23810245 Reading Rehabilitation 11-13-08

8/2/2019 23810245 Reading Rehabilitation 11-13-08

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Reading

Rehabilitation

Implementing Patient-Focused Care
http://www.healthsouthreading.com/default.asp


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Reading Rehab Hospital Roots

HealthSouths RRH Facility Built in 1925 the historic

Stone Manor on a 30-acre campus.

The million dollar home.

Was originally the homeof Isaac Eberly, aprominent businessman

and hosiery mogul.


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Leading Change

Clint Kreitner: CEO of RRH from 1989-2000

History:

Early career as a Naval officer

Respected entrepreneur with 4 successfulcompanies

On board of RRH for 3 years


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Kreitners Forecast

Kreitner: The hospital had an awesome reputation, adedicated staff, and no debt.

Instincts: his insight of business told him that RRH was

headed for difficult times Reasons:

Over 50% of RRH referels came from one large hospital Industry was inflicting double digit annual increases on the U.S.

economy

Action: He began forums with the staff to communicate need for change Opened the financial books to the staff to show them what he saw


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Staff Reaction

This type of communication was a first for RRHand not typical for that industry.

It made many of the staff feel uncomfortablebecause they had been in a thriving industry for15-20 years and did not want to believe theywere in trouble.

Needless to say, his opinion was not universallyshared due to his lack of healthcare industryexperience.


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Rehabilitation Services

Brief History of RRH from 1958 to present In 1998 RRH had 76 beds, 116 therapists and 25 million in

revenue Most patients came to RRH after treatment of an illness or injury

at an acute care hospital Rehab hospitals restore basic functioning, such as walking,

climbing stairs, getting dressed, and feeding oneself Used Functional Independence Measures (FIM's) Goal was to help patients leave functioning as independentely as

possible


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Rehabilitation Services RRH, like other rehab hospitals, also differed from acute care hospitals in being smaller than

most of them. RRH's annual revenues of $25 million compared to more than $200 million for the largest and

$45 million for the smallest acute care hospital in its region RRH admitted patients with a wide range of diagnoses

Head injury Stroke Spinal cord injuries Orthopedic problems

Received care from 5 disciplines Physiatrists (rehab dr.) Nurses Social workers Physical therapists Occupational therapists

If patient had head injury or stroke: Psychologists Cognitive therapists Speech therapists


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Effectiveness

Measured effectiveness by using three dimensions: Average length of stay Increase of functional outcomes Patient satisfaction

Average length of stay compared favorably to the national averagewhich was 21 days Achieved nearly the same increase in the level of functional

independence Patients were more satisfied with quality of care at RRH compared to

national benchmark)

Patient care declined over the next 8 years This was due to shorter lengths of stay rather than due to fewer patients Fewer patient days = Less revenue


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Mission

Mission of Reading Rehabilitation As a subsidiary of Adventist Health Ministries, Inc, Reading

Rehabilitation Hospital was a non profit organization inPennsylvania.

The well being of the patient is the number one priority of theRRH, together with its sister companies.

Because of the centers affiliation with the Adventist church,commitment to the patients well being became stronger.

The mission of the Reading Rehabilitation center did not limititself to the physical healing, but spiritual healing as well.


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Purpose

The organizations values, as well as strategicand operational decisions were also base on thisvision.

The mission and vision of ReadingRehabilitation Hospital was put at a test due tothe competitive world of health care.

As mentioned by Kreitner, the CEO brought in

since 1989, finding balance between missionand real world business practice was one of thegreatest challenges faced by Reading Rehab.


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Pressures from Managed Care 1980s and 1990s healthcare costs were escalating out of control

with adverse consequences for both the federal budget and U.S.corporations.

The government responded with changes to Medicare and Medicaid.

In 1983, Medicare introduced a Prospective Payment System (PPS)under which standard payments were made based on a patientsdiagnosis, regardless of the institutions actual cost.

Medicaid, funded through state budgets, declined in funding over the

1980s and 1990s, reducing the level of reimbursements.

One of the most significant innovations affecting the U.S. healthcareindustry was the rapid emergence of managed care.
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What is Managed Care?

The term managed care is used to

describe a variety of techniques intended

to reduce the cost of providing healthbenefits and improve the quality of care.

According to the National Library of

Medicine, managed care encompassesprograms.
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Main Purpose:To reduce unnecessary health care costs through a varietyof mechanisms such as:

Programs for reviewing the medical necessity of specific services

Increased beneficiary cost sharing

Economic incentives for physicians and patients to select less costly forms of care

Controls on inpatient admissions and lengths of stay

Selective contracting with health care providers

Intensive management of high-cost health care cases
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Fee-for-Service (FFS)

Until 1980s private health insurance plans allowed patientsto choose their own doctors.

Under this fee-for-service (FFS) model, the role of theinsurance company was simply to pay the bills.

Doctors were free to prescribe any treatment consistent with acceptedmedical practice and to determine fees for such treatment.
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Change This all changed in 1980s with new state laws that allowed

insurance companies to negotiate prices directly with health careproviders.

In attempt to reduce costs

Managed care organizations (MCO) adopted a more business-likeapproach for delivering care.

The idea was to get doctors and hospitals under contract atdiscounted prices and then control the use of services by managedcare health plan members.
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What would happen

Patients would choose from a predetermined listof participating doctors, a primary care physician

(PCP) who served as the gatekeeper for thepatient.

These changes meant that hospitals had toperform tasks more efficiently so costs did notexceed payments received from MCOs.
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Reading Rehabilitation Hospital Acute Rehabilitation hospitals like RRH were cushioned

from some of these changes in the healthcaresystemat least for the time being!

Most RRH patients were on Medicare, and the more

generous the Medicare rate was, the more advantage itwas for the Reading Rehabilitation Hospital. Kreitner noted, At times, we would keep patients twice

as long as we do, and get reimbursed for it. But we cant afford to get lazy. So we strive to keep

costs down and maximize incentive pay, rather thanmaximizing the reimbursement.
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Main Goal

RRH (Reading Rehabilitation Hospital) was at advantage because they

would keep patients longer and they would get reimbursements

Prospective Payment System did not force them to lower their cost becauseMedicare would pay the difference between average cost and what their limit was

TO MAXIMIZE INCENTIVE PAY
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Competition

Reading Rehabilitation HospitalOnly acute rehab in Pennsylvania market

Accounted for about 6% of market share

Shared the market with 3 acute care hospitals

Reading Hospital & Medical Center (RHMC): 57% St. Josephs Medical Center: 24%

Community General Hospital: 13%

Upstream acutecare hospitals

RehabilitationHospitals

DownstreamOrganizations
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Patient Flow

Local Acute Care Hospitals

Trauma Centers

Physicians (home/nursing homes)

Incoming Patients

Discharged Patients

Home

Nursing homes


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Continuum of Care

Acute care hospitals kept patients longer

Create new efficiencies and fill empty beds

Traditional nursing homes began offeringmany rehab services

Rehab expansion of other industryparticipation would have a negative effecton RRH


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Market Conditions

RRH = only licensed provider of acute rehabservices in Berks County

RHMC tried to buy RRHs licenseClint Kreitner valued it at $6-$8 Million

Pennsylvania Regulations required Certification ofneed (CON) before granting license for new acute

rehab service CON limited rehabs services others could provide


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Market Conditions

Increasing competition in product market

Highly competitive labor market

Occupational Therapists Physical Therapists

Unfavorable Supply/Demand

Kreitner: We constantly live in fear that our therapists

will bail out en masse and as a result, theorganization will be brought to its knees.


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The Rehabilitation Process

Admission from upstream providers

Care providers from multiple discipline

evaluate patients Weekly conference involving interaction

between the patient and care providers

Integrated plan care Discharge


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The Rehabilitation Process


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Process Improvement

Kreitner assumed Leadership

Patient care across disciplines ineffective

Delay in treatment and inconsistency amongtreatments

Kreitner Implemented Continuous ImprovementInitiative

Kaizen Effect Process


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Process Improvement


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Process Improvement (Barriers)

Issues impacting the process improvement

Staff disciplines cannot cross train

Staff could not be in ready statusPatient severity was not known in advance

Shorter length of stay, immediate need to the

discipline


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Performance Improvement

(Barriers) Variance in patient acuity leads to

scheduling problems

Service lines are not flexible for the shortlength of stay

Medicare reimbursement is driven to the

therapy target loss of revenue


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Staffing Barrier Specifics

COP for CMS Requirements for IRF

Daily access to Physician

24 hour nursingMinimum 3 hours per day/5 days

Two forms of therapy available


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Reading Rehabilitation Hospital:

Where are they now? Acquired by HealthSouth Corp in 1998

One of multiple purchases in the 1990s Others included NovaCare, Columbia/HCA Mix of facilities, including acute care rehab

Not unlike RRH, faced challenges due to changing reimbursementlandscape Medicare Balance Budget Act Managed Care Organizations

Succeeded in maintaining, then increasing revenue projections Diversification Capturing market share (simultaneously solving RRH volume problem)


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Changes in Organization Model

Prior to sale, RRH returned to the departmental structure Staffing efficiencies returned Issues relation to patient care addressed via better process coordination

As HealthSouth, RRH continues to use this model, now lead by a primarynurse

24-hour team of registered nurses and personal care assistants assess andattend to each patient's needs. They work in partnership under the primarynurse-model, which assures continuity of care.

Although time-limited twice weekly conferences were piloted, weeklyinterdisciplinary team meetings have been adopted under HealthSouth

Each week your treatment team will meet to discuss your progress, goals and dischargeplan.


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Continued Growth and Success

The HealthSouth Reading Rehabilitation Hospital has expanded to offer Inpatient Rehabilitation Outpatient Rehabilitation Home Heath Care Service

Continues to demonstrate high levels of patient satisfaction, as evidencedby higher than average ratings in two important measures: Would You Recommend

Overall Quality of Care.

Utilizes an Outcomes Measurement tool to track each patients functioning

both upon admission and after treatment

Uses such data to benchmark outcomes and ensure programs are meetingpatient rehabilitation needs


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Reading Rehab Group:

Jimmie Olazaba Stacey Benson Anemone Basabakwinshi Tahira Raza Ailiya Raza Quynh Smith

Charles Workman Kenith Causey Grace Cruz


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References

Commitment Quality. Retrieved November 7, 2008, from HeathSouthReading Rehabilitation Web site:http://www.healthsouthreading.com/quality_commit.asp

Frequently Asked Questions. Retrieved November 7, 2008, from

HeathSouth Reading Rehabilitation Web site:http://www.healthsouthreading.com/quality_commit.aspGittell, J.H (1999). Reading Rehabilitation Hospital: Implementation

Patient-Focused Care, Teaching Note. Harvard Business Review,5(899-139), 1-16.

Managed Care. Medline Plus. Retrieved November 4, 2008, from

http://www.nlm.nih.gov/medlineplus/managedcare.htmlManaged Care. Retrieved November 4, 2008, fromhttp://en.wikipedia.org/wiki/Managed_care
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23810245 Reading Rehabilitation 11-13-08

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