Using eRehabData Referral Tracking
to Market Your Program
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
 Know
 Know
 Know
your hospital case mix
your market
your 60% rule compliance percentage
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
 60% rule 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
Managing Internal Referrals
• Trending Information:
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Referral source
Referring physician
Zip code where patient resides
Payor source
Basic patient profile (anticipated CMG)
Accepted or denied with reason for denial
Other Views
• Referrals Outcomes:
 Designed to trend referral sources, referring
physicians, and conversion rates.
 Offers information on reasons for denied admission.
 You can filter the information to drill down on
physician, referral source, internal vs. external fill, and
reason for denied admission.
Other Views
• Referrals Outcomes:
 Use information to determine referral trends by• Referral source
• Referring physician
• Internal versus external fill
• Zip code breakdown
• Payor source breakdown
• Conversion rates
• Reasons for denial
 Drill down by RIC, CMG, and Patient
• Patient reports list patients denied
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
Managing External Referrals
• Trending Information:

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Referral source
Referring physician
Zip code where patient resides
Payor source
Basic patient profile (anticipated CMG)
Accepted or denied with reason for denial
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
Analyzing Your Market Data
External SWOT Analysis
This Rehab Center
That Rehab
Center
The Other Rehab
Center
xx, NC
xy, NC
xy, NC
30 miles
20 miles
20 miles
Type of
Program
IRF
IRF
LTACH
Number of
Beds
70
23
50
JCAHO/CARF
JCAHO/CARF
JCAHO
Brain Injury,
Spinal Cord Injury,
General Rehab
General Rehab
Long Term Placement
for Patients on
Ventilators, Wound
Care
Location
Miles from
Program
Accreditation
Specialties/
Focus
External SWOT Analysis
Strengths
Level 1 Trauma
Center; established
reputation; strong
neuro service; able
to care for medically
complex patients in
acute care
throughout the
geographic region;
medical school;
good internal
support and
effective internal
case management
for the hospital; PT,
OT, ST training
programs through a
local university,
CARF accredited.
Location; freestanding, new
building; up-todate amenities; 2
admissions
coordinators in
the community
creating a
marketing
presence; CARF
accredited.
Able to care for
patients that require
long term acute
care; equipped for
ventilator dependent
patients; wound
care, one person
dedicated to
marketing as a short
term rehab unit to
outside referral
sources. Able to take
patients at a lower
level of care.
External SWOT Analysis
Weaknesses
Staffing problems
have resulted in
closed beds; old
facilities
Recent
management
changes; staff
dissatisfaction
known in the
community;
strong
orthopedics unit
that is struggling
with the 75%
compliance.
Not a team
oriented rehab
process; staff
dissatisfaction;
not aggressive
therapy.
Opportunities
Get host’s county
residents back to
our facility.
Get host’s county
residents back to
our facility.
Develop referral
relationships for
patients that
progress past
that level of care.
External SWOT Analysis
Threats
Strong case
management
that creates the
tendency to keep
patients in their
system. Doctors
tell patients that
they will receive
better services at
this rehab center.
Strong case
management
that creates the
tendency to keep
patients in their
system.
They are
marketing
themselves as a
short term rehab
provider.
Internal SWOT Analysis
Number of Beds
16
Average Daily
Census
4
Specialties/
Focus
General Rehab
Strengths
History of providing good rehab care; family
atmosphere; team approach; new gazebo area for
treatment
Weaknesses
Exemption status was revoked; facilities are not state of
the art; difficult to recruit staff; no neurologist in the
locale; low staff morale; location
Internal SWOT Analysis
Opportunities
Utilize marketing resources to increase knowledge of our
services in the market; use promotional marketing
strategies to remind consumers of services; develop
stronger alliance with partner hospitals
Threats
Competitors are not offering their patients the choice of
returning home for rehab; many out of town referral
sources do not know about the rehab program or believe
that the rehab unit has closed; potential internal referrals
are captured at a <75% rate; exemption status concerns;
partner hospitals are not encouraged to utilize a rehab
center in their network; confusion in the marketplace over
what providers are IRFs.
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 60% rule compliant
Conducting a Non-Admission Review
What can we do about the too
impaired category?
 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
Action Plan Suggestions:
 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
Denial because “Too Functional”
 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
Action Plan Suggestions:
 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 60% 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 60% 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 Functional Independence Measure scores, and
60% rule compliance)
 Discuss what the outcome would likely be if the patient was
seen in another level of care.
Questions?
Lisa Bazemore
Lbazemore@erehabdata.com