How to Run a Successful Acute Rehab Program


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Improving Outcomes by Overcoming Patient Access and Reimbursement Challenges

In today’s rapidly evolving healthcare environment, providers are faced with more challenges than ever when running acute rehabilitation programs. From treating the right patient at the right time to costly reimbursement battles, there is no shortage of issues that can interfere with delivering the best level of care.

Addressing these problems is especially urgent when it comes to treating highly acute patients. To succeed, providers must learn strategies for overcoming the two most daunting obstacles: patient access and reimbursement.

This guide examines the best practices for meeting these challenges. Serving as a case study is a partnership between Kindred Hospital Rehabilitation Services (KHRS) and University Hospitals (UH). The two entities worked together to implement these solutions successfully.

 


Challenge Icon of figure jumping hurdleCHALLENGE

Patient Access

Establishing a consistent flow of incoming patients who qualify for acute care is vital for a rehabilitation program’s success, and is difficult to accomplish without a specialized partner.Many factors come into play when determining if a patient meets the stringent criteria required for rehab care.Unfortunately, because rehabilitation is so complex, many providers and payers don’t always know when it is the best solution. This uncertainty can result in costly disputes with payers.Additionally, for rehab to be most effective, patients need extensive education before admittance. Unlike other forms of care, rehab requires patients to be actively involved in their treatment. Clinical liaisons therefore play a critical role inappropriately educating patients and their families on what rehabilitation entails.

Solutions Icon of arrow hitting bullseye targetSOLUTIONS

Clinical Liaison Identification

Clinical liaisons serve as patient advocates and help identify patients that are appropriate for acute rehab. Recruiting staff must be trained to find the most competent clinical liaisons via a thorough vetting process. In order to identify the right patients, clinical liaisons need ongoing feedback from management, plus regular training to understand patient access criteria.

Accreditation

Healthcare providers who aren’t appropriately accredited are prone to underperformance and limited in the types of patients they can treat.1 Accredited providers can maximize their program’s scope and optimize care delivery. For instance,CARF is an alternative to The Joint Commission and provides accreditation services for rehabilitation. CARF-accredited programs increase their annual patients served by 26%.2

Individual Program Implementation

Rehab programs are more effective when they are tailored to specific conditions. By providing specialized care, such programs create a clear framework for patient qualification, reduce hospitalizations and secure better patient outcomes.

 


Challenge Icon of figure jumping hurdleCHALLENGE

Reimbursement

Reimbursement rejections are a common obstacle due to strict standards surrounding patient qualification for acute care programs. These rejections require providers to redirect hours and other valuable resources toward the appeals process rather than concentrating on optimal patient care.Many providers are reporting denial rates as high as 80-100%,which can translate into losses of hundreds of thousands of dollars.3 Following best practices for reimbursement ensures that providers minimize rejection-related losses.

Solutions Icon of arrow hitting bullseye targetSOLUTIONS

Training for ADRs

Staff must be trained on how to properly and promptly respond to Additional Document Requests (ADRs) from Medicare reviewers. Higher staff literacy in ADR procedure lowers reimbursement denial rates.

Outsource Management of Appeal and Denial Process

Allowing an outside partner to manage the Medicare and Medicare Advantage appeals and denials process relieves the burden on hospital staff and increases chances of success.

Third-Party Audit Support

A partnering agency can assess program practices, identify any clinical or administrative issues and give guidance on compliance with documentation requirements and clinical standards.

Assistance with Regulatory Compliance and Guidelines

Receiving outside help with monitoring regulatory changes and ensuring compliance helps to relieve the burden on hospital administration.

Regular Compliance Education

Staff should attend regularly-scheduled conferences and webinars that cover new regulations and compliance strategies.

 


UniversityLogoKHRSWhitePaperCASE STUDY: Better Outcomes for Providers and Patients Alike

In order to maximize patient care and gain greater rehab focused expertise, University Hospitals (UH) partnered with Kindred Rehabilitation Services (KHRS). UH selected KHRS for the partnership because of its successful track record and extensive experience addressing key concerns including patient access and regulations. For instance, KHRS relieved the burden of managing the appeal process by deploying their specialized Appeal and Denial Management Team, which has a success rate of 90%. RehabQuoteKHRSWhitePaper

As of 2017, UH achieved a Patient Evaluation Model (PEM) score that put them in the top 11% of rehabilitation hospitals in the country. Additionally, they were recognized among the highest quality providers in the nation with a FIM Gain and Discharge to Community above UDS Nation.

“University Hospitals is focused on providing the highest quality patient care. KHRS helps us do this every day by providing the highly trained staff, and the best regulatory and financial expertise,” reported Blasiole.

This level of performance demonstrates that implementation of the aforementioned solutions can lead to greater outcomes for patients and healthcare providers. Further, partnerships like the one between UH and KHRS can serve as a powerful strategy for improving quality and efficiency of rehabilitation programs.

 


How KHRS Can Help

Kindred Hospital Rehabilitation Services’ clinical expertise, technology and patient engagement tools help over 150 hospital-based programs achieve operational success and the best possible patient outcomes. To learn more about why KHRS is the partner of choice for hospital systems across the country, contact us today.

References

  1. Alkhenizan A, Shaw C. Impact of Accreditation on the Quality of Healthcare Services: a Systematic Review of the Literature. Annals of Saudi Medicine. 2011;31(4):407-416. doi:10.4103/0256-4947.83204.
  2. CARF International. Accreditation Benefits. http://www.carf.org/Accreditation/ValueOfAccreditation/Benefits/.
  3. Youngstrom N, B Anholzer. IRF Claim Denials Are Mounting; Auditors Use Coverage Guidelines, Eye Physician Notes. Report on Medicare Compliance. 2017 Sept;26:1-3. https://www.hcca-info.org/Portals/0/PDFs/Resources/Rpt_Medicare/2017/rmc092517.pdf?ver=2017-09-22-104822-433.