REHAB/SNF/LTAC work anyone???

[Gpan]

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Does anyone here work at SNF, REHAB, LTAC as Hospitalsits as a side gig? If so, could you tell us how your daily round is like? What to do and what notes to write? What to look for and when to send pt back into acute ER? I'd appreciate it !!!

 

[USCguy]

I have 30-40 patients at my local SNF at any given time. Most are long term care, 5-10 in the subacute rehab. I see the long term folks every 6-8 weeks; the rehab people every week unless they are having problems (maybe they didn't finish diuresing are the hospital and need further titration).

I write a regular soap note and bill 99308-99310

 

[Gpan]

so for rehab pt you see them once a week? For Ltac pt once every 6 weeks? Do we actually do anything at these SNF? Like treating PNA, UTI ect. or just follow them along with their rehab course and make sure they are not missed and send them back to the ER if needed???

 

[geripalgal]

Correct me if im wrong, but im fairly certain USC guy is not working at an Ltac but a Snf.


Ltacs (long term acute care) are more like a mini hospital and patients there need to be seen daily because of day to day adjustments (vent weaning, wound care etc). Patients there typically have complex medical issues.


Long term care at a SNF is for patients that live at the nursing home (ie not there for rehab), and are usually medically stable.They are seen once a month(ish) for a "check up" type of visit. This frequency is likely a medicare rule. If acute issues arise (ie pt has a cellulitis, pna, etc), then the pt would be seen more often depending on the situation and if warranted transfered out. Its sort of like primary care pcp visits; except the bare minimum is a visit once every 4-6 weeks.

Physicians at the rehab site provide medical oversight to their rehab stay, but again these patients are medically stable (hopefully). The doctors documentation is likely required by medicare/insurance to justify the need for rehab stay vs discharge home.

If you are a resident in IM im sure you will have a geriatrics rotation where you spend a portion at your time at the snf seeing patients for the routine visits and for the acute issues.

 

[USCguy]

Correct me if im wrong, but im fairly certain USC guy is not working at an Ltac but a Snf.


Ltacs (long term acute care) are more like a mini hospital and patients there need to be seen daily because of day to day adjustments (vent weaning, wound care etc). Patients there typically have complex medical issues.


Long term care at a SNF is for patients that live at the nursing home (ie not there for rehab), and are usually medically stable.They are seen once a month(ish) for a "check up" type of visit. This frequency is likely a medicare rule. If acute issues arise (ie pt has a cellulitis, pna, etc), then the pt would be seen more often depending on the situation and if warranted transfered out. Its sort of like primary care pcp visits; except the bare minimum is a visit once every 4-6 weeks.

Physicians at the rehab site provide medical oversight to their rehab stay, but again these patients are medically stable (hopefully). The doctors documentation is likely required by medicare/insurance to justify the need for rehab stay vs discharge home.

If you are a resident in IM im sure you will have a geriatrics rotation where you spend a portion at your time at the snf seeing patients for the routine visits and for the acute issues.

I should have been a little clearer; probably some definitions are in order.

LTAC would be for folks with fairly serious illness that aren't improving or are improving so slowly they seem to not be improving. I.e. Chronic vent patients, etc. usually need at least 3 days in ICU to qualify with most insurance companies. I've never worked in an LTAC.

Acute rehab: a facility for people needing strenuous rehab as well as close medical followup; usually have to have two rehab needs (i.e. Speech and PT) as well as close medical supervision. I most often see stroke or patients that had required emergency surgery for something (trauma, SAH etc). 3 hours total therapy per day is expected. In my experience, these are run like hospitals and are often attached to hospitals (I've seen free standing rehab hospitals and a corporation rent a floor in a hospital). Our hospital has an acute rehab facility with about 12 beds. The patients are rounded on by the hospitalists for medical management and the PM&R doc. I usually see these patients every other day at least when I'm covering. Write a regular note like you would for a inpatient, bill a regular inpatient management code. Some hospitals will have swing beds that can function as both regular med/surg and acute rehab.

Subacute rehab: usually at a nursing home. For folks that don't qualify for acute rehab (maybe an older person that can't do the 3 total hours per day, etc). I usually see these folks once per week. Spend a decent amount of time on phone with facility managing patients via phone (my office nurse actually spends all the time on the phone).

SNF/NF: I think these get intermixed and I honestly couldn't tell you what differentiates NF from SNF. Our SNF has a couple of RN managers and the LPNs do all the med admin, wound care, etc. nursing aides give showers, feed, turn, etc. these patients often get some physical therapy over time called "restorative therapy" to help with whatever quality of life issue they are having. These facilities are regulated by state agencies. These patients have to be seen every two months to sign orders, etc. lots of regulations that don't often make sense or aren't intuitive so easy to miss things and get an administrator on your backside

 

[W19]

I have 30-40 patients at my local SNF at any given time. Most are long term care, 5-10 in the subacute rehab. I see the long term folks every 6-8 weeks; the rehab people every week unless they are having problems (maybe they didn't finish diuresing are the hospital and need further titration).

I write a regular soap note and bill 99308-99310

How much do you make from that per year if you don't mind sharing?

 

[USCguy]

25-30k