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877.802.4593 | www.BESmith.com

10 Questions for ImprovingYour Rehab Performance

By Rita Green, BAABS, MBA

Your inpatient rehabilitation unit (IRU) has

always been a premier service for your organization.

But with ever-tightening regulatory constraints,

your IRU isnt the performer it once was. Maybe

census has dropped, your operating margin

may be compromised and/or employee expense

has increased. Perhaps youve noticed that case

management refers patients to your rehab

competitors a bit too often. Why? Its time to ask

some tough questions to gauge your organizations

readiness to face the challenges of a changing

business market.

1. How is your IRU tracking and validating itsoutcomes and practices?If your IRU is using an Internet-based system, then

youre likely receiving real-time financial and clinical

outcomes, as well as benchmarking your facility

against regional and national data. Ask to see the

last six months of unit reports and compare your

performance against your region and the nation. If

your IRU is manually tracking data, ask your leaders

why they collect and track the information that they

do, how they compare to industry standards, and

how they utilize the information in business practices.

Tracking the same data year after year without a

clear understanding of the necessity and benefit of

the information collected could hinder the prosperity

of your IRU.

2. How long does it take from the time your rehabreceives a referral to notification of the admit/denydecision?Pose this question to your rehab team first, and

then validate their response by asking your acute

case managers who make referrals to the IRU. If

you receive different answers, then you most likely

have a process issue that could result in a leakage

of admits to your competitor. Case managers are

evaluated on how they manage length of stay (LOS),

and they will likely take the path of least resistance

to discharge patients. If your rehab is perceived

as a barrier to discharge, case managers will natu-

rally go around that barrier by discharging to your

competitor.

3. What is your current 60/40 ratio?For every inpatient rehabilitation facility (IRF),

60% of the patients admitted must be in one of the

following categories regardless of payer:

Stroke

SpinalCordInjury

CongenitalDeformity

Amputation

MajorMultipleTraumas

FractureofFemur(Hipfracture)

BrainInjury

NeurologicalDisorder

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8/7/2019 10 Questions for Improving Your Rehab Performance

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Burns

ActivePolyarticularRheumatoidArthritis

SystemicVasculidities

SevereorAdvancedOsteoarthritis KneeorHipReplacementJoint

replacement during an acute hospital-

ization immediately preceding the IRF

admission and also meeting one or more

of the following:

a) bilateral knee or bilateral hip

replacement

b) morbidly obese with BMI of at least

50 at time of IRF admission and

stated by physical in IRF record

c) age 85 or older at the time of IRF

admission

4. Is your units 60/40 ratio significantlyabove the Centers for Medicare &Medicaid Services (CMS) 60% threshold?If your units threshold is significantly

above CMS threshold, that may indicate

an overly conservative admission decision.

This may be creating unnecessary denial

of access to service to otherwise qualifying

patients and consequently, negatively

impacting your IRU census.

5. If a patient is admitted to your acutehospital on Friday and a rehab screeningis ordered for him/her on Friday nightor Saturday morning, when does thescreening actually occur?If the answer indicates that your IRU is a

Monday-Friday, during business hours

only hospital unit, is that acceptable to

you? Patient admissions are likely on the

same schedule, with an occasional admit

on Saturday before noon if all pre-screen

paperwork is previously completed. You

mighthavejustdiscoveredapossible

impact on your hospital LOS.

You may hear a lot of reasons why Monday-Friday is the admitting schedule standard,

such as insurance pre-cert is not available

on weekends; the day of admit is counted

as the first rehab day and the patient is

unlikely to get three hours of therapy;

weekend coverage for therapy is difficult;

the admitting physician is unavailable on

weekends; and weekend nursing staff is

unable to handle new admits. While these

same arguments have been around for

years, the business of rehab has changed.

Perhaps it is time to work with your leaders

tohelpthemadjusttheirpracticesto

accommodate new business challenges and

place their primary focus where it belongs

on the patients need for services.

6. What is your IRUs conversion ratio?Conversion ratio is the percentage of referrals

converted to admits. Perhaps your unit

conversion ratio is low because your rehab

receives inappropriate referrals. What is

your IRUs definition of an inappropriate

referral based on CMS criteria? You will

most likely be surprised at the barriers to

services that have built up over the years

that are preventing qualified patients from

accessing your IRUs services.

7. Has your IRU bed-capped the unit?In the interest of gaining a perceived

competitive edge, IRUs may block qualifying

patients from being admitted so that existing

patients have a private room, thus negatively

impacting your IRUs capacity.

8. What is your IRUs average LOS?Is your average LOS (ALOS) longer than

the regional and national average? If so,

your unit staff members may be under theimpression that your rehab patients are

more impaired/acute/sicker than other

facilitiesincludedintheranking.However

Internet-based systems use weighted or

adjustedbenchmarksthatvolume-adjust

the regional and national average to match

your facilitys case mix using your case mix

group (CMG) and tier groups.

9. How effective is your inpatient rehab program?Review your programs functional measure

outcomes compared to regional and nationaoutcomes. If your functional measure

change is lower than regional and national

figures, your program may not be as strong

or effective as it could be, and worse,

your competitors may be using your own

outcomes against you.

10. What percentage of your patientsdischarge from your IRU back to their home?If fewer patients return home from your

IRU compared to regional and national

statistics, ask yourself why.

Next stepsOnce you have the answers to these 10 all-

important questions, you will have a much

better idea of where your IRU stands and

how youre positioned for what is sure to

be a challenging future. Regardless of your

current performance level, assistance is

available to help transform your IRU into a

bottom-line performer for your organization

and an efficient, high-performing facility

conducive to your patients needs.

10 Questions for Improving Your Rehab Performance

2010 B. E. Smith, Inc. WP111

B. E. Smith: Integrated Healthcare Leadership Solutions

Founded in 1978, B. E. Smith is a full-service leadership solutions firm for healthcare

providers. B. E. Smiths comprehensive suite of services includes Interim Leadership,

Permanent Executive Placements and Consulting Solutions. The company is comprised

of veteran healthcare leaders who partner with each client to create a solution that

uniquely fits that clients individual needs. Recently, B. E. Smith placed more than 600

leaders into healthcare organizations worldwide.

For more information, visit www.BESmith.com or call 877.802.4593.

Rita Green, BAABS, MBA,is a consultinginterim with B. E. Smith who has nearly 30 years

of healthcare leadership and administrative

experience. She has served in a variety of

leadership positions within national rehabilita-

tion and acute care organizations. Her expertise

and ability to quickly assess the operational

performance of the rehabilitation service line

provides clients with the focus needed to sustain

a high level of clinical and fiscal performance.