Subacute/SNF rehab

[Durhamdoc04]

Has anyone had any experience or know someone who has worked with Premier Medical Rehab Group?

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[PMR2008]

Has anyone had any experience or know someone who has worked with Premier Medical Rehab Group?

Don't know much about them. I think they have been at the AAPM&R job fair the last few years.
Just did a quick search online. The website and social media does not mention much.

PREMIER MEDICAL REHAB GROUP LLC NPI 1386173656

Premier Medical Rehab Group Llc is a physical medicine rehabilitation in Jacksonville, FL 32218 with taxonomy code 208100000X.

healthprovidersdata.com

The business address is a SNF
and seems to be run by Dr. Jordan Klein

Premier Medical Rehab Group LLC · 11411 Armsdale Rd, Jacksonville, FL 32218-3311 · Physical Medicine & Rehabilitation Physician

Premier Medical Rehab Group LLC is a Physical Medicine & Rehabilitation Physician (organization) practicing in Jacksonville, Florida. The National Provider Identifier (NPI) is #1386173656, which was assigned on June 8, 2017, and the registration record was last updated on November 9, 2018...

opennpi.com

Plenty of small groups like this around the country. Some are great to work with and others not so much.

 

[SCISavant]

I've debated with myself on whether to comment in this thread given how contentious some of these posts are getting, but given that this is a forum aimed towards helping medical students and residents find the right career path I felt the need to weigh in. I've worked with and trained many bright and hardworking residents over the years who ended up working in a subacute rehab setting. I've had the opportunity to talk with them candidly about their experiences as well as review documentation from SNF consults when patients are transferred to the hospital.

While I don't doubt the type of practice that PMR2008 describes where a physiatrist plays a critical role in the care of these patients exists, this is definitely NOT the norm. In my opinion the majority of SNF consulting practices are rackets - seeing large volume of patients, billing, and providing little value in terms of changing management or care. One of my former colleagues who eventually found a different job described rounding as "sneaking in like a burglar" - seeing as many patients as possible in a facility where the nurses, therapists, and support staff don't know and don't care who you are. It's easy to say that "well I won't practice like that" but from my experience the vast majority of the skilled nursing facility ecosystem is resilient to change and uncaring. The system is built to provide to care of as many patients as possible for as little money as possible, and I've seen this wipe the compassion out of many good doctors.

I find it appropriate that SNF consults are being compared to pill mills and unethical pain practices in that "there are some bad apples which give all of us a bad name". Guess what? The government is cracking down and regulating opiate prescriptions like never before. I can't imagine in the 5-10 years we won't see an overhaul of SNF consults. As it stands right now, it's a loophole in our healthcare system which needs to be further examined.

 

[PMR2008]

I've debated with myself on whether to comment in this thread given how contentious some of these posts are getting, but given that this is a forum aimed towards helping medical students and residents find the right career path I felt the need to weigh in. I've worked with and trained many bright and hardworking residents over the years who ended up working in a subacute rehab setting. I've had the opportunity to talk with them candidly about their experiences as well as review documentation from SNF consults when patients are transferred to the hospital.

While I don't doubt the type of practice that PMR2008 describes where a physiatrist plays a critical role in the care of these patients exists, this is definitely NOT the norm. In my opinion the majority of SNF consulting practices are rackets - seeing large volume of patients, billing, and providing little value in terms of changing management or care. One of my former colleagues who eventually found a different job described rounding as "sneaking in like a burglar" - seeing as many patients as possible in a facility where the nurses, therapists, and support staff don't know and don't care who you are. It's easy to say that "well I won't practice like that" but from my experience the vast majority of the skilled nursing facility ecosystem is resilient to change and uncaring. The system is built to provide to care of as many patients as possible for as little money as possible, and I've seen this wipe the compassion out of many good doctors.

I find it appropriate that SNF consults are being compared to pill mills and unethical pain practices in that "there are some bad apples which give all of us a bad name". Guess what? The government is cracking down and regulating opiate prescriptions like never before. I can't imagine in the 5-10 years we won't see an overhaul of SNF consults. As it stands right now, it's a loophole in our healthcare system which needs to be further examined.

I would agree with you that the practice I described is not the norm. I can speak for the 150+ providers in the group that I belong to. Currently we have data that shows close to a 1,000 PM&R physicians work in the subacute setting. Probably a couple of hundred PA/NP's under these physicians. I am responsible for creating clinical protocols, audits, billing and coding for the group. We do not tolerate physicians who are not actively involved with the facility. We mandate attending team conference, actively being involved with med management and discharge planning etc. With PDPM the facilities depend on us to capture relevant diagnosis which has a direct correlation with reimbursement (Prior to October 2019 subacute billing was based on number of therapy minutes provided). A lot of the docs in the group perform bedside injections.
Historically subacute were okay with just having a Physiatrist on staff who was not actively involved. They used Physiatry foe marketing and also to potentially gain more patient referrals. The vast majority of the owners/Admins now have significantly changed how they view us. Most faculties that we start want to do a trial before they let us continue. They are looking at value added data points including readmission, discharge to home, pain, satisfaction etc.
In a number of markets hospital systems are mandating PM&R consult. We are part of a number of post acute networks and ACO's/bundled plans that truly see the value. As Physiatrist we have to show value otherwise the field is dead.
5 times more rehab is done in the SNF setting and this trend is not going away. My subacute CVA patients are staying for 20 days while less than 5 years ago they would easily stay 80+ days. The patients I see in subacute are the ones I saw in IRF a decade ago. The patients in the IRF setting will get more complicated and will need co management with IM.
I am very bullish on the future of Physiatry in this setting and large systems and organizations feel the same. But just like anything else we need guidance from our national organizations on how to practice appropriately in this setting. I spent time with subacute physiatrists in residency who would "see" 60 patients a day, pain docs who did epidurals x3 on everyone and Physiatrists who did H reflex on every single EMG. But I chose not to practice that way. The SNF consulting Physiatrist you have talked to are the problem and not the practice of subacute consulting.