PREPARING THE PATIENT FOR TRANSFER TO AN INPATIENT REHABILITATON FACILITY (IRF) University Hospitals 8th Annual Neuroscience Nursing Symposium

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1 PREPARING THE PATIENT FOR TRANSFER TO AN INPATIENT REHABILITATON FACILITY (IRF) University Hospitals 8th Annual Neuroscience Nursing Symposium May 31, 2013

2 2

3 DEFINITION: INPATIENT REHABILITATION FACILITY An inpatient rehabilitation facility (IRF) is an inpatient rehabilitation hospital or part of a rehabilitation hospital, which provides an intensive rehabilitation program to inpatients; 60% of these inpatients have one of the 13 CMS qualifying conditions. 3

4 Inpatient Rehabilitation Facility (IRF) Criteria To Be Classified As Hospital 1. Preadmission screening required. 2. Physician visit required every 2 3 days. 3. Full time Medical Director of Rehabilitation. 4. Registered nursing 24 hours/day. 5. Intensive rehabilitative services (PT, OT, ST), 3 hrs/day 5 days/wk or 15 hours over 7 days. 6. Interdisciplinary Team Conference 7. 75% rule i.e., 60% of conditions must be within 13 diagnoses. 4

5 Question #1 Frequently Asked By Prospective Patients What is the difference between an Inpatient Rehabilitation Facility and a Skilled Nursing Facility? Centerre HealthCare Corporation 5

6 Inpatient Rehabilitation Facilities (IRF s) Are Different Than Skilled Nursing Facilities (SNF s) REQUIRED BY MEDICARE Close Medical Supervision By a Physician With Specialized Training INPATIENT REHAB HOSPITALS & UNITS Yes NURSING HOMES 24 Hour Rehabilitation Nursing Yes No Patients must require hospital level care Yes No Physician approval of preadmission screen and admission Yes No Medical care and therapy provided by a physician led interdisciplinary medical team including specialty trained registered nurses 3 hours of intensive therapy per day/5 days per week or 15 hours of therapy within a 7 day period of time Discharge rate to community 81.1% 45.5% The data cited in this slide are drawn from the Medicare Payment Advisory Commission s March 2011 Report to Congress 6 Yes Yes No No No

7 7

8 IRF criteria for qualifying conditions 60% of all admissions must fall within 13 categories (Known as Compliance Threshold) 1. Stroke 2. Brain Injury 3. Amputation 4. Spinal Cord 5. Fracture of Femur 6. Neurological Disorders 7. Multiple Trauma 8. Congenital Deformity 9. Burns 10. Polyarthritis Same As HCFA-10 Replaced by new categories (10-12) 1. Stroke 2. Brain Injury 3. Amputation 4. Spinal Cord 5. Fracture of Femur 6. Neurological Disorders 7. Multiple Trauma 8. Congenital Deformity 9. Burns 10. Osteoarthritis (after less intensive setting) 11. Rheumatoid Arthritis (after less intensive ) 12. Joint Replacement Bilateral Age >85 BMI >50 Original - March 2013 University Hospitals Rehabilitation Hospital - Beachwood 13. Systemic Vasculidities (after less intensive setting) 8

9 IN ORDER TO BE COVERED BY MEDICARE OR MEDICAID, EACH PATIENT MUST: Require active and ongoing intervention of multiple therapy disciplines (PT, OT, SLP, or prosthetics/orthotics), at least one of which must be PT or OT. 9

10 IN ORDER TO BE COVERED BY MEDICARE OR MEDICAID, EACH PATIENT MUST: Require an intensive rehabilitation program, generally consisting of : 3 hrs of therapy per day at least 5 days per week; or In certain well documented cases, at least 15 hours of intensive rehabilitation therapy within a 7 consecutive day period, beginning with the date of admission. 10

11 IN ORDER TO BE COVERED BY MEDICARE OR MEDICAID, EACH PATIENT MUST: Reasonably be expected to actively participate in, and benefit significantly from, the intensive rehabilitation therapy program. 11

12 IN ORDER TO BE COVERED BY MEDICARE OR MEDICAID, EACH PATIENT MUST: Require physician supervision by a rehabilitation physician. 12

13 IN ORDER TO BE COVERED BY MEDICARE OR MEDICAID, EACH PATIENT MUST: Require an intensive and coordinated interdisciplinary team approach to the delivery of rehabilitative care. 13

14 Question # 2 Frequently Asked By Prospective Patients Does the IRF have an intake representative who is available to answer any questions that I have relative to my insurance coverage or other admission related questions? 14

15 CLINICAL LIAISONS A RESOURCE TO THE PROSPECTIVE PATIENT, HIS/HER FAMILY, AND HEALTHCARE PROFESSIONALS Screening patients for admission/applying the admission criteria Obtaining insurance pre authorizations A resource to the Social Worker/Discharge planner A resource to patients and family members 15

16 Question # 3 Frequently Asked By Prospective Patients What clothing items should I bring with me to an inpatient rehabilitation facility? 16

17 List of Clothing Items That Can Serve The Patient Well In An IRF 5 Changes of comfortable, loose fitting clothing for wear during daytime hours (i.e. jogging pants with elastic waist). Shoes that have treading on the bottom and an enclosed heel (i.e. tennis shoe). 5 Changes of nightwear (i.e. loose fitting pajamas). 17

18 18

19 The Care Team Is Usually Led By A Physiatrist (Although Some IRF s Have Designated a Neurologist or Internist To Serve As Medical Director) A physiatrist is a medical doctor or doctor of osteopathic medicine who specializes in Physical Medicine and Rehabilitation (also called PM&R physicians). Physiatrists diagnose and treat both acute pain and chronic pain and specialize in a wide variety of nonsurgical treatments for the musculoskeletal system. 19

20 Internal Medicine Physicians Often Work In Conjunction With Physiatrists In IRF s Chronic Diseases Treated By Internists in IRF s: Hypertension Diabetes High cholesterol Musculoskeletal disorders Neurological disorders Gastrointestinal problems Thyroid problems Acute Diseases Treated By Internists in IRF s: Heart disease Asthma & lung disease Unstable angina High blood pressure Glucose monitoring 20

21 Interdisciplinary Team Approach Is Required Interdisciplinary team conferences, directed by the rehabilitation physician, should be held at least weekly. Interdisciplinary team must include the rehabilitation physician, rehab nurse, social worker or case manager, and a licensed or certified therapist from each therapy discipline involved in treating the patient. 21

22 Close Medical Management Required Close medical management is provided by a rehabilitation physician at least three times weekly via face to face visits. 22

23 Question # 4 Frequently Asked By Prospective Patients Can my family physician or specialist visit me in the IRF and write orders? 23

24 Physicians Generally Need To Be Credentialed By An IRF In Order To Conduct Visits And Write Orders IRF s tend to have a number of physicians on staff who can attend to patients. Occasionally, the patient s family physician or specialist has privileges at the IRF. If he or she does not and there is a desire to attend to a certain patient, the practitioner should contact the IRF s Medical Staff Office to learn about provisions for temporary or emergency privileges. 24

25 Question # 5 Frequently Asked By Prospective Patients How long do patients usually remain in an Inpatient Rehabilitation Facility? 25

26 Average Length of Stay In An IRF IMPAIRMENT GROUP Based On Impairment All 13.4 Stroke 15.9 Replacement of Lower Extremity 9.3 Nontraumatic Brain 13.4 NT Spinal Cord 15.1 Neurological 12.8 Pain Syndrome 10.4 Traumatic Brain Injury 15.8 Fracture of Lower Extremity 13.0 Other Orthopedic 11.5 NATION MEAN LENGTH OF STAY AS OF MAY 28,

27 Average Length of Stay In An IRF Based On Impairment Cont d IMPAIRMENT GROUP NATION MEAN LENGTH OF STAY AS OF MAY 28, 2013 Amputation, LE 13.1 Miscellaneous 11.7 T Spinal Cord 24.2 Amputation, Other 12.5 Osteoarthritis 11.9 Rheumatoid, other 12.2 Cardiac 10.9 Pulmonary 11.2 MM Trauma no BSCI (MMT NBSCI) 12.8 MM Trauma w/bsci (MMT BSCI) 17.9 Guillian Barre

28 28

29 Day Starts Early Patients are typically served breakfast at 7:00am to start their day. 29

30 Three Total Hours of Therapy Speech Therapy Swallowing evaluation and treatment Cognitive training Therapy for expressive and receptive aphasia 30

31 Three Total Hours of Therapy Physical Therapy Walking, Stairs, Transfers, Balance and Strengthening Therapy/Modalities for altered tone Occupational Therapy Training with Activities of Daily Living UE ROM/Strengthening Therapy/Modalities for altered tone 31

32 Question # 6 Frequently Asked By Prospective Patients Will I have to attend three straight hours of therapy? 32

33 The patients are encouraged to eat in the cafeteria. Getting out of their rooms for meals is very beneficial. 33

34 Therapy Gym The majority of the three hours of therapy are spent in the facility s gym. 34

35 Question # 7 Frequently Asked By Prospective Patients How do I know when I am ready to go home? 35

36 Many Facilities Are Using A Designated Independence Day This is the patient s last day in the hospital prior to discharge. Final FIM ratings are taken starting at 7:00 am through 6:59 am the next day. These final scores demonstrate the overall improvement of the patient compared to the initial scores when the patient was admitted. 36

37 THANK YOU OPEN DISCUSSION, QUESTIONS & ANSWERS 37

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