December/January 2001

Entrepreneurial Spirit

By Nancy J. Beckley, MS, MBA

Keeping your eyes and your heart open can lead to new opportunities in rehab and beyond.

The last rush of association meetings before the year is over is coming to a close. This year, as I attended the National Association of Rehabilitation Agencies (NARA) meeting in Las Vegas and The American Medical Rehabilitation Providers Association (AMRPA) meeting in Cape Cod, Mass, I could not help but notice the change in spirit and the upswing in mood.

EXPLORING THE CORF OPTION

Even the speakers with the traditional Medicare topics have spirited and uplifting speeches—gone was the doom and gloom that has prevailed since the dark days of the passage of the Balanced Budget Act of 1997 (BBA). In fact, much to the chagrin of the NARA conference planners, the comprehensive outpatient rehabiliation facility (CORF) seasons were packed as current CORFs and rehab agencies as well as potential CORF applicants studied the CORF model. Using the CORF destination (Medicare certification category) as a possible way to meet the needs of medically complex patients on an outpatient basis was a hot topic. Many have said that the CORF. essentially an outpatient rehab hospital with beds, was a rehab model before its time,

The ironic thing about this renewed interest in CORFs is that people are exploring this possibility knowing that Medicare reimbursement is based on the fee schedule. The same reimbursement for each procedure billed is no different than the reimburse ment given to private practitioners, hospital outpatient rehab departments, and rehab agencies. CORFs do have a number of special codes for those services only allowed in these facilities, such as nursing services, as well as the possibility of reimbursement based on costs where it is allowed by local medical review policy (LMRP) for pulmonary rehab programs.

MAKING A QUANTUM LEAP

The most spirited parts of the meeting were outstanding sessions that had nothing to do with rehab business per se, but everything to do with putting the audience participants in a mode to think. The evaluations reflected this point; comments highlighted the opportunity to plan, create, and invent new opportunities in rehab business. Keynote speaker David Benzel opened up the program with the question—are you ready to make a quantum leap? In this session we learned:

• Almost anything is possible when dream and goals meet passion and determination.
• The Language of the brain is imagery—words create pictures, which create emotions, which lead to beliefs, which cause an action that gets results.
• You are what you think about most
• Change your thinking, change your world,
• Act the way you want to become, until you become the way you act
• Your outside world is a reflection of your inside condition.

Benzel recounted how he left a great job as a college admissions officer in Minnesota at age 30 to follow his lifelong dream of becoming a championship water-skiier. He threw caution to the wind and moved to Florida, and through hard work, determination, and an incredible beleif in creating his dream, he became a five time national champion water skiier.

The exhibit hall was missing the exhibitors of the past—notably those vendors offering expensive items and therapy equipment. They were replaced by vendors offering a variety of information technology and software for rehab items. In fact, one vendor offered golf cruises for stressed rehab executives. Mary Marshall, PhD, a rehab consultant and expert in rehab agencies, said that after an unusual year of consulting she needed to do something that would lift her spirits. She dug deep into her past when, as a championship caliber junior golfer, she longed for a career on the Ladies PGA tour, but instead followed a successful path to consulting as a speech-language patho1ogist, More people at her booth were interested in the concept of a golf cruise than in rehab consulting services. Mary never took the smile off her face. and by the time she left the meeting, she was busy planning for the first ever Women's Executive Golf Cruise.

Mark Anderson, PT, president of Mountain Land Rehabilitation in Salt Lake City, described an incredible year of getting out of the Medicare box. He formed a statewide network of physical therapy and rehab providers that has been successful in getting a statewide exclusive contract for outpatient therapy. He also developed a new corporation that specializes in credentialing physicians and other providers. Medicare has become less important in the overall scheme of many rehab providers as they close their eyes and dream of creating new and wonderful opportunities.

OPPORTUNITIES FOR REHAB

The mood at the AMRPA meeting was anticipatory as representatives from rehab hospitals and units pondered and discussed the potential scenarios associated with the proposed inpatient rehabilitation prospective payment system (IRPPS). As we go to press, the proposed rule was just released and experts are busy studying it, developing pro forma scenarios to determine viability and options under the new Medicare reimbursement. One large, publicly traded national rehab provider has posted its projected case rate Medicare reimbursement under the new system on its Web site, offering assurance to investors and stock market analysts. While Medicare business is a major part of most rehab hospitals and units, many have studied and learned the lessons from the skilled nursing PPS. Costs have been brought into line, various scenarios have been studied, and reimbursement portfolios have been diversified.

Wayne Lerner, PhD, president and CEO of the Rehabilitation Institute of Chicago, in a recent speech noted the following rehab opportunities:

• The overall demand for rehabilitation services is expected to increase by 15% for the next several years.
• Arthritis is the leading cause of disability, increasing from 1/6 of the disabled population to 1/5 of the population.
• The incidence of stroke is increasing as we are living longer. In fact, there is a potential that those experiencing a stroke will have more than one.
• The incidence of spinal cord injury (SCI) is down and new drugs have been helpful in preventing secondary damage. Patients with SCI are living longer and need continued wellness, prevention, and rehabilitation services.
• The incidence of traumatic brain injury (TBI) is also down. In fact the incidence of TBI is down 22% from 1979 to 1992. As with SCI, this population, particularly those most severely disabled, may need additional rehabilitative care as they are living longer.

Approach the new year with a little bit of serendipity and let discoveries happen! Happy New Year.

Nancy J. Beckley, MS, MBA, is the president of Bloomingdale Consulting Group in Tampa, Fla, and an entrepreneur at heart. Questions and comments from those seeking to unleash their creative side are encouraged at (888} 999-0275 or via email at bcgbeckley@aol.com.

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