Outcomes & Beyond: Maximizing Benefits of Short Term Rehab

Transcription

1 Outcomes & Beyond: Maximizing Benefits of Short Term Rehab March 16, 2015 Speakers Todd Boslau ParenteBeard, Partner Cara D. Todhunter MA, CCC/SLP-L, NHA, MPM Asbury Heights, Administrative Director of Healthcare Services Martin Siefering AIA Asbury Heights, Board Member Perkins Eastman, Principal Motivation for Creating This Session A lack of understanding of who the Short Term Rehab customer is Including a belief that Short Term Rehab and Long Term Care customers were essentially the same people A disbelief that there were benefits beyond financial reward A shortage of good Short Term Rehab planning information 1

2 Learning Objectives Learn key ingredients to building or growing a short-term rehab program Develop an understanding of the factors that influence positive outcomes Explore ways to maximize the benefits from building a successful short-term rehab program Agenda Short Term Rehab Background Info National and State Data Survey Response from regional providers A Case Study from Asbury Heights What We Learned Keys to Success What makes Short Term Rehab important National and State Data 2

3 Excerpt From American Health Care Association s 2013 Quality Report A slight decrease but remember that this is at any one time Excerpt From American Health Care Association s 2013 Quality Report Short Term Rehab touches the lives and introduces your community to many more people every year Excerpt From American Health Care Association s 2013 Quality Report 3

4 Excerpt From American Health Care Association s 2013 Quality Report Touching almost 3x more lives Excerpt From American Health Care Association s 2013 Quality Report Not a big difference in age Excerpt From American Health Care Association s 2013 Quality Report But a huge difference in Cognitive Ability 4

5 Short-Term Rehabilitation Statistics What is PEPPER? Program for Evaluating Payment Patterns Electronic Report Information provided by Centers for Medicaid and Medicare Services ( CMS ) for SNFs Contains provider specific data statistics for episodes of care identified as potentially vulnerable to improper Medicare payments SNFs are encouraged to review the reports and focus on areas in which they are an outlier Short-Term Rehabilitation Statistics National Pennsylvania Average LOS for Therapy RUGs days days days days days days Average LOS for Non-Therapy RUGs days days days days days days SOURCE: PEPPER Short-Term Rehabilitation Statistics Top RUG Categories and LOS National Pennsylvania RUB - Rehabilitation Ultra High 24.1 days 22.9 days (ADL 6-10) RUC - Rehabilitation Ultra High 27.2 days 28.4 days (ADL 11-16) RUA - Rehabilitation Ultra High 19.6 days 19.6 days (ADL 0-5) RVB Rehabilitation Very High 17.4 days 18.5 days (ADL 6-10) RVC - Rehabilitation Very High 19.3 days 16.7 days (ADL 11-16) RVA Rehabilitation Very High 16.3 days 14.3 days (ADL 0-5 These six categories approximate 75% billed nationally & 76% billed in Pennsylvania SOURCE: PEPPER 5

6 Survey Response from 35 of our collective clients Who are the respondents? 35 Providers (several multi-campus) 91% Executive Team 9% Management/Administration Skilled Nursing Beds Includes Multi-site providers 300 or More 35% Fewer Than % They were distributed in various eastern states: RI MA CT DC FL OH NY NJ PA % % % How many Skilled Nursing Beds are provided by your organization for rehab? (either short or long term) Census and Revenue Typically, what percentage of your skilled nursing census consists of short term rehab patients? Typically, what percentage of your skilled nursing revenue is provided by short term rehab patients? 9% 19 % 15 % Short Term Rehab Census % Short Term Rehab Revenue % 18 22% 15% % 30% or more Less Than 10% Less Than 10% 6% 30% or more 10-14% 25-29% 17% 20-24% 15-19% 10-14% 22% 15% 25-29% 19% 20-24% 15-19% 22% 6

7 Census and Revenue Typically, what percentage Note of that those with a larger Typically, what percentage of your skilled nursing census census have a relatively your skilled nursing revenue consists of short term rehab higher % revenue gain. consists of short term rehab patients? patients? 9% 19 % 15 % Short Term Rehab Census % Short Term Rehab Revenue % 18 22% 15% % 30% or more Less Than 10% Less Than 10% 6% 30% or more 10-14% 25-29% 17% 20-24% 15-19% 10-14% 22% 15% 25-29% 19% 20-24% 15-19% 22% Change in Revenue and Length of Stay 60% of respondents saw a decrease in length of stay for short term rehab patients 19% saw no change 13% saw an increase 22% Short Term Rehab Revenue Growth 28% No Growth 1-4% Growth 10% Growth or More 5-9% Growth What amount of growth did your organization experience in short term rehab revenue in the past year? 28% 22% Changes in Length of Stay From those who saw an increase: How much did the average length of stay increase during the past year? 1-2 days per patient 3-5 days per patient 6-10 days per patient INCREASE Don t Know From those who saw a decrease: How much did the average length of stay decrease during the past year? 1-2 days per patient 3-5 days per patient DECREASE 7

8 Qualitative Evaluation 54% of respondents organizations separate short term rehab programs from long term care What percentage of your short term rehab patients stay in private rooms? 31% of respondents organization do not 15% of respondents organizations do so on a facility by facility basis What is the condition of the physical environment of your short term rehab program? New Construction Recently Renovated 50% or More 50% Less than 10% 35% Minor Repairs Needed Major Repairs Needed 30-39% 6% 10-19% 6% 20-29% 3% Future Goals 90% of respondents said their organization is looking for ways to increase their short term rehab census What is the growth in demand for short term rehab in your marketplace? What is the goal for your organization with regard to short term rehab census growth? 22% No Demand Unknown 1-4% Growth 31% 14% Census Growth Goals Don t Know 30%+ Growth 3% 7% 25-29% Growth 7% 20-24% Growth Less than 10% Growth 31% 31% 25% 10%+ Growth 5-9% Growth 13% 17% 15-19% Growth 10-14% Growth 28% Challenges to Success and Growth What have been the challenges to your success in short term rehab? What have been the challenges to growing your short term rehab census? Don t know No Challenges Community Reputation Past Patient Referrals Relationship with Referral Sources Quality of the Physical Environment Other No Challenges For-profit Competition Non-profit Competition Strategic alignment with referral sources Lack of private rooms No separation from LTC Outdated physical environment Not enough demand Finding appropriately trained staff Retaining appropriately trained staff Other Other Answers Included: Declining Length of stay Discharge to home CCRC resident needs State regulation Mission focus on LTC limits bed availability Distance from other hospitals 8

9 Measuring Success: Outcomes 65% of respondents said that their organization uses a metric to measure medical outcomes of short term rehab Common Metrics from Respondents Readmission/Rehospitalization FIM Measure Functional Improvement Admission to Discharge Evaluation Length of Stay vs. Diagnosis Infection Rates Falls Experienced We don t understand how 35% could not be measuring outcomes. Measuring Success: Customer Satisfaction 75% of respondents said that their organization uses a metric to measure customer satisfaction in short term rehab Common Themes from Customers (Positive or Negative) Quality of Staff (positive except for CNAs and call bell response) Culinary Services (positive and negative) Semi-private Rooms (big negative) Experience in Therapy (universally positive) Aesthetics of Physical Environment (generally negative) Billing Confusion (negative) Discharged Too Soon (due to insurance limits) Operations/Staff 69% of respondents said that their organization outsources one or more of its short term rehab services Keys for Recruiting/Retaining Excellent Staff Work Environment Level of Teamwork Recognition Cultural Fit Client-centered Approach Competency of Other Staff 9

10 Threats Respondents ranked the following threats in order of severity. On the chart, a higher score represents a more threatening average rank. Discharges directly to home/homecare Hospitals taking more control Competitor providers Decline in reimbursement rates Cost of care rising disproportionately Proposed bundled payment system Asbury Heights A Case Study Planning Short Term Rehab 10

11 Asbury Heights Senior Living Community Independent living Personal Care Nursing Care Providing care for over 100 years Not-for-profit organization Located in Pittsburgh Significant non-profit and for-profit competition Nursing Center History Loss of $50,000 in direct cost (2006) and missing revenue opportunities (RUGS and length of stay) Rehab services contracted in 2007 Process improvement focus in 2009 Prior to 2011, private pay was largest payment source > 50% of annual revenue Strategic Planning discussions re: future with board and senior management in SWOT Analysis, 2012 Strengths High quality outcomes Therapy program, strong High Customer satisfaction Strong social service program Dedicated, consistent management Physician group, geriatric medicine 5-Star Facility Weaknesses Semi-private rooms, shared baths Weak relationships with hospitals, d/c planners Lack of appeal to younger population Co-mingled resident population Limited capital resources No land or space to expand physical plant Limited number of physicians and physician extenders 11

12 SWOT, continued Opportunities Medicare and HMO reimbursement, reduce medical assistance Marketing opportunities Census building in PC and Independent Threats Reimbursement Expenses, cost of care Hospitals expanding into long-term care market Short Term Rehab residents converting to long term care 5-Star rating, instability Competitive market Outcome of SWOT Become a short-term rehab provider Designate a community to focus short-term rehab Plan for changes! Planning for the future as a short-term provider Focus on current condition and future needs Staffing Quality of Care / Satisfaction Corporate Compliance Physical Plant Marketing Financial 12

13 Increase Staff Additional staff support Admissions RNACs Social Services Health Information Management Corporate Compliance Officer Nurses Physicians and physician extenders Therapy (therapists and management) We didn t increase the number of beds, but we need more staff, why? Nurse tasks Skilled documentation Assessments Routine nurse care, more acute needs Nurse to Physician report, orders Support to family Care conferences Discharge planning MDS process Medical records Compliance tasks Admissions Constant referrals Contract Completion Health Care Admissions and Planned Discharges (Jan-May) Extrapolated for Admissions Discharges

14 Quality: Focus on Measurement Facility measurement Hospital Re-admissions Falls/Accidents Infections Hypnotic medication Antipsychotic medication Pressure Ulcer Incidence Quality indicator report Customer satisfaction Suggestions for Planning and Managing Quality of Care Review current programs Develop disease specific programs Utilize process improvement/ lean strategies Use measurement to guide decisions and evaluate outcomes Involve staff at all levels Best practices, use research Seek out experts Physicians Universities Home Care Providers Hospitals Hospice Training programs for staff, resident and family Plan for electronic medical record Satisfaction Survey Overall, how would you rate. Would you recommend Asbury Health Center to a friend or family member? How well informed did you feel you were kept of your condition? What are some things you particularly liked about Asbury Health Center? Is there anything you think should be changed or improved? 14

15 Asbury s Satisfaction Outcomes Overall Satisfaction Caregiver Staff Asbury Health Center Nursing Care Social Services Rehab *Satisfaction Scale 1 (very poor) - 10 (excellent) Corporate Compliance Revisit compliance requirements, conditions for Medicare participation Appoint a Compliance Officer Review and/or implement compliance training/tasks Triple Check Certifications/ recertification Medical record audits Physician visits and signing orders QAPI, upcoming regulation changes Periodic Reports to Board Marketing Consider the competition Update marketing materials Designate marketing responsibilities Connect with community Market and develop relationships with Potential residents and families Hospitals Home care Home health Physician offices 15

16 Financial Planning Manage payment mix Case Management RUG utilization Discharge planning Medical Assistance process Manage Expenses Drugs Laboratory testing X-rays Transportation services Medical supplies Census Revenue 16

17 Discharges within Campus 35 Number of Residents Discharged to Campus Venues Asbury s Experience Successes Instituted a CODE-H Instituted satisfaction survey Already had a strong process improvement and planning culture Increased staff in some areas: Admissions Social Services RNAC Mistakes Over looked hypnotic, and psychoactive medications ordered for new admissions Did not plan for symptom management programs Underestimated staffing needs Did not prepare staff Misjudged demand on staff time No customer service training to address new service population s expectations and needs. Underestimated parking needs Lack of processes for compliance management, monitoring What have we learned? 17

18 Keys To Success Five-Star Rating and care reputation Physician relationships good outcomes, happy patients Location High levels of customer satisfaction Quick response time on day of discharge Bed availability Know who the customer is! Know Who The Customer Is Customers are generally younger in appearance, functional and cognitive abilities than typical LTC residents Short Term Rehab customers don t like the stigma of Long Term Care and prefer to be separate. LTC Household Short Term Care LTC Household 18

19 Know Who The Customer Is Focused on going home rather than settling in more hospitality than residential. Know Who The Customer Is Customers are unlikely to bring any personal items therefore, room should be complete on arrival i.e. television, colorful, decorative accessories... 19

20 Know Who The Customer Is They had active lives that they don t want to give up and want to get back to it as soon as possible wifi, connectivity to the rest of life no time for customers to set up relationships with phone, data, cable providers they must be ready and gratis. Customers will compare experience to the hospital they came from rather than their homes hospitals are quickly moving to private rooms to better provide better infection control Short Term Rehab providers find that private rooms make admissions easier (infection control, no need to gender manage) 20

21 Know Who The Customer Is They are typically not interested in making social connections with other customers but they do have many more visitors social spaces are more often for families and residents to share - make provisions for children, parking. Slide E Know Who The Customer Is There are many traumatic moments for families create private family meeting space 21

22 Know Who The Customer Is Frequency of admission and discharge is high need staffing and streamlined process of admission / arrival. 100% arrive via EMS on a stretcher create private VIP entry. Private VIP Entry Public Entry Private VIP Entry Public Entry 22

23 Know Who The Customer Is They are busy they have outside commitments, they have families visiting, they have therapy make meals flexible to fit around their schedule. Know Who The Customer Is Time spent being transported to rehab and waiting consumes time, is stress provoking and wasteful of staff time. It puts stress on everyone to force the customer to leave what they are doing to go to rehab consider doing rehab on the unit/in the house look at rehab at home models. 23

24 Slide I Know Who The Customer Is Quiet is meaningful less stress and more sleep. Slide J 24

25 Importance Of Short Term Rehab Higher reimbursement levels and higher net revenue Touch a lot of lives and introduce your community to new customers they may become residents in another part of the continuum An STR program that excels will attract the customers that you want and ultimately what admissions you get to LTC and other elements of your community It creates opportunities for linkages with many hospitals, physicians, discharge planners, home care, outpatient rehab and ultimately the broader community If you do a good job, you will have repeat customers this is a new concept to senior living Questions? 25