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Philosophy Goals for Census Development Serve the patients from the host hospital, in the communities, and surrounding areas where we live. Extend the reach of case management Follow through for patients with post acute needs from time of admission Reduce the burden on the referral source
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Enhancing Occupancy
Lisa Bazemore, MBA, MS, CCC-SLPDirector of Consulting Services
Objectives
•Today we will talk about the following topics:
Identify market potential based on publicly available data
Analyze operational practices to identify barriers to patient admissions
Identify data points to track and trend for non-admission review
Data entry requirements and reports generated in the referral tracking system of eRehabData
Apply information from referral tracking reports to program marketing
Philosophy
•Goals for Census Development Serve the patients from the host hospital, in the
communities, and surrounding areas where we live.
Extend the reach of case management
Follow through for patients with post acute needs from time of admission
Reduce the burden on the referral source
Objectives of Market Sizing
• Facility data review: Analyze DRG data from hospital patients to determine
appropriate rehabilitation impairment classification codes based on the patient’s discharge diagnosis.
Apply appropriate rehabilitation conversion rates based on actuarial judgment.
Given industry length of stay, determine the optimal number of beds for internal admissions.
Objectives of Market Sizing
• Primary and secondary market data review: Using industry Medicare data (like American Hospital
Directory data), determine the acute care providers in the primary and secondary market, as well, as rehabilitation competitors.
By medical service line determine the approximate number of rehabilitation patients in the market.
Apply appropriate rehabilitation conversion rates based on actuarial judgment.
Given the industry length of stay, determine the optimal number of beds for all patients (internal and external) and residual volume given the number of available beds in the marketplace.
Facility Data Review
•Version One Example Hospital calendar year 2006 hospital
discharge data was analyzed and ICD-9 codes were assigned to the most common rehabilitation impairment classification (RIC).
This patient volume was reduced to reflect your Medicare population percentage-64%.
Patient volume by RIC was further classified by industry conversion percentage to determine the potential patient volume by RIC.
The anticipated number of beds required was calculated from the derived potential patient volume.
Facility Data Review
RIC Acute Patient Volume
Medicare Patient Volume
Anticipated Rehabilitation Volume
01 Stroke 463 296 10402 Traumatic Brain Injury 79 51 1103 Non-Traumatic Brain Injury 311 199 2904 Traumatic Spinal Cord Injury 13 8 705 Non-Traumatic Spinal Cord Injury 143 92 29
06 Neurology 117 75 4007 Facture of the LE 108 69 1908 Replacement of the LE 363 232 2309 Other Orthopedic 379 243 210 Amputation, LE 874 559 4911 Amputation, Other 4 3 012 Osteoarthritis 0 0 0
Facility Data Review
RIC Acute Patient Volume
Medicare Patient Volume
Anticipated Rehabilitatio
n Volume13 Rheumatoid Arthritis 48 31 714 Cardiac 3519 2252 1415 Pulmonary 471 301 516 Pain 157 100 617 Major Multiple Trauma, no brain/SC injury
62 40 3
18 Major Multiple Trauma, with brain/SC injury
13 8 0
19 Guillain Barre 0 0 020 Miscellaneous 1310 838 3221 Burns 7 4 0
Total 8441 5402 381
Facility Data Review
• Represents 381 patients• Total revenue of $6,426,084• 60% Rule Conditional Compliance of 75.46% • Based on national benchmark length of stay of 14.5.• Beds needed equals 17• Occupancy rate based on 85% would be 15.1
Example Hospital Capture by RIC
RIC Anticipated Rehabilitatio
n Volume
Example Hospital
Admissions01 Stroke 104 2602 Traumatic Brain Injury 11 303 Non-Traumatic Brain Injury 29 204 Traumatic Spinal Cord Injury 7 005 Non-Traumatic Spinal Cord Injury 29 406 Neurology 40 307 Facture of the LE 19 1508 Replacement of the LE 23 3509 Other Orthopedic 2 110 Amputation, LE 49 611 Amputation, Other 0 012 Osteoarthritis 0 0
Example Hospital Capture by RIC
RIC Anticipated Rehabilitatio
n Volume
Example Hospital
Admissions
13 Rheumatoid Arthritis 7 014 Cardiac 14 015 Pulmonary 5 016 Pain 6 017 Major Multiple Trauma, no brain/SC injury
3 1
18 Major Multiple Trauma, with brain/SC injury
0 0
19 Guillain Barre 0 020 Miscellaneous 32 121 Burns 0 0Total Discharges 381 97
Primary Market Data Review
• American Hospital Directory data was analyzed to determine patient volumes for the primary service market excluding Example Hospital, which is defined as a 50 mile radius around your zip code.
Patients Patient Days Beds Needed
2112 30620 96
Primary Market Data Review
•American Hospital Directory Data AHD calendar year 2006 hospital discharge data was
analyzed and medical service line codes were assigned to the most common rehabilitation impairment classification (RIC).
Frequency of use values were applied to the medical service line totals and then they were assigned to the aforementioned RIC.
Patient volume by RIC was further classified by industry conversion percentage to determine the potential patient volume by RIC.
The anticipated number of beds required was calculated from the derived potential patient volume.
Primary Market Data Review
RIC Acute Patient Volume
Anticipated Rehabilitatio
n Volume01 Stroke 582 20402 Traumatic Brain Injury 137 2903 Non-Traumatic Brain Injury 531 7804 Traumatic Spinal Cord Injury 17 1405 Non-Traumatic Spinal Cord Injury 206 6406 Neurology 223 12007 Facture of the LE 394 22708 Replacement of the LE 1363 46309 Other Orthopedic 1302 27110 Amputation, LE 285 2511 Amputation, Other 6 112 Osteoarthritis 0 0
Primary Market Data Review
RIC Acute Patient Volume
Anticipated Rehabilitatio
n Volume13 Rheumatoid Arthritis 158 3514 Cardiac 5857 8315 Pulmonary 3636 7616 Pain 474 2917 Major Multiple Trauma, no brain/SC injury
158 13
18 Major Multiple Trauma, with brain/SC injury
79 3
19 Guillain Barre 0 020 Miscellaneous 6958 37621 Burns 8 0Total Discharges 22374 2112
Primary Market Data Review
• Represents 2112 patients• Total revenue of $19,257,917• Based on national benchmark length of stay of 14.5• Bed need equals 56• Occupancy rate based on 85% would be 49
Primary Market Data Review
•Percent of Population: 4-6% of Medicare patients discharged from the hospital
will require inpatient rehabilitation stays. Patient days and bed need are based on 85%
occupancy and an average length of stay of 14.5 days, which is consistent with eRehabData national averages.
4% 6%Bed Need 41 61
Patient Days 12977 19465
Primary Market Data Review
• Residual Table:
Beds and patient counts reported by AHD in 2006 Based on 14.5 average length of stay and 85% occupancy
Reported Needed
Beds 108 73
Patient Days 15517 23353
Secondary Market Review
• Repeat for secondary and tertiary market as desired and necessary to capture market potential.
Analyzing Operational Practices
• Assess preadmission screening and admissions process Interview and shadow the preadmission screeners who are likely
making the initial determination of the impairment group and admitting and ongoing diagnoses.
Determine how referrals are captured and managed for internal and external sources.
Determine the medical director’s role in monitoring compliance and making admission decisions to ensure compliance with the 2010 IRF PPS Final Rule.
Determine philosophy on case finding versus referral management.
Analyzing Operational Practices
• Conduct a review of referrals not admitted to determine changes since my previous review.
Review pre-admission screenings for 30 referrals at each facility not admitted to determine patterns or trends.
Analyzing Operational Practices
• Observations in an example facility: Adequate number of beds to accommodate the in-house
volume. Should medical necessity be a concern when evaluating these patients, you have the option to fill your excess capacity with non-Medicare patients.
A review of the operational process revealed an attitude of screening in to rehab versus screening out. I believe that patients referred are automatically considered sub-acute patients until proven otherwise, which is determined on diagnosis alone.
You are not working with hospital case managers as team members. Instead of working together to find the appropriate discharge plan, rehab and case management are working independently.
Given the discrepancy between available patients and admitted patients, I recommend increasing the amount of time spent on direct marketing efforts within your facility first.
Marketing Plan
• Observations in the facility: To do:
• Visit each case manager to determine what they feel the barriers to rehab referrals and admissions are.
• Educate case managers on basic IRF concepts and referral methods.• Review the hospital census daily. Approach case managers to ask about
patients that may have rehab potential. • Target Medicare patients with an ALOS of 4 days or more and all patients
with a typical rehab diagnosis.• Employ the assistance of your medical director in making contacts with the
physician referral sources.• Manage the referrals received closely for appropriate decision making by
the admissions coordinator.• Utilize the eRehabData referral tracking system. Log each referral into the
system. Those admitted will become active patients and those denied will be stored with the reason for non-admission.
• Utilize referral outcomes to show who is generating the referrals and reasons for non-admission.
• Managing physician and case manager trends to enable rapid response to declining referrals.
Marketing Plan
• Observations in the primary and secondary market: You have ample capacity in the primary and secondary market to
meet the demands of Medicare patient population. According to the patient days needed, there are patients who meet
the diagnostic criteria for rehab who are not being admitted. These patients may be receiving services in a SNF or other level of care.
I recommend that you begin marketing within your community and primary market place. Approximately 25% of your marketing efforts should be spent with physician referral sources and external case managers from surrounding hospitals.
Given the volume available in Example Hospital, I do not believe that you require a full-time marketing coordinator. You do, however, need to establish and then maintain a presence in the external market with efforts concentrated on contacts with hospital case managers.
Direct marketing to physicians should be included in the marketing plan, but this should not be the primary focus of the marketing plan in the secondary markets.
Marketing Plan
• Observations from the primary and secondary market: To do:
• Rank facilities by discharges, referrals, and admissions• Develop call list for external territory coverage within a 50 mile radius of
your facility.• Develop marketing message and collaterals for your program that reflect
the level of service uniquely provided by LMH’s inpatient rehabilitation unit.
• Employ the assistance of your medical director in making contacts with the physician referral sources.
• Manage the referrals received closely for appropriate decision making by the admissions coordinator.
• Utilize the eRehabData referral tracking system. Log each referral into the system. Those admitted will become active patients and those denied will be stored with the reason for non-admission.
• Utilize referral outcomes to show who is generating the referrals and reasons for non-admission.
• Managing physician and case manager trends to enable rapid response to declining referrals.
Referral Tracking System
•Trending Information:
Referral source Referring physician Zip code where patient resides Payor source Basic patient profile (anticipated CMG) Accepted or denied with reason for denial
Referral Tracking System
•Referrals Outcomes:
Designed to trend referral sources, referring physicians, and conversion rates.
Offers information on reasons for denied admission.
You can filter the information to drill down on physician, referral source, internal vs. external fill, and reason for denied admission.
Referral Tracking System
• Referrals Outcomes:
Use information to determine referral trends by-•Referral source•Referring physician• Internal versus external fill•Zip code breakdown•Payor source breakdown•Conversion rates•Reasons for denial
Drill down by RIC, CMG, and Patient •Patient reports list patients denied
Referral Tracking System
• Non-admission review: The review of all patients that have not been admitted to
rehab unit. This is done by reviewing the pre-admission forms and reviewing the section that notes the reason for not admitting to the rehab unit to help identify trends and changes that occur over a quarter.
•Common ReasonsToo impairedToo functionalNo bed availablePhysician did not agreePatient or family refusedInsurance did not authorizeNot 60% rule compliant
Referral Tracking System
• Review data entry for tracking referrals
• Review referral outcomes reports
• Study facility data for opportunities
