top of page


Updated: Feb 19, 2020

The therapy program is a critical component of a provider’s operation so it’s vital that leaders have a good understanding of the benefits and pitfalls between the contract and in-house therapy models. Don’t be fooled, therapy will always be a vital component of a skilled nursing facility and will continue to drive successful patient outcomes. Savvy providers understand this and examine a multitude of factors across their organization when considering which model is ideal for their operation to ensure short and long term success.

Here we help break down important decision criteria under today’s post-acute care landscape when considering in-house vs. contract therapy.

At First Glance

During a period of change under PDPM, providers may be considering in-house therapy in order to achieve perceived short term cost savings and greater operational control over this critical department.  But if we dig deeper and consider the fact that many providers have not fully optimized process, coding practices and training under PDPM, the question that rises to the top is ‘what opportunities are being missed and how do these gaps get filled?’   The answer can be found with expert coding practices, proven collaboration processes, and ultimately a leadership team that is empowered with financial and clinical knowledge to be effective leaders.

A Deeper Look

With this early performance analysis of gaps in process and patient coding practices, the focus for post-acute care leaders needs to be establishing the best model to optimize their operation, taking into consideration their real financial, management and staffing competencies. Important questions become:  How can I best manage the risk inherent in operating under this new model? With the constant evolution of compliance and process standards and shifting staffing needs, does a partner that will carry much of the load bring value to my organization? Or does greater control help me better manage risk and am I equipped for what this requires under PDPM 1.0 and beyond?

To help providers answer these questions, we have broken down the characteristics unique to a contract therapy partnership vs. an in-house model, exploring the criteria across financial, management and staffing requirements.

Evaluating these criteria across both models allows post-acute care leaders to align benefits and risks with internal capabilities, operational and financial goals.  It will also allow them to answer important questions under this new model including:

  • How am I going to ensure accurate MDS coding under a more complex set of requirements?

  • What protocol will I implement to ensure therapy and nursing staff are collaborating effectively to improve quality measures and assure accurate reimbursement?

  • Considering my business goals and the changing industry landscape, do I need the burden and added expense of recruiting, compliance, denial management, and program development?

  • Could my cash resources benefit from therapy labor costs being deferred from a payroll expense to an accounts payable expense?

Risk vs. Reward During A Period of Reform

The driving factor for most skilled nursing facilities to make the switch from in-house to contract therapy is based on clinical and operational benefits that are offered by those quality therapy companies that are focused on adding real value that reflect industry headwinds at any given time. Providers may be hesitant to relinquish control or fear a lack of cohesiveness; partnering with a therapy company with a proven history of success and established protocols will alleviate those fears and instead offer an optimized rehab operation and specialized insights so that leaders can focus on the rest of their business and overall strategy.

When To Make The Switch?

This is a growing question for many skilled-nursing facility leaders and these criteria are offered to help you establish which therapy model best suits your needs in order to achieve short and long term goals. As a therapy provider with more than 40 years of experience and a commitment to provider success, we are here to help reduce risk and power your success. With the implementation of PDPM, and new demands of PDPM 2.0 on the horizon, our partners continue to lean on us for specialized tools, resources, programming and expertise that optimize each facility’s operational needs. If you’d like to learn more and speak to one of our Post-Acute Care Strategists please contact Kim Saylor at or Caryn Enderle at

Not ready to commit to a full contract therapy model? Ask us about our In-House Management Model that offers the benefit of a fully Concept Rehab-managed therapy program and resources combined with a traditional in-house program of your own therapy staff.



bottom of page