Lisa Bazemore, MBA, MS, CCC-SLP
Director of Consulting Services

Objectives
• Today we will talk about the following topics:
 Review of census development strategies
 Analyzing your facility's patient selection criteria
 How to expand the population that you serve
 Conducting a review of patients who were denied admission

Philosophy
• Goals for Census Development
 Serve the patients from the host hospital, in the communities, and surrounding areas where we live.
 Extend the reach of case management
 Follow through for patients with post acute needs from time of admission
 Reduce the burden on the referral source

Census Development
• Principles of census development
 Know your hospital case mix
 Know your market
 Know your 75% rule compliance percentage
 Know who is referring, when, and how much

Internal Case Finding
• Daily Activities
 Address all referrals
 Complete floor rounds
 Face to face meetings with physicians
 Surgical list, Pre-admission testing
 Review new admissions to the hospital in previous 24 hours
 Analyze Out-migration
• ED, Transfers
 Plan for weekend coverage

Managing Internal Referrals
• Set goals
 Admissions and referrals
 Census, LOS
• Know
 75/25% compliance
 Hospital med-surg census
 Referrals
• Acceptance
• Pending
• Denied and the reasons why

Managing Internal Referrals
• Do not rely on referrals only
• Be proactive in approaching referral sources
• Be an extension of case management
• Educate with each acceptance / denial
• Share outcomes with physicians and referral sources
• Reduce the following denials:
 Managed care
 Inappropriate denials from the Medical
Director

Tools for External Census Development
• What tools do you need to accomplish this?
 A map of your geographic primary and secondary coverage area
 A list of all acute med-surg hospitals, skilled nursing facilities and acute rehab facilities in your area – KNOW their bed capacity, actual occupancy rate and trauma levels
 Knowledge of affiliations, partnerships, alliances and services offered
 MedPar data or hospital association data
 Hospital’s ER log to determine facility outmigration

Analyze your market data
• Map It
 Create a visual of your market – use a map to note all hospitals, SNFs and acute rehab facilities in your geographic coverage areas
 Complete a SWOT – Strengths, Weaknesses,
Opportunities and Threats of each of you competitors

Develop a Customer Hit List
 Create a Customer Hit list for each organization that you plan to market – Hospitals, SNFs,
Physician clinics, Payors, Home Health
Agencies…
 Target all individuals who can influence and/or decide the next level of care for the patient

Ranking
• Rank your referral sources based on the volume that they send
 “A”- highest volume referral sources
• Visit these on a regular basis
 “B” - potential growth customers
• Increase the time dedicated to these referral sources
 “C” - low volume referral sources or potential where contact is necessary but excessive time spent here would be wasted
• Fill in your free time with these referral sources

Preparing for a Marketing Call
• Establish your goals for the call
• Find out what you can up front
• What do you want to know/ask?
• Anticipate Their questions
• Anticipate Objections
• Practice!

Physician Calls
Information to give and receive
 Where are they on staff?
 What is the conversion ratio for their patients
 What have the outcomes been for their patients
 Share Progress Notes as applicable
 Find out how your program can meet the physician’s needs
 Conduct a needs assessment for specialty programming

Discharge Planner Calls
Information to give and receive
 What is the conversion ratio for their patients
 What have the outcomes been for their patients
 Your Location - what areas your patients come from
 Community discharge rate
 Utilization of Post Acute Continuum

Managed Care Plan Calls
• Information to give and receive
 Your conversion percentage
 Your location
 Average length of stay & outcomes
 Specialty Programs
 Continuum of Services
 Admit 24/7 – Weekend/Holiday Therapy
 Percentage transferred to SNF, Acute, Home

Conducting a Non-Admission Review
• Non-admission review:
The review of all patients that have not been admitted to rehab unit. This is done by reviewing the pre-admission forms and reviewing the section that notes the reason for not admitting to the rehab unit to help identify trends and changes that occur over a quarter.
• Common Reasons
 Too impaired
 Too functional
 No bed available
 Physician did not agree
 Patient or family refused
 Insurance did not authorize
 Not 75% rule compliant

Conducting a Non-Admission Review
 Determine if the admission denial was based on objective criteria
 Identify if the denial was based on staff’s lack of competency
 Clarify with Medical Director his/her comfort level with the staff managing a patient with that diagnosis or at that level of acuity

Conducting a Non-Admission Review
 Identify staff educational needs for diagnoses that are being denied
 Ask Medical Director to provide in-services if appropriate
 Provide educational in-services that enhance staff’s skill set to care for more complex patients
 Consider adding these skills to staff’s competency list

Conducting a Non-Admission Review
 Review the referral date against the actual date of the screen
 Would reducing the number of onset days have resulted in a decision to admit?
 Determine what the patient’s deficits really were and if they could have benefited from a stay in an IRF.

Conducting a Non-Admission Review
 Consider offering an in-service to case managers regarding the referral time frames
 Review the discharge disposition and consider if those that are discharged to skilled might have been appropriate for ARU
 Shorten up the time frame between referral and actual screen if not done the same day

Making Admission Decisions
• How should the process work?
 The admissions coordinator or liaison screens the patient
 The AC makes a determination about whether or not the patient meets the conditions of participation
 If yes, the AC reviews the case with the program director
 If no, the patient is denied and the reason for denial is tracked for later review under the performance improvement plan

Making Admission Decisions
• How should the process work?
 The program director determines if the patient meets the criteria for 75% rule compliance and whether they are eligible for admission given their current compliance threshold
 If yes, the case is taken to the medical director to make a final admission decision
 If no, the case is tracked as a denial for later review

Making Admission Decisions
• Making a good decision demands good information, so what does the medical director need to know in order to make good decisions:
 Why does the patient need a stay on rehab?
 What do you think will be involved in the caring for that patient?
 Are their 75% rule compliant conditions? Tiering comorbidities?

Making Admission Decisions
• Making a good decision demands good information, so what does the medical director need to know in order to make good decisions:
 Will the patient be able to participate in 3-hours of therapy?
 What evidence supports the medical necessity of this admission?
 Is the patient ready for transfer?

Making Admission Decisions
• What are your barriers to admission?
 Does your medical director advocate for patients to have an opportunity at rehab?
 Do you advocate for patients to have an opportunity at rehab?
 Rehab patients no longer fit the typical mold. Who do you take? Who do you deny?
 Being able to calculate the risk is necessary. What is a smart risk?

Making Admission Decisions
• What are your barriers to admission?
 What can your staff handle? How do you know?
 What are you doing to remove the barriers?
 What is the alternative placement?
 Is that a good option for you patient?

Making Admission Decisions
• So how do you sell it to the Medical Director and the team?
 Present the case as if rehab is the only place for the patient.
 Discuss the medical needs and how you plan to meet them.
 Talk about your experience with patients with that diagnosis.
 Talk about your facility averages and why you think this patient is worth the risk. (Transfer payments, ALOS, admission FIM scores, and 75% rule compliance)
 Discuss what the outcome would likely be if the patient was seen in another level of care.

Lisa Bazemore
Lbazemore@erehabdata.com