Annual Outcome Comparison Report-Source One/Village Jan 1, thru Dec 31, 2013

1 SOURCE ONE REHAB Annual Outcome Comparison Report-Source One/Village Jan 1, thru Dec 31, 2013 This report was presented to the stakeholders and Board of Directors. Index to this report: Overall program information: Summary/trends/items requiring action plans: Page 2-3 Demographics: Page 4 Program Distribution: Pages 4-5 Continuum of care/transition: Page 5 Satisfaction surveys: Page 5 Average number of program hours per day: Page 6 Average Length of Stay: Page 7 Discharge Disposition: Page 8 Program Completion: Pages 9-10 Durability of Outcomes/Follow up information: Pages 10-11 Efficiency: Pages 11-12 Specific Program Breakdown information: Work Conditioning: Page 12-13 Work Hardening: Page 13-14 Chronic Pain: Page 14-15 Brain Injury: Page 16-17

2 Overall Summary of all Program Patients: Trends: Program patient census has increased from 2012 of 21 patients total to 91 persons served as a company. At the Village, in 2013, 17 patients were served in a return to work program. For Source One in 2013, 74 persons were served in a return to work program. 102 individuals completed the Work Hardening and Work Conditioning programs in 2011. This remains a focus for facility viability and stability. o 75% of those served in return to work programming were involved in work conditioning or work hardening programming. o 70% of the persons served were in return to work programming attended less than 8 hours per day. Increased program flexibility has allowed for us to serve more patients this year. We have seen an increase in patients who worked simultaneously with attending a work program and attended less than 5 days per week. Patient Satisfaction: Patients and their families reported an average score of 1.20, indicating overall excellent satisfaction with the programs on the surveys. Scores have been maintained in the excellent category since 2011. (1=Excellent; 2=Good; 3=Fair; 4=Poor) Completion of the Program: In 2013, at the Village, there were 17 persons served. For work conditioning and work hardening, 85% completed their program as recommended. For chronic pain and brain injury programming at the Village, neither patient completed the program. For 2013, for Source One, 95.37% completed the recommended program as compared to 70% in 2012. For both programs combined, 90% of those served completed the recommended programs. Durability of Outcomes: For 2013, work conditioning and work hardening in both programs, 54.5% of the patients continued to improve post discharge as demonstrated by the increase in percentage of patients who returned to work modified or full duty, 3 months after discharge. Number of visits as compared to time to complete the program for work conditioning, work hardening and brain injury program patients. Overall average was 17.38 for both facilities combined, which met goal set of 18 day difference including weekends. This also includes patients who attend three days per week. This is one measure to look at efficiency with the least amount of lag time for approvals, patient absences, ect required to complete the program. Continuum of Care: 45% of those served in both programs combined, transitioned from traditional therapy to return to work programming; 55% of the patients seen in return to work programming were from outside sources. Trends requiring action plans or continued surveillance: Average length of stay for 2013 overall average for both facilities was 16 days. For 2012, average length of stay was 16 days for all programs combined. Average length of stay for 2011 was 39.25 for Work Hardening, Conditioning and Chronic Pain Programs combined. There is a growing trend for physicians to perceive work conditioning programs as means to extend therapy beyond the ODG guidelines. For example, in theory, all treatment such as injections should be completed prior to beginning a return to work program. There have been instances where the treating physician has waited to do the injections until the program has been completed, then requested additional therapy post the injections, despite treatment team recommendations to do them early on in the course of the program. Preferably, a patient would be placed on hold, have the procedure and return to the program to complete their program and successfully return to work. Access to services as measured by length of time from referral to admission (number of days from referral to admission)

3 2013 2013 2013 Village Source 1 Total Overall 25.7 39.96 31.99 Return to work: In 2013, 57.75% of the WH/WC persons served returned to work, school or a vocational counselor was involved for both facilities combined. As compared to 2012 where 66.5% of the same population returned to work in either a modified or full time capacity. For 2011, persons served who completed the WH/WC programs. 76% returned to work, school or a vocational counselor was involved. Overall, 38% of the persons served attended modified programs in 2013, whereas 17.5% participated in modified programming in 2012. This is a reflection of the staff s willingness to balance the needs of the stakeholders. There has been an increasing demand on flexibility for the clinicians to balance funding source demands as compared to the persons served and ultimately successful return to work. For example 70% of the patients served attended less than 8 hours per day. Many attended 3 days per week as well. This impacts many factors such as efficiency, length of stay and program satisfaction. Behavioral Programming: For Chronic Pain programming, reduction of pain medications, reported pain levels at discharge, perceived levels of depression and anxiety are areas for improvement. Education of patients regarding their perception and/or misperception of pain levels, depression and anxiety are paramount to the success of the Chronic pain program. Their ability to self-manage pain and lead a more normal life outside of therapy and the medical model are crucial components of the program. Dr. Gant has taken a more active role in the training of the behavioral staff. We have also changed medical directorship to Dr. Michael Ellman. New measures were put in place, plan to continue to analyze outcomes and data for program improvement. For example, are the FABQ, Beck inventories and CIQ the measures we want to continue to use to measure clinical outcomes? The FABQ was discontinued as an outcome measure. Latency of intervention, date of injury to admission, overall average was 502.5 in 2012, 564.06 in 2013 for both facilities combined. Earlier intervention is critical to successful return to work and durability of outcomes.

4 Demographics 2013 2013 2013 Total Village Source 1 Male 84% 93% 75% Female 16% 14% 25% Age 43.65 42.38 44.93 Ethnicity Caucasian 52% 54% 50% African American 29% 28% 30% Hispanic/Latino 10.5% 9% 12% Other 8.5% 9% 8% 8.5 10.5 29 52 Caucasian Afr Amer Hispanic Other Program Distribution/Number of persons served: 2013 2013 2012 2013 2012 Total Village Village S1 S1 Total number served 91 17 1 74 21 Work Conditioning 32 10 1 22 3 Work Hardening 24 5 19 7 Chronic Pain 13 1 12 5 Brain Injury 22 1 21 6

5 Program distribution combined: 47 28 15 WH BIP CPP WC 10 2013 2013 2013 2012 Total Village Source 1 Work Conditioning 47% 59% 35% 14% Work Hardening 28% 29% 27% 33% Brain Injury 15% 6% 24% 29% Chronic Pain 10% 6% 14% 24% Continuum of Care: Transition from conservative therapy with Source One to one of the return to work programs. 2013 2013 2013 2012 Total Village Source 1 Total Overall 45% 55% 34.75% 43.75% o Work Conditioning 36% 30% 43% 75% o Work Hardening 42% 60% 25% 75% o Chronic Pain 33% 33% 25% o Brain Injury 38% 38.25% 0 Satisfaction Surveys: 1=Excellent; 2=Good; 3=Fair; 4=Poor 2013 2013 2013 2012 2011 Total Village S1 Overall satisfaction 1.20 1.17 1.23 1.14 1.21 Work Conditioning 1.24 1.26 1.22 1.20 Work Hardening 1.18 1.08 1.29 1.17 Chronic Pain 1.27 1.27 1.19 Brain Injury 1.14 1.14 1.0 Summary: Overall satisfaction scores have maintained in the excellent category.

6 Average number of hours of treatment per day: 2013 Total Program 8 hrs 7 hrs 6 hrs 5 hrs 4 hrs 3 hrs 2 hrs Overall 30% 4% 5% 5% 33% 13% 10% WC 53% 21% 10% WH 54% 2% 31% 8% 6% CPP 37% 4% 4% 4% BIP 12% 12% 4% 2% 12% 6% Summary: 70% of the persons served were in return to work programming attended less than 8 hours per day. Increased program flexibility has allowed for us to serve more patients this year. We have seen an increase in patients who worked simultaneously with attending a work program and attended less than 5 days per week. 2013 Village Program 8 hrs 7 hrs 6 hrs 5 hrs 4 hrs 3 hrs 2 hrs Overall 10% 10% 5% 58% 10% 5% WC 75% 17% 8% WH 40% 20% 40% CPP 100% BIP 100% 2013 Source 1 Program 8 hrs 7 hrs 6 hrs 5 hrs 4 hrs 3 hrs 2 hrs Overall 53.56% 8.37% 3.15% 5.5% 16.87% 24.87% 17% WC 25.25% 6% 31.25 25% 12.5% WH 68% 10% 22% CPP 75% 8% 9% 8% BIP 25% 25% 8% 5% 25% 12% 2012 Source 1 Program 8 hrs 7 hrs 4 hrs Overall 61.75% 20.75% 17.5% WC 67% 33% WH 100% CPP 80% 20% BIP 83% 17%

7 Average length of stay: 2013 2013 2013 2012 (Number of days/visits) Total Village Source 1 Overall 15.39 13.05 17.73 16.1 Work Conditioning 9.27 7.8 10.75 16.6 Work Hardening 19.63 20.4 18.87 18 Chronic Pain 13.7 10 17.4 15 Brain Injury 18.95 14 23.9 14.8 2013 vs 2012 Average length of Stay: 25 20 15 15.39 16.1 16.6 19.63 18 13.7 15 18.95 14.8 10 9.27 5 0 2013 Total 2012 Total 2013 WC 2012 WC 2013 WH 2012 WH 2013 CPP 2012 CPP 2013 BIP 2012 BIP Summary: For 2013, for combined facilities, there is a one day difference for length of stay as compared to 2012. The most significant decrease was for work conditioning of 7 days less than 2012.

8 Disposition at Discharge: Based on the Occupational Status Score: 0 not working; 1-seeking additional medical intervention; 2-Vo retraining/school; 3-actively seeking work; 4 RTW modified duty; 5-Return to work full duty This is the number of patients that returned to work modified/full duty: 2013 2013 2013 2012 Total Village Source 1 Overall average 58.5% 55 50.62% 48.75 Work Conditioning 50.75% 50 51.5% 100% Work Hardening 64.75% 60 69.5% 58% Chronic Pain 25% 25% 20% Brain Injury 56.5% 56.5% 17% 120 100 100 80 60 58.5 48.75 50.75 58 64.75 56.5 40 20 25 20 17 0 Summary: 58.5% of all program patients served return to modified or full duty in 2013 as compared to 48.75 in 2012. This is for both facilities combined.

9 Completion of the Program In 2013, at the Village, there were 17 persons served. For work conditioning and work hardening, 85% completed their program as recommended. For chronic pain and brain injury programming at the Village, neither patient completed the program. For 2013, for Source One, there were 75 persons served discharged from Source One Rehab in 2013. Of those, 95.37% completed the recommended program as compared to 70% in 2012. Of those who terminated their program early, for both facilities combined these were the reasons: Work Conditioning: N=32; Village N=10; Source One N=22 Declined services 0 Non-compliance DC 0 Limited potential 1 Unplanned discharges/transfers to acute medical facilities 1 Transitioned to another program within the continuum of care 0 Summary: For 2013, at the Village, 90% of the persons served completed the program. (G. Jordan) For Source One 91% of the persons served in the Work Conditioning program completed the recommended program. One patient was placed on hold for spinal cord stimulator adjustment surgery. He resumed services the end of June. One patient had a diagnosis of inguinal hernia, the program aggravated the situation, his physician was contacted and his program was discontinued. Work Hardening: N=24; Village N=5; Source One N=19 Declined services 0 Non-compliance DC 0 Limited potential 0 Unplanned discharges/transfers to acute medical facilities 2 Transitioned to another program within the continuum of care 0 Summary: For 2013, at the Village, 80% completed the program. (C. Stewart did not complete the program). For Source One, 89% of the persons served completed the program as recommended. Two patients were discharged due to medical procedures (lumbar injections). One patient returned as an outpatient for 4 sessions, then returned to work.

10 Chronic Pain: N=13; Village N=1; Source One N==12 Declined services 0 Non-compliance DC 0 Limited potential 1 Unplanned discharges/transfers to acute medical facilities 1 Transitioned to another program within the continuum of care 0 Summary: In 2013, at the Village, the person served was placed on hold for a surgical consult (R. Taylor) and did not return. For Source One, 92% completed the program. One individual attended 3 days and was placed on hold by his physician due to an unrepaired hernia (non- compensable) that was aggravated by the activities and 8 hours of program. Brain Injury: N=22; Village N=1; Source One=21 Declined services 0 Non-compliance DC 0 Limited potential 0 Unplanned discharges/transfers to acute medical facilities 0 Transitioned to another program within the continuum of care 0 Summary: In 2013, at the Village, the person served was denied continued treatment. For Source One, 100% of the persons served completed the program as recommended Durability of Outcomes: 3 month Follow-Up Information for all programs combined: In 2013, at the Village, 9 calls were made for all program patients served. We were able to successfully reach 56%. For Source One, 68 Follow up calls were made for all program patients served. We were able to reach 65% in total. 51% contacted were working. 51% were working for an overall average at the time of discharge, demonstrating durability of outcomes 3 months post discharge. At the Village in 2013 % working 3 months after DC % at DC o Work Conditioning 80% 50% o Work Hardening 33% 60% o Chronic Pain o Brain Injury o Overall average 56.5% 55%

11 For Source One in 2013 % working 3 months after DC % at DC o Work Conditioning 45% 51.5% o Work Hardening 60% 69.5% o Chronic Pain 50% 25% o Brain Injury 50% 56.5% o Overall average 51% 51% Summary: For 2013, work conditioning and work hardening in both programs, patients continued to improve post discharge as demonstrated by the increase in percentage of patients who returned to work modified or full duty, 3 months after discharge. Efficiency: Access to services as measured by length of time from referral to admission (number of days from referral to admission) 2013 2013 2013 Village Source 1 Total Overall 25.7 39.96 31.99 Work Conditioning 27.92 28 27.96 Work Hardening 25.2 22 23.6 Chronic Pain 19 39.45 29.22 Brain Injury 24 70.4 47.2 By funding for Source One in 2013: Letter of Protection (LOP) 85.72 Workers Compensation (WC) 55.5 Latency of intervention, reported date of injury to date of admission in days: 2013 2013 2013 2012 Total Village Source One Overall average 564.06 670.88 457.25 502.5 Work Conditioning 350.46 188.92 512 271 Work Hardening 234.8 304.6 165 442 Chronic Pain 765 730 800 919 Brain Injury 906 1460 352 378

12 Outcomes Year to Date (YTD) by program: Work Conditioning: Village N=10; Source 1 N=22; total served=32 Functional Improvements: Return to work: For 2013, at the Village, 58% returned to work full or modified duty. At Source One in 2013, 69.5% of the Source One patients returned to work modified or full duty. For both facilities, average return to work was 63.75%. There have been challenges such as physicians making medical intervention recommendations post program, such as injections or second surgical opinions. For 2013 patients improved a combined average of 33.21% for J-Tech static lifts meeting minimum goal set. At the Village, average increase was 20.55 %, meeting minimum goal set. For Source One, persons served demonstrated an average 45.87% improvement meeting goal. Behavioral Measures: Pain Management: In 2013, average reported pain level at DC was 2.92 at the Village and 3.2 at Source One using the NAS scale. In 2013, YTD average reported pain levels for both facilities were 3.06 meeting goal expectations upon program completion. Efficiency Measures: Length of Stay In 2013, Average length of stay as compared to actual number of visits was 18.34 days for both facilities, meeting goal set of 18 days. At the Village, average time frame was 24.68 days, meeting min goal set; 12 days for Source One, meeting goal set. This time frame counts weekends in the number of days to complete the program. Referral to Admission In 2013, average number of days from referral to admission was 27.96 days for combined facilities. This did not meet minimum goal set of 10 days. At the Village in 2013, average number of days from referral to admission was 27.92 days as compared to Source One at 28 days. Neither met minimum expectations. Continuum of Care: In 2013, at the Village, 60% transitioned from traditional therapy to Work conditioning; 43% for Source One for a combined average of 51.5%.

13 Satisfaction Surveys: In 2013, average satisfaction combined facility scores were 1.3 meeting optimal goal, meeting goal set of 1.5, indicating excellent-good satisfaction. Average satisfaction score=1.38 for the Village, for Source One average satisfaction score=1.22 meeting goal set. Follow Up: In 2013, at the Village, 100% of the patients attempted to be contacted were successfully contacted. 80% were working. For Source One, 55% of the patients attempted to be contacted were successfully contacted. Of those, 43% were working modified or full duty. Work Hardening: Village N=5; Source 1 N=19; Total served N=24 Functional improvements: Return to Work: o In 2013, combined facility average percentage of persons served 68.5% returned to work full-time, meeting the optimum goal. This is a decrease from 2012 at 75.87%. In 2011, it was 55%.For 2013, at the Village, 60% returned to work at modified or at regular duty. At Source One for 2013, average return to modified or full duty was 77%. o In 2013, at the Village persons served demonstrated an average improvement of 48.05% using the J-Tech static NIOSH lifts as a measure of functional progress. For 2013, at Source 1, average improvement was 101.6%, exceeding goal set of 40%. For 2013, combined facility average improvement was 74.82%, exceeding opt goal. In 2012, combined average of 66.5%, exceeding optimum goal set of 50%. Behavioral Measures: Pain Management o In 2013, average reported pain level at DC for the Village and Source One was 3.24, meeting goal. For the Village, average reported pain level at DC was 2.9, meeting goal set of 0-3. At Source One average reported pain level at DC for 2013 was 3.59, meeting goal set of 0-3. For 2013 average facility combined reported pain levels were slightly higher than for 2012 at 2.85. Depression o For 2013, YTD average DC score for the Village persons served, for the Beck Depression Inventory-II was 7.2, exceeding optimum goal set of 14, indicating mild impairment. For 2013, YTD average DC score at Source One, for the Beck Depression Inventory-II was 8.6, exceeding optimum goal set, indicating mild impairment. YTD average DC combined facility scores for the Beck Depression Inventory-II was 7.9, exceeding optimum goal set of 14, indicating mild impairment. Anxiety o For 2013, YTD average DC score at the Village for the Beck Anxiety Inventory was 2.5, exceeding optimum goal. Average DC score at Source One for the Beck Anxiety

14 Inventory was 6.5, meeting goal. Average DC score for combined facilities on the Beck Anxiety Inventory was 2.5, exceeding optimum goal. Efficiency measures: Length of Stay o In 2013 at the Village, average length of stay as compared to actual number of visits completed did not meet minimum goal set. There was a 8.2 day difference, which exceeded goal. At Source One, there was a 13.37 day difference, which exceeded goal. Combined facilities there was a 10.78 day difference, exceeding opt goal set of 12 days. This measure does include weekends and the majority of programs are 5 days per week, this should be considered in the overall scope when assessing efficiency. Referral to Admission o In 2013 at the Village, average number of days from referral to admission was 25.2 days. This did not meet minimum goal set. At Source One, average number of days from referral to admission was 22 days. This did not meet minimum goal set. Overall average time to convert a referral to admission for both facilities was 23.6, which did not meet min goal set of 10 days. Continuum of Care: o For 2013 at the Village, 40% made the transition from therapy to work hardening programming. At Source One, 40% made the transition from therapy to a return to work program. Overall average for both facilities was 40% for persons served who moved from conservative care to a return to work program. Satisfaction Surveys: o For 2013, the Village average satisfaction score=1.08. At Source One, average score=1.29. Overall average for both facilities was 1.18, meeting optimum goal of 1.0. Follow up: o For the Village in 2013, 33% were available of those patients contacted. 33% working; 33% not working. For Source One: 67% patients were successfully contacted. 60% were working modified or full time. Overall average for both facilities was 46.5% working modified or full-time 3 months post discharge. Areas for improvement: YTD average number of days from referral to admission is below expectations, taking an average of 23.6 days to convert referrals to admissions for work hardening programs. Chronic Pain: Village N=1; Source One N=12; Total served=13 Functional Community Integration questionnaire (CIQ): For 2013, Source One YTD avg DC score=16.8 met goal Mayo Portland Inventory Questionnaire: For 2013, Source One YTD= 46.25, exceeding optimal goal set of 25.

15 Behavioral For Source One, in 2013, YTD avg pain level=6.0 did not meet min goal. For Source One, in 2013 YTD 75% met min goal. Behavioral measures were changed this year from the PAIRS to the Fear Avoidance Beliefs Questionnaire (FABQ), Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI). The psychology department felt that the new measures would be better measures to assess change for individuals involved in the Chronic Pain Program. o 2 nd Q Avg DC scores for the FABQ were 20, which did not meet min goal set. Consideration to Discontinue this measure. o For Source One, BDI-II YTD avg DC scores were 19, meeting min goal set of 17.6 indicating mild impairment. o For Source One, BAI YTD avg DC score=12.76, meeting min goal set of 16, indicating mild impairment. Patient Satisfaction For Source One in 2013, YTD average patient satisfaction score=1.11 meeting goal. Efficiency Measures Length of Stay In 2013, at the Village, there was a 10 day difference average length of stay as compared to actual number of visits completed. For Source One there was a 20.87 day difference, average length of stay as compared to actual number of visits completed, meeting min goal set of 25. Overall, there was a 15.43 day difference for both facilities combined. This was an improvement for 2012, where the difference was 33.12. Referral to Admission For 2013, at the Village, average number of days from referral to admission was 24 days. For Source One, average number of days from referral to admission was 70.4 days; 85.72 for LOP cases did not meet min goal. In 2012, average number of days from referral to admission for Source One was 40.4 days, min goal not met. Follow up For 2013 at the Village, zero patients were contacted for Chronic Pain. For Source One, we were able to reach 67% of those that were attempted. 50% of those were working modified or full time duty. Areas for improvement: Days from Referral to admission Patient perceived reported pain levels.

16 Brain Injury: Village N=1 Source One N=21; total served=22 Functional For 2013, at the Village the one person served was not working at discharge. For Source One, 61.75% returned to work or modified duty. In 2012, 25% of persons served returned to work part-time, meeting the optimum goal. For 2013, at the Village, information for the Mayo-Portland was not available. For Source One, average Mayo-Portland Inventory-4 DC T-scores were 35.5, indicating mild impairment, meeting opt goal set of 35. In 2012 there was insufficient data for the Mayo-Portland 4 inventory. For 2013, at the Village average DC score was 15/29 for the CIQ, meeting min goal set. For Source One, average DC score=15.9/29, meeting min goal set of 15. In 2012, there was insufficient data for the CIQ. Behavioral For 2013, at the Village, average reported pain was 5/10, meeting min goal set of 3. For Source One, average reported pain level =2.69 met goal. In 2012, Average reported pain level at DC was 2.6 using the NAS scale. Goal met. For 2013, at the Village, information was not available for the BDI-II. At Source One, for the Beck Depression Inventory-II, average DC scores were 16.82, meeting min goal set of 19, indicating mild impairment. In 2013, at the Village, information was not available for the BAI. At Source One, for the Beck Anxiety Inventory average DC scores were 10.94, meeting opt goal set of 10, indicating mild impairment. Patient Satisfaction For 2013, at the Village, information was not available. For Source One, average score=1.14, indicating excellent satisfaction with the program, meeting optimum goal set. In 2012, average satisfaction score, including 1 family member was 1.0, exceeding goal. Efficiency Measures Length of Stay In 2013, at the Village, there was a 16 day difference average length of stay as compared to actual number of visits completed. For Source One there was a 17.02 day difference, average length of stay as compared to actual number of visits completed, meeting min goal set of 25. This was an improvement for 2012, where the difference was 33.12. Referral to Admission For 2013, at the Village, average number of days from referral to admission was 24 days. For Source One, average number of days from referral to admission was 70.4 days; 85.72 for LOP cases did not meet min goal. In 2012, average number of days from referral to admission for Source One was 40.4 days, min goal not met. Continuum of Care In 2013, at the Village, 0 patients transitioned from traditional therapy. At Source One, 14% of persons served were referred from the therapy program at Source One.

17 Follow up For 2013, At Source One, 75% of the patients that we attempted to contact, were available. 50% of those were either working modified duty, full time or involved with DARS. Areas for improvement: Referral to admission conversion