In Part I of the question of whether the grass is really greener on the other side, we asked whether the grass is really greener with in house therapy. In Part II we want to look at whether the grass is greener with a contract therapy company.

Our company recently completed an RFP project for contract therapy services for a client.

After listening to presentations from five contract therapy companies I would not blame anyone for stating that contract therapy is the right option for any skilled nursing organization. Each company presented a compelling argument for the benefits of using a contract therapy firm over an in house therapy model.

Contract therapy companies will highlight a number of reasons why a skilled nursing organization is better off using their services rather than moving therapy in house. Those areas include:

• Clinical Education and Programming
• Regulatory Expertise
• Shared Risk (Insurance Denials)
• Census Development Support
• MDS Support

Clinical programming is focused on treatment plans for a variety of patient diagnoses. Most therapists with experience in skilled nursing have the knowledge and skills to treat the variety of diagnoses of patients. If a contract therapy company is highlighting their clinical programming it is important to drill down to understand what makes their programming unique. It is also important to understand how these clinical programs generate above average patient outcomes compared to the market. Unique clinical programming or therapist certifications can certainly provide a unique competitive advantage if hospitals understand the value for their patients.

Regulatory expertise generally focuses on the rules around reimbursement for therapy services. While adhering to the rules and regulations governing Medicare and private insurance is important, there are resources available for in house providers to stay within compliance. The EMR provider is a significant source of expertise and information which helps organizations stay compliant.

Another benefit touted by contract therapy providers is the concept of shared risk, which addresses the issue of insurance payment denials. A standard clause in contract therapy contracts states that if there is a denial of payment by an insurance company (or Medicare) the contract therapy company will reimburse the SNF for the therapy charges related to that patient. It is important to note that contract language states that the denial must be due to the fault of therapy and therapy must be notified within 5-7 days after the SNF was made aware of the denial. Contract therapy providers will point out that in house programs will be out the cost of therapy in the case of a denial. It is important to review the contract language to understand the likelihood of being reimbursed in the event of an insurance payment denial.

While the core business for contract therapy companies is providing therapy services, they have expanded their ancillary services as a means of differentiating themselves from the competition. A few years ago census development support generally meant providing outcome data to share with referral sources. Some contract therapy companies are now providing access to CMS data for both hospitals and skilled nursing facilities. This data can be used to help SNF leadership understand how their facilities compare to others in the marketplace and to use that data in marketing to their referral sources. In addition to the data they may offer additional support in building census, such as the development of marketing materials. Census development support can appear to be an appealing service but it is important to understand exactly what they are offering and how to ensure they will follow through on the commitments.

The other ancillary service that some contract therapy companies are offering is MDS support in the way of access to consultants or technology. This has become more prevalent since the shift from RUGS to PDPM. There can be real value in this service, as it can help increase reimbursement, without a direct cost to a skilled nursing organization. They key in evaluating MDS support is to understand exactly what they will provide, including number of hours of support from an MDS consultant. If they are providing technology, like an MDS scrubber, it is important to ask how they will support the adoption of the tool by your MDS team.

It can certainly appear that the grass is greener with a contract therapy company. Their core clinical and regulatory expertise coupled with ancillary support services such as MDS consulting certainly seem to make the case for contract therapy. For many organizations using a contract therapy company is the best option for a variety of reasons. For those companies that believe an in house therapy program is the better option, there are resources available to help provide the clinical and regulatory expertise provided by contract therapy companies. Both in house therapy and contract therapy bring benefits to an organization. Ultimately it comes down to a thorough analysis of the options and evaluating which is the better fit for an organization.