator, Community Education Manager, Medical Director (Independent contractor), and therapy staff and nursing staff as requested
What benefits would the development of an acute rehabilitation program bring to the hospital?
Offering an acute inpatient rehabilitation provides a variety of benefits including better management of ALOS outliers as a result of a seamless transition of patients in need of physical rehabilitation out of medical/surgical beds, the alignment of patient needs with reimbursement, and providing a needed service to the community while adding an additional revenue source to the hospital’s bottom line. To find out more about the benefits your hospital could receive from offering a physical rehabilitation program contact us today.
How long does it take to develop a program?
The amount of time it takes to develop a program is dependent on a number of variables. Two of the most critical are whether or not a CON is required and the amount of construction that will be necessary. While Horizon has worked with hospitals to open programs in extremely short time-frames, in general the process should begin 6 to 9 months prior to the projected opening date. If a CON or major construction is required the timeline for program development could be even longer. We would be happy to discuss your specific situation with you and provide you with an estimate of the time necessary to develop a program. Simply call us or complete the form on the Contact Us page and we’ll have someone get back with you.
Can I open a program anytime during the fiscal year?
A physical rehabilitation program can be opened at anytime during the year. However, it can only be exempted from acute PPS reimbursement at the beginning of a fiscal year. Therefore, if the unit is opened at anytime other than the beginning of the fiscal year it will be reimbursed under DRGs from the date of opening through the end of the fiscal year. A unit must receive exemption prior to the beginning of the fiscal year. Therefore, if you wish to operate the program as a Medicare distinct part unit exempt from acute PPS then it should be opened during the last month of the fiscal year. For more information contact us today.
If we open a physical rehabilitation unit will we have to go through 12 months of payment under DRGs?
If developing the unit involves new construction, the re-licensure of skilled beds or a change in ownership it may be possible to exempt the program without operating for a full year under DRG reimbursement. To find out more about strategies for opening a program without operating for 12 months under DRGs call us or complete the form on the “Contact Us” page today.
Do you assist with the CON process?
Yes. Horizon will assist the hospital in completing the CON process by providing detailed information on demographics, bed need and competitor information.
If we contract with Horizon to manage our acute inpatient rehabilitation unit can you assist us with the management of other aspects of the post-acute continuum?
Yes. An acute inpatient rehabilitation unit is just one component of the rehabilitation services continuum. When you partner with Horizon to manage your acute inpatient rehabilitation unit, we can also assist you in overseeing or managing the other components of the continuum including Hospital Therapy Services, Skilled Nursing/Transitional Care Unit, Outpatient Therapy Services, and Inpatient Therapy Services. Contact us to find out more about the ways Horizon can assist you in managing your physical rehabilitation continuum.
Can an acute rehabilitation unit assist us in managing ALOS outliers?
Yes. An acute inpatient physical rehabilitation unit is a critical component of the post-acute continuum – allowing the seamless transition of patients in need of intensive physical rehabilitation services out of acute care beds. Discover how a Horizon managed program can assist you in the management of ALOS outliers.
We have a SNU. Why would we also need an acute inpatient rehabilitation unit?
It is likely that some of your patients in skilled beds could benefit by receiving a higher level of care and the hospital would benefit from receiving a higher level of reimbursement as a result of providing the more intensive treatment. To find out more about the benefits of providing both skilled and acute rehabilitation services in an integrated post acute format contact us today.
Does Horizon Health Physical Rehabilitation Services provide therapy staffing services?
As an adjunct to a contracted service arrangement, Horizon is more than happy to take on the responsibility of managing the therapy staff. In today’s market, therapists are difficult to recruit and keep; and many hospitals are turning to Horizon to handle this task. With our own dedicated recruiters, we readily accept this challenge and make it seamless for you.
What types of patients are appropriate for acute inpatient rehabilitation?
Individuals appropriate for treatment in an acute physical rehabilitation program include those disabled as a result of chronic illness such as post-stroke conditions, congestive heart failure, acute arthritis, multiple sclerosis, Parkinson’s and other degenerative diseases; those disabled as a result of major, multiple trauma including people with complex orthopedic conditions, burns, brain and spinal cord damage and amputation and those disabled by premature birth or congenital defects.