Reading Rehabilitation

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Reading Rehabilitation

• Implementing Patient-Focused Care

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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 home of Isaac Eberly, a
  prominent 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 successful
  companies
• On board of RRH for 3 years

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Kreitners Forecast

• Kreitner The hospital had an awesome
  reputation, a dedicated 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 RRH
  and not typical for that industry.
• It made many of the staff feel uncomfortable
  because they had been in a thriving industry for
  15-20 years and did not want to believe they were
  in trouble.
• Needless to say, his opinion was not universally
  shared due to his lack of healthcare industry
  experience.

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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 average which 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 in Pennsylvania.
• The well being of the patient is the number one
  priority of the RRH, 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 limit itself to the physical healing, but
  spiritual healing as well.

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Purpose

• The organizations values, as well as strategic
  and operational decisions were also base on this
  vision.
• The mission and vision of Reading Rehabilitation
  Hospital was put at a test due to the competitive
  world of health care.
• As mentioned by Kreitner, the CEO brought in
  since 1989, finding balance between mission and
  real world business practice was one of the
  greatest 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 patients
  diagnosis, 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. healthcare industry 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 health benefits and improve the
  quality of care.
• According to the National Library of Medicine,
  managed care encompasses programs.

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Main Purpose

• To reduce unnecessary health care costs through a
  variety
• of mechanisms such as

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Fee-for-Service (FFS)
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Change

• This all changed in 1980s with new state laws
  that allowed insurance companies to negotiate
  prices directly with health care providers.
• In attempt to reduce costs

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What would happen

• Patients would choose from a predetermined list
  of participating doctors, a primary care
  physician (PCP) who served as the gatekeeper
  for the patient.
• These changes meant that hospitals had to perform
  tasks more efficiently so costs did not exceed
  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
  healthcare systemat least for the time being!
• Most RRH patients were on Medicare, and the more
  generous the Medicare rate was, the more
  advantage it was 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 than maximizing the reimbursement.

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Main Goal
TO MAXIMIZE INCENTIVE PAY
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Competition

• Reading Rehabilitation Hospital
• Only 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

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Patient Flow
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Continuum of Care

• Acute care hospitals kept patients longer
• Create new efficiencies and fill empty beds
• Traditional nursing homes began offering many
  rehab services
• Rehab expansion of other industry participation
  would have a negative effect on RRH

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Market Conditions

• RRH only licensed provider of acute rehab
  services in Berks County
• RHMC tried to buy RRHs license
• Clint Kreitner valued it at 6-8 Million
• Pennsylvania Regulations required Certification
  of need (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, the organization 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 among
  treatments
• Kreitner Implemented Continuous Improvement
  Initiative
• 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 status
• Patient 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 short
  length 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 nursing
• Minimum 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
  reimbursement landscape
• 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 primary nurse
• 24-hour team of registered nurses and personal
  care assistants assess and attend to each
  patient's needs. They work in partnership under
  the primary nurse-model, which assures continuity
  of care.
• Although time-limited twice weekly conferences
  were piloted, weekly interdisciplinary team
  meetings have been adopted under HealthSouth
• Each week your treatment team will meet to
  discuss your progress, goals and discharge plan.

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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 evidenced by 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 meeting patient 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 HeathSouth Reading Rehabilitation Web
  sitehttp//www.healthsouthreading.com/quality_co
  mmit.asp
• Frequently Asked Questions. Retrieved November 7,
  2008, from HeathSouth Reading Rehabilitation Web
  sitehttp//www.healthsouthreading.com/quality_co
  mmit.asp
• Gittell, 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/mana
  gedcare.html
• Managed Care. Retrieved November 4, 2008, from
  http//en.wikipedia.org/wiki/Managed_care