Rehabilitation after the hospital in a skilled nursing facility (SNF); what patients should know

Listen to Dr. Jonathon Whiteson interview Dr. Steve Gnatz, Chief Medical Officer at Integrated Rehab Consultants (IRC), about Rehabilitation after the hospital, specifically in the skilled nursing facility (SNF) setting, also known as the sub-acute setting.

Dr. Jonathon Whiteson is a physiatrist and the host of Doctor Radio, which broadcasts health & medical information programmed by the NYU Langone Medical Center. The original interview took place Monday, December 9th, 2019 at 5:30 am on Sirius XM Satellite Radio, channel 110.

REHABILITATION AFTER THE HOSPITAL, WHAT YOU SHOULD KNOW

The Center for Medicare and Medicaid Services (CMS) mandates a rehabilitation physician (physiatrist) must be involved in the admission and continuing care of patients undergoing Rehabilitation in an Inpatient Rehabilitation Facility (IRF). However, most patients will go to a Skilled Nursing Facility (SNF) for Rehabilitation, where this rule does not exist. Instead, a primary care physician is usually assigned to a patient to oversee their treatment while they are at the SNF.

Under current Medicare SNF guidelines, the primary care physician at the SNF is required to see a patient "at least once every 30 days for the first 90 days after admission, and at least once every 60 days after that, unless there is a problem" [42 CFR 483.40(c); Tag F386]. Therefore, SNF patients are usually cared for by nurses, certified nursing assistants, and therapists the majority of their stay.

However, it's important patients, and their families know they can choose which SNF they will go to for rehabilitation. Patients and/or their families should visit a few SNFs beforehand to ensure they pick one that meets their needs. It's also a good idea to ask if care will be CO-MANAGED by a Primary Care Physician AND a Physiatrist (a physical medicine and rehabilitation physician) in addition to other specialty physicians (should the patient need them).

WHAT IS A PHYSIATRIST?

A physiatrist (fizz-I-a-trist) is a physician who specializes in physical medicine and Rehabilitation (PM&R). Physiatrist have eight or more years of training after college and are fully licensed to practice medicine in the United States.

PM&R provides care in the treatment of all musculoskeletal and neurologic disabilities. It focuses on the restoration of function to people with problems ranging from simple mobility issues to those with more complex medical problems.

HOW CAN A PHYSIATRIST HELP REHABILITATION?

A physiatrist is a physician who has completed additional training aimed at enhancing and restoring functional ability and quality of life to those with physical impairments or disabilities. A physiatrist typically helps with patients who have injuries to the muscles, bones, ligaments, or nervous system (such as stroke victims) using NON-SURGICAL means. They work with the rehab and nursing team to assess patients for functional deficits, to both minimize disability and maximize independence, while helping manage pain.

In addition, they help the care team set goals appropriate to the needs of the patient and their family and work to eliminate barriers impeding the transition to home or a more home-like environment.

PROBLEMS TREATED

Ankle pain,
Arthritis,
Carpal Tunnel
, Foot pain
, Generalized joint pain
, Gout
, Knee pain
, Low back pain
, Neck pain
, Nerve injury,
Parkinson's Disease,
Post-surgery care,
Shoulder pain
, Spine Stenosis,
Stroke
, and many more.

While at a SNF, patients undergoing rehab will most likely be seen by the physiatrist on a weekly, consistent basis. The primary care physician and physiatrist will communicate with one another regularly to help ensure the patient's rehab goes as smooth as possible.

Studies show having a primary care physician manage general medical needs, and a Physiatrist managing rehabilitation needs enhances care and helps restore a patient's function to the highest achievable level, getting them home as quickly and safely as possible!

DOES INSURANCE COVER A PHYSIATRIST?

Yes, physiatry services are just like any physician's services and are covered by Medicare and usually by most insurance providers. However, you can check with your insurance provider ahead of time.

IS A REFERRAL NEEDED TO SEE A PHYSIATRIST?

No, Medicare/Insurance does not require a referral to see a physiatrist.

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For more information, go to www.irehabconsultants.com or email questions for Dr. Gnatz to [email protected]