How RCS-1 Will Impact Travel Therapists

In a galaxy far far away, eggheads strapped to the cubicles of the CMS death star have created a new and menacing weapon to unleash upon the innocent therapists across our great land.

They have named it: RCS-1

Similar to R2-D2 or C-3PO, RCS-1 is cold, robotic, and likely not as useful as it claims to be.

Unlike R2-D2 or C-3PO, RCS-1 is not lovable, easily shut down, or containing a message of hope for all mankind. 

RCS-1 is the Resident Classification System version 1.  It has been christened as the successor to the RUG (Resource Utilization Groups) levels currently utilized to determine payment for skilled nursing facilities. 

Article summary:

• RCS-1 will change how SNF’s are paid (no longer paid by the minute)
• Estimations between 2% and 33% reduction in payment
• How RCS-1 will impact travel therapists:
  • Likely Less SNF work
  • SNF jobs will return to being patient centered vs. productivity based
  • More Home Health work

*While I am not a billing specialist, I have attempted to pull reliable resources to make this article as factual yet easy to read as possible.  The RCS-1 link above is astonishingly thorough and would make great bedtime reading.

With roll-out scheduled for October 1, 2018, the RCS-1 is making sweeping changes to the SNF payment structure. 

Here are a few highlights:

• payment will now be more directly determined by patient specific characteristics instead of minutes of therapy
• Case-mix categories expanded from just SN and therapy to: PT/OT, SLP, SN, and NTA (nontherapy ancillary)
  • 97 different case-mix groups will be created underneath these categories for patients to fall into
  • comorbidities would be considered for only SLP and Nontherapy ancillary

• 25% limit on co-treatments (only 25% of total minutes can be spent co-treating)
• Increase in mandatory assessments

So what does this mean?

Essentially SNFs will go from a therapy heavy payment model, where the more minutes a patient was seen by therapy the more money the facility would receive, to one that is spread out across all disciplines (therapy and non-therapy).  From what I have been able to find out, the thought was that it would pay heavily for nursing services during the initial parts of a patients stay, as most likely they will need higher level nursing care as the acuity is also higher at this time.  Then as the nursing needs subside so would payments.  Therapy care would be paid based on a specific case mix group and no longer minutes of service.  Interestingly, CMS is expecting a mere 2% reduction in overall payments.

Because facilities will only be paid the expected need of the patient based on their case mix group – NOT by minutes of therapy provided, facilities that frequently place all patients at very-high or ultra-high RUG levels, the reduction of payment may be shocking.

How RCS-1 will impact travel therapists

It is unclear the impacts that this will have on the clinicians working at the SNF settings.  the APTA has reported an expected decrease in payments for services of 33%.  Should this be the case there may be a temporary decline in travel therapist positions in this arena.  Travelers are expensive, and a reduction in payments of anywhere close to 1/3 will be devastating to payroll expenses. 

On the flip side of this situation, because payment is based on patient characteristics and not timed codes, a return to patient centered care is likely.  Facilities will be highly incentivized to get patients healthy and out the door in a efficient and effective manner.  This is a fantastic opportunity for highly skilled PTs to establish themselves as experts in this area of care.

For those of you worried about dwindling job opportunities in the SNF setting, fear not!  With patients being discharged sicker and quicker the home health setting looks to explode during this time.  The need for competent home health clinicians will drastically increase and likely so too will wages.  In the lucrative setting of home health it only looks to become even more profitable for the skilled clinician. 

So what should you do?

1. If you enjoy the skilled nursing facility setting my recommendation is to focus on growing your skills to become more efficient in patient care.  Getting better results faster!  This will serve you well in future travel SNF positions as these changes unfold.  The skills you develop will also spill over into other settings should you choose to leave the SNF field. A growing number of our close friends are pursuing their GCS (Geriatric Certified Specialist) to further their skills and directly benefit this patient population.

2. If you do not have any home health experience at this time I would strongly recommend getting some.  Take a PRN job or even a short travel job to gain some experience in the field.

In my opinion the home health setting is still in its infancy.  As healthcare costs continue to soar the low overhead model that home health therapy follows serves as one of the only remaining business models in medicine that is easily profitable.  Home health, love it or hate it, is going to soon rival outpatient as the dominant setting type.

So while RCS-1 may not be the delightful Star Wars character its name may imply, it will likely be one we all remember once we have seen it in action. 

 

Written by: Stephen Stockhausen, PT, DPT, OCS