PARTNER WITH ASCENSION
Primary Care Providers
Community Primary Care Providers are increasingly tasked with managing complex, aging, and medically fragile patients across fragmented care settings. Limited visit time, transportation barriers, and inconsistent follow-through with outpatient therapy often make it difficult to ensure patients receive the rehabilitation services needed to maintain function and avoid preventable decline.
Ascension Rehab Care partners with Primary Care practices to deliver outpatient-level therapy directly in the patient’s home, improving access, adherence, and continuity of care. Our mobile clinicians support patients who may not qualify for Home Health services but still require skilled therapy to address mobility limitations, fall risk, chronic pain, and functional decline.
By extending care into the home, Ascension Rehab Care serves as an ongoing clinical extension of the Primary Care team—monitoring patient progress, identifying early signs of deterioration, and communicating meaningful updates that support proactive care planning. This partnership helps improve functional outcomes, reduces avoidable emergency department visits and hospitalizations, and enhances patient satisfaction—allowing Primary Care Providers to focus on comprehensive, value-driven care while trusting rehabilitation needs are met.
Accountable Care Organizations and Bundle Payment Program Participants
Legislation. Regulation. Constant change.
Today’s healthcare environment continues to reshape how providers deliver care. Value-based initiatives, accountable care models, and bundled payment programs such as BPCI and CJR have accelerated the need for cost transparency, measurable outcomes, and seamless care coordination across the post-acute continuum.
Ascension Rehab Care is intentionally designed to thrive in this evolving landscape. Our mobile outpatient therapy model delivers high-quality, patient-centered care directly in the home—at a cost that is often more efficient than traditional therapy settings. By eliminating barriers such as transportation, clinic wait times, and fragmented transitions of care, we improve access, adherence, and overall outcomes.
Our in-home outpatient services effectively bridge the gap between Medicare Part A Home Health and Part B Outpatient Therapy, ensuring continuity of care when patients need it most. This approach supports higher compliance rates, stronger functional gains, and a more convenient experience—while aligning with the goals of today’s value-based healthcare models.
Hospitals and Outpatient Rehab Facilities
The post-acute care continuum begins when a patient is discharged from an acute care setting—such as a hospital or ambulatory surgery center—and continues through their recovery and return to independence. Traditionally, this process concludes with a referral to an outpatient rehabilitation clinic, often within the same health system where acute care was delivered.
Ascension Rehab Care enhances this transition by providing mobile outpatient therapy services directly in the home, improving access and adherence to prescribed care. Many patients do not meet the medically homebound criteria required for home health services, yet still face significant barriers—such as limited mobility, transportation challenges, pain, or fear of falling—that prevent them from safely attending clinic-based therapy.
Our clinicians meet patients where they are. By delivering outpatient-level therapy in the comfort of the home, we reduce gaps in care, improve compliance, and help prevent avoidable re-hospitalizations. As patients regain strength, confidence, and functional independence, we support a smooth transition to clinic-based outpatient therapy when appropriate—ensuring continuity, quality, and patient-centered care throughout the recovery journey.
Senior Living Facilities
Assisted Living and Independent Living communities are focused on helping residents maintain independence, safety, and quality of life—while minimizing avoidable transfers to higher levels of care. Mobility decline, fall risk, and difficulty accessing traditional outpatient therapy can quickly impact a resident’s ability to remain safely in their current living environment.
Ascension Rehab Care partners with Assisted and Independent Living communities by providing outpatient therapy services delivered directly on-site, within residents’ apartments or common areas. Our mobile clinicians help residents who may not qualify for Home Health services but still require skilled therapy to address strength, balance, mobility, and functional limitations.
By bringing therapy to the resident, Ascension Rehab Care removes transportation barriers, improves participation, and supports earlier intervention—often preventing decline that could lead to hospitalizations or transitions to skilled nursing. Our therapists collaborate closely with community staff, monitor residents for early signs of functional or medical decline, and communicate actionable updates that support care planning.
This partnership helps communities improve resident satisfaction, reduce fall-related incidents, support longer length of stay, and reinforce their commitment to aging in place—while ensuring residents receive high-quality, convenient, and clinically appropriate rehabilitation care.
Skilled Nursing Facilities
Reducing length of stay while preventing re-hospitalizations is a constant challenge for today’s skilled nursing facilities. Value-based care models, including ACOs and bundled payment programs, increasingly rely on preferred-provider and high-performance networks—often impacting referral patterns and long-term census stability for SNFs.
Ascension Rehab Care helps bridge this gap by extending care beyond the SNF walls. Our mobile outpatient therapy model allows patients to continue receiving high-quality, clinically appropriate therapy after discharge—particularly when they no longer qualify for Home Health services or are transitioning from Home Health under a dual-prescription continuity-of-care model.
By remaining engaged with patients during these vulnerable transitions, we help reduce avoidable hospital readmissions and support stronger outcomes that matter to upstream referral partners, including hospitals and health systems. Our clinicians are trained to identify early signs of decline and re-hospitalization risk, enabling timely intervention. When a higher level of care is needed, we coordinate prompt re-admission to the SNF—helping avoid unnecessary emergency department visits while supporting census stability and continuity of care.
Home Health Organizations
Home Health agencies face increasing challenges in meeting the clinical demands of Medicare Part A patients. Workforce shortages, combined with strict homebound eligibility requirements, often limit both the frequency and duration of services that can be provided under current reimbursement models.
Ascension Rehab Care partners with Home Health agencies to extend care beyond these constraints. We collaborate as a clinical partner—supporting patients who no longer qualify for Home Health services yet continue to require skilled therapy to maintain progress, improve function, and reduce the risk of decline. Our mobile outpatient therapists provide continuity of care in the home, ensuring a seamless transition following Home Health discharge.
By remaining engaged with patients during this critical phase, Ascension Rehab Care helps improve functional outcomes, supports quality-of-life goals, and provides an additional layer of clinical monitoring—allowing Home Health agencies to focus resources where they are needed most while maintaining high standards of patient care.