By Teresa Williams, MSW, LCSW, Managing Partner, HomeCare Connect
Some injured and ill workers need to transfer from hospitals to post-acute care (PAC) facilities to continue healing before they can receive home healthcare. Gaps in the continuity of care can arise during the transition, gaps that can affect recovery time and outcomes.
Finding the right PAC facility isn’t easy. For one thing, skilled nursing facilities do not all provide the same services or level of care. Some don’t offer IV therapy or complex wound care, for example. Others cannot accommodate the powerchairs and Hoyer lifts that young quadriplegics need, and there are skilled nursing facilities that don’t take patients under 55 years old.
Claims representatives who get a last-minute hospital discharge scramble to find a facility that delivers the type and level of care the injured or ill (think long-haul COVID-19) employee needs. Then, negotiating prices presents a nearly insurmountable hurdle for claims reps.
Negotiators first need to know the rates for facilities in a specific jurisdiction and try get the facility to accept them. There are no fee schedules for skilled nursing centers, and very few states have workers’ compensation schedules for acute rehab centers. Injury severity determines the level of care, which affects the per-diem rates. In addition, PACs consider workers’ compensation a slow payer and hesitate to accept comp cases.
Additionally, negotiating takes time—as in weeks—not hours—and is best conducted well in advance of admitting a case. Individual payers usually end up reimbursing at off-the-shelf rates. Meanwhile, the injured worker remains in the hospital longer than necessary at cost that is easily twice as much as they would pay a skilled nursing facility.
Unlike with hospitals, outpatient and ancillary services, there aren’t many networks for PAC facilities. Three years ago, HomeCare Connect built the first workers’ comp network of skilled nursing centers, acute rehabilitation facilities, specialized centers treating traumatic brain and spinal cord injuries, and other post-acute care facilities for its clients.
PAC Facility Cost-Containment Tips
- Have a home healthcare ancillary company like HomeCare Connect become your PAC partner and manage the transition from the hospital to the PAC. They should make sure the injured worker transfers to the facility as soon as they are ready and ensure that the physician’s orders are incorporated into the facility’s treatment plan.
- The PAC partner should have a robust network of credentialed, high-quality PAC facilities and workers’ compensation durable medical equipment (DME) providers, and nursing service agencies.
- The PAC facility may not be conveniently located near the injured employee’s home, so the partner needs to compassionately explain why the center was selected. Understanding the center’s expertise and attempts to find a comparable one closer to home goes a long way towards reducing friction. Good communication alleviates fear and anxiety and addresses family dynamics, another psychosocial factor in recovery. When an employee and family know that someone cares about them and realize they are receiving the right care at the right time, they’re more likely to engage in treatment, be satisfied with their care, and the worker recovers faster.
- HomeCare Connect starts its relationships with injured employees by asking how they want to communicate: phone or text? Nearly 70 percent choose text, which we do in English and Spanish. Texting gives them a way to express concerns and get questions answered quickly.
- PAC facilities have basic DME like manual wheelchairs and walkers and typically do not charge extra for their use. If the case needs complex DME, such as a customized powerchair, order it through your PAC partner who can obtain it more cost effectively than a skilled nursing facility.
- Similarly, request any necessary one-on-one nursing aide services through the PAC partner.
- Ask your PAC partner to monitor the facility’s treatment for appropriateness and medical necessity. In addition to helping manage costs, this enables HomeCare Connect to anticipate discharge and make sure home modifications are completed well in advance. We are able have all DME, nursing services, and supplies set up, so the home is ready when the employee is ready to come home.
Neither the payer nor the injured employee wants extra days in a skilled nursing center. At the average national daily rate of $255 a day it can add thousands to the claim. And the emotional stress on a family who has been traveling to a facility or separated from their loved one is incalculable.
Injured employees should experience a seamless transition from hospital to home even when a stay in a PAC facility is part of the trip.
For clinically driven care and cost management, come to HomeCare Connect, 855-223-2228, www.homecareconnect.com.
This is a sponsored post from WorkCompWire marketing partner HomeCare Connect.