10 Steps to Optimize Your Hospital’s Rehabilitation Unit

With greater emphasis being placed on care transitions and readmission rates, especially as facilities work to recover from COVID-19, inpatient rehabilitation units have incredible potential to become high-performing centers of excellence that create greater patient access and enhance the performance of the entire hospital. Rehabilitation is a critical component in a patient’s recovery, especially as the medically complex patient population continues to rapidly increase and skilled nursing facilities are limited in the level of care they can provide.

While the benefits are clear, maintaining a fully optimized rehabilitation unit is complex and requires specialized expertise. Further, compliance remains crucial as penalties are severe – making a well-run program important for reducing readmission rates and associated financial penalties.

This guide outlines 10 steps hospital leaders can take to maximize the performance of their rehabilitation unit and position their organization for continued success.

Many programs today do not reach their full potential because operational expertise and resources are difficult to develop and maintain. There are many regulation constraints – including the 60% rule and the requirement that patients receive at least three hours of therapy per day, five days per week – making compliance and efficient care delivery more challenging.

By following the 10 outlined steps below, rehabilitation units can thrive and drive greater value for their hospital while increasing patient access to these much-needed services.


Below are detailed steps and considerations a hospital can take to help ensure peak performance, operational standards, staffing requirements and facility outcomes.


Overall Performance


1. Assess the performance of your inpatient rehabilitation unit.


How does your unit’s performance compare to the industry’s highest performing inpatient rehabilitation units? Have you successfully adapted to treating the growing medically complex patient population by integrating best practices around infection control protocols, providing thorough education and continuous training to clinical staff and utilizing highly-trained clinical liaisons? Analyze and benchmark internal admissions and discharges, external admissions, internal costs, 60% compliance, key quality metrics including case mix index (CMI) and functional efficiency, CARF/Joint Commission survey results and financial performance.

Ensuring specialized training and orientation for medical directors and staff is critical to a hospital’s overall performance. Further, developing and continually optimizing a business plan for the program based on this analysis will provide both short- and long-term benefits as the rehabilitation unit evolves with the healthcare landscape.

2. Evaluate internal and external market demand for rehabilitation services.

What percent of your medical/surgical patients who need rehabilitation services are discharged to your inpatient rehabilitation unit? What diagnoses? With expected growth in market share, it is important to evaluate where patients are going to receive rehabilitative care and where there is an opportunity to keep patients within the system. Understanding internal and external opportunities and implementing strategies to capture downstream business will increase market share and stabilize program volume.

3. Determine strategic direction for your rehabilitation unit.

Should you expand upon or consider opening a rehabilitation unit? Often these programs are ‘siloed’ and not fully integrated as a critical component of a hospital’s services. A rehabilitation unit provides a seamless transition for patients in need of intensive, quality rehabilitation services and contributes to the hospital’s financial performance, while boasting low readmission rates back to acute care or other care settings. Further, as seen throughout the pandemic, rehabilitation offers critical care to those recovering from COVID-19 in addition to other medical complexities – a population that is expected to grow as the number of patients with comorbidities continues to rise.

2 Operations and Patient Access

Operations and Patient Access


4. Ensure appropriate leadership expertise.


Rehabilitation unit leaders must have expertise, beyond staffing, to optimize the overall performance of a rehabilitation unit. Given the complexities of this service, program leaders need to be skilled in patient access, medical staff management, staff recruitment and leadership, regulatory compliance, as well as operational and financial management.

5. Educate both internal and external constituents on the value of your rehabilitation unit.

Maintaining optimal patient volume and case mix requires a focused, integrated and disciplined approach. This includes a team approach to ensure the right patients are admitted to your program at the right time in their recovery journey.




6. Measure and track outcomes.


The ability to track and report outcomes is critical for quality improvement and positioning for reform initiatives. Do you capture and track clinical quality metrics? Are you able to compare outcomes to peer facilities? Do you measure hospital readmission rates? Can you demonstrate superior outcomes?

7. Know the regulations and comply.

Federal and state regulations, including adherence to the 60% rule and the requirement that patients receive at least three hours of therapy per day, five days per week, require constant attention and oversight, especially following the increased scrutiny and high denial rates many facilities face. Equally important is documentation competency to ensure accuracy and to reduce denial risk. Do you have a comprehensive pre- and post-admission process to comply with regulations? Are you equipped with a dedicated appeals and denials team to efficiently and successfully navigate the ever-changing denials landscape? Having experts in this field is essential as the regulatory environment is ever-changing and often difficult to navigate. This, in turn, reduces denial rates and opens the door to a larger patient population in need of vital care.


Administrative Oversight/Staffing Issues


8. Become CARF-Accredited.


Accreditation by the Commission on Accreditation of Rehabilitation Facilities (CARF) can help demonstrate to patients, payers and referral sources the quality of clinical care, service delivery and overall excellence of your rehabilitation services. Further, CARF and Joint Commission certifications improve the comprehensiveness of patient treatment and the range of patients a program may treat, as well as support improved program performance. On average, CARF accredited programs experience a 26% increase in annual patients served, as well as a 37% increase in accordance to quality standards.1 Are you CARF-ready?

9. Choose medical directors carefully, define expectations, and provide education and training.

A medical director who fully understands changing regulations and has peer support will have a positive impact on the overall success of the rehabilitation unit. It is important to ensure medical directors are engaged members of the team and have the tools they need to drive program results. It’s also crucial to remain flexible as the healthcare landscape fluctuates due to regulatory changes and population needs.

10. Invest in staff education and utilize an interdisciplinary approach.

Ongoing training and education for managers and staff is critical for the delivery of quality care, skill enhancement and leadership development. The interdisciplinary team approach within the hospital is also important. It has shown proven results during times of public health uncertainty – ensuring a consistent patient experience across the care continuum. Program directors should serve as ambassadors to integrate nursing and therapy staff, and coordinate external resources.

The Bottom Line

Inpatient rehabilitation units are a growth opportunity for hospitals and an important component of the care continuum. Understanding the intricacies of rehabilitation can help hospitals improve quality outcomes, their competitive advantage in the marketplace and, most importantly, provide an unparalleled level of patient care.

Further, the right rehabilitation management partner can help position an inpatient rehabilitation unit for success by keeping it on track with strategies and dedicated expertise related to growth, operations, reimbursement, compliance, clinical programming and outcomes.

Whether you closed your unit, reduced admissions, or limited diagnostic types as a result of the pandemic, Kindred Rehabilitation can help you relaunch this service line. Kindred works with more than 300 hospital-based programs nationwide to help them excel in these 10 areas, therefore bringing greater success and improved outcomes to their acute rehabilitation settings.

The right rehabilitation management partner can position an inpatient rehabilitation unit for success by keeping it on track with strategies and dedicated expertise related to growth, operations, reimbursement, compliance, clinical programming and outcomes.

How Kindred Can Help

To learn how Kindred can help optimize the performance of your rehabilitation unit, visit kindredrehab.com.


1. CARF International. Accreditation Benefits. http://www.carf.org/ Accreditation/ValueOfAccreditation/Benefits/

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