HealthcareLeadership
Healthcare Leadership White
White Paper
Paper Series
Series
Healthcare Leadership White Paper Series
10 Questions for Improving
Your 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 isn’t the performer it once was. Maybe
census has dropped, your operating margin
may be compromised and/or employee expense
has increased. Perhaps you’ve noticed that case
management refers patients to your rehab
competitors a bit too often. Why? It’s time to ask
some tough questions to gauge your organization’s
readiness to face the challenges of a changing
business market.
1. How is your IRU tracking and validating its
outcomes and practices?
If your IRU is using an Internet-based system, then
you’re 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 rehab
receives a referral to notification of the admit/deny
decision?
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
• Spinal Cord Injury
• Congenital Deformity
• Amputation
• Major Multiple Traumas
• Fracture of Femur (Hip fracture)
• Brain Injury
• Neurological Disorder
877.802.4593 | www.BESmith.com
10 Questions for Improving Your Rehab Performance

• Burns
• Active Polyarticular Rheumatoid Arthritis
• Systemic Vasculidities
• Severe or Advanced Osteoarthritis
• Knee or Hip Replacement — Joint
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 unit’s 60/40 ratio significantly
above the Centers for Medicare &
Medicaid Services’ (CMS) 60% threshold?
If your unit’s 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 acute
hospital on Friday and a rehab screening
is ordered for him/her on Friday night
or Saturday morning, when does the
screening 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
might have just discovered a possible
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
to help them adjust their practices to
accommodate new business challenges and
place their primary focus where it belongs
— on the patient’s need for services.
6. What is your IRU’s 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 IRU’s 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 IRU’s 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 IRU’s capacity.
8. What is your IRU’s average LOS?
Is your average LOS (ALOS) longer than
the regional and national average? If so,
your unit staff members may be under the
impression that your rehab patients are
more impaired/acute/sicker than other
facilities included in the ranking. However,
Internet-based systems use weighted or
adjusted benchmarks that volume-adjust
the regional and national average to match
your facility’s case mix using your case mix
group (CMG) and tier groups.
9. How effective is your inpatient rehab program?
Review your program’s functional measure
outcomes compared to regional and national
outcomes. 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 patients
discharge 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 steps
Once you have the answers to these 10 all-
important questions, you will have a much
better idea of where your IRU stands and
how you’re 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.

B. E. Smith: Integrated Healthcare Leadership Solutions Rita Green, BAABS, MBA, is a consulting
interim with B. E. Smith who has nearly 30 years
Founded in 1978, B. E. Smith is a full-service leadership solutions firm for healthcare of healthcare leadership and administrative
providers. B. E. Smith’s comprehensive suite of services includes Interim Leadership, experience. She has served in a variety of
Permanent Executive Placements and Consulting Solutions. The company is comprised leadership positions within national rehabilita-
of veteran healthcare leaders who partner with each client to create a solution that tion and acute care organizations. Her expertise
uniquely fits that client’s individual needs. Recently, B. E. Smith placed more than 600 and ability to quickly assess the operational
leaders into healthcare organizations worldwide. performance of the rehabilitation service line
provides clients with the focus needed to sustain
For more information, visit www.BESmith.com or call 877.802.4593. a high level of clinical and fiscal performance.

© 2010 B. E. Smith, Inc. WP1110