Typically, patients following an arthroplasty are discharged to a costly post acute center or to a home health agency. Physical therapist Dr. Tim Fox, a board-certified geriatric clinical specialist and founder and chairman of Fox Rehabilitation headquartered in Cherry Hill, N.J., explains that prior to FOX, discharge planners had few other options, and tended to move towards the path of least resistance. Those times have changed.
Today, Dr. Fox and his team of more than 800 house-call clinicians are changing the rules, offering an alternative option for providers to refer patients directly to physical therapy in their home — house calls.
Dr. Fox was frustrated with the traditional Medicare Part A Model whose unfortunate regulations limit frequency, duration and intensity of interventions. It prohibited him from dosing his patients effectively as per best practice guidelines. In 1998, Dr. Fox combed the Medicare Part B regulatory guidelines; the Medicare benefit covers inpatient physician and other healthcare costs outside of medical facilities, including services like outpatient procedures and lab tests. Dr. Fox found he could offer in-home physical therapy services to patients under Medicare Part B in their own home without the limiting homebound regulation and the cost associated with the home health agency.
"If you examine the scope of licensure of a doctor of physical therapy, you will begin to understand how it covers a wide range of interventions that were once thought to be only provided by nurses as a part a more costly HHA through Medicare A," says Dr. Fox.
Providers, payers and patients will now be able to access in-home physical therapy. This innovative model is changing the healthcare culture of in home care. "Our patient experience scores are indicating that patients consistently would refer us to a family or friend," says Dr. Fox. In addition, moving away from the traditional costly home health agency has tremendous potential savings.
FOX partnered with a Philadelphia orthopedic group in a bundling model and in only three months increased home discharges by 54.5 percent, decreased discharges to SNF by 24.6 percent and decreased discharges to inpatient rehabilitation facilities by 13.8 percent, while also reducing readmissions.
More patients will also benefit from the positive experience of in-home physical therapy if social workers and discharge planners begin to offer this third option, outside of post acute rehab and the traditional home health agency.
"Healthcare groups who are considering utilizing proactive models of innovative care need to be deliberate and insist that discharge planners push patients toward this model in order for the bundling payment system to be even more successful. If you offer a patient a nurse, of course they are going to say yes, I need a nurse. Do they?" says Dr. Fox.
Although Dr. Fox doesn't know of any other physical therapy groups providing this bundled payment system currently, organizations are increasingly intrigued by his group's services. "As organizations seek innovative and novel providers that can improve outcomes," this bundled payment model may rise to popularity.