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Therapists and nurses get their rehab acts together

Rehab Regs, January 1, 2005

How collaboration can benefit both you and your facility

In the outpatient rehab programs at Beaumont Health Center in Royal Oak, MI, therapists focus on patient care. The credit for this is due to registered nurse case coordinators who initiate the referral process, act as family liaisons, and obtain prescriptions for equipment and authorization to purchase equipment, etc. These are all necessary tasks that eat away at treatment time.

"I think nurses are the number-one liaison between the physician and other healthcare providers," says Lynn Steffes, PT, president of Steffes & Associates, a consulting firm in New Berlin, WI.

When collaboration between these two groups of healthcare providers works ideally, they can help each other ensure that no patient care detail falls through the cracks. They provide continuity during a patient's treatment and recovery from an acute neurological episode.

"Case coordinators are helpful because if [a patient] doesn't have a proper referral, or if the therapist needs to request equipment, they'll pursue it," says Kelly Keim-Johnson, CBIS, neuro supervisor at Beaumont.

To collaborate with the 36 therapists at Beaumont, there are six case coordinators at the health center assigned to the three outpatient rehab programs:

One in the neuro rehabilitation program. This nurse works with patients who have experienced any diseases or conditions that neurologically affect their ability to function. He or she assists the patient and family in establishing a treatment schedule, obtains referrals, and maintains the continuity of care during the transition from inpatient to outpatient services.

Two in the day rehabilitation program. In addition to providing structure, supervision, therapeutic procedures, nursing and personal care, these nurses review patient charts, meet with families, contact external case managers, and attend weekly rehab meetings.

Three in the neurotrauma rehabilitation program. These nurses specialize in patients with traumatic brain and spinal cord injuries, many of whom come to the facility as referrals from external case managers employed by auto or workers' compensation insurance companies. The nurses, physicians, and therapists all attend weekly decision-making meetings.

Productivity

Logically, the less therapists have to play "double-duty" in a facility by completing tasks other than actual rehab, the more quality time they can spend with their patients.

Some of these chores are unavoidable-such as documenting properly-but others can be given to case coordinators to complete.

"I'm getting more units per day from therapists this way," says Keim-Johnson. "It's a great gatekeeper for me."

For example, the nurses coordinate the program schedules and know which therapists are comfortable working with specific injuries or diagnoses. They can juggle scheduling and cancellations as well as manage their caseloads, which include doing dressing changes, blood pressure, and self-care management. Keim-Johnson says therapists usually spend 30 minutes to an hour each day writing notes.

Recruitment

Because the case coordinator positions at Beaumont Health Center are not common in outpatient rehab facilities, few nurses know that jobs like this are available.

"I don't think nurses see themselves as independent providers," says Steffes.

Because of this mentality, Keim-Johnson's department circulated an article detailing the positions in Beaumont Health Center's employee newsletter to educate nurses about what roles case coordinators fill at the facility in case any positions become available.

"We don't get a lot of calls about the position until [the nurses] really understand it," says Keim-Johnson.

Reimbursement

Even the best of programs just aren't feasible without the proper reimbursement. And cash-strapped clinics may be unable to afford the extra expense. Keim-Johnson cites insurance issues as the program's biggest challenge.

Reimbursement methods for outpatient nurses are different from those working in an inpatient setting. Instead of being part of the facility's staff, they work as independent providers.

But Steffes predicts facilities that turn to a private pay model could build the cost into their fees.

"The challenge is that nurses aren't cheap or easy to find," says Steffes. "But as more and more rehab facilities transition to private pay, nursing could become a part of that model."