Between rising SNF closures and hospital admissions, hospitals are strained to find post-acute settings equipped to meet patient needs. Discover the benefits of inpatient rehabilitation and how its quality and outcomes compare to SNFs.
All post-acute settings are not created equal.1 The growing rate of skilled nursing facility (SNF) closures has only reinforced this gap in care quality, leaving patients and hospitals straining to find care settings equipped and available to meet their unique needs.
This article highlights the benefits of inpatient rehabilitation and how its level of specialized care and excellent patient outcomes compare to SNFs.
Unique Benefits of Inpatient Rehabilitation
No other care setting offers inpatient rehabilitation’s specialized programming for hospital-level patients requiring intensive physical, occupational, and speech therapy.2 This distinction sets inpatient rehabilitation facilities (IRFs) apart from SNFs across key outcome measures.
2023 Performance: SNF vs. IRF3
Inpatient rehabilitation operations maintain a 70% discharge to the community rate - 37% higher than SNFs on average.
SNF average length of stay (ALOS) was 2X higher than IRF ALOS.
SNF 90-day readmission rate was 500,000 patients higher than IRF rates.
SNF 30- and 90-day mortality were nearly 2X IRF mortality.
But what enables IRFs to produce these exceptional outcomes? Here are 7 unique IRF attributes:
IRF: Certified as acute level of care. Licensed as freestanding inpatient rehab hospital or distinct rehab unit within a host hospital.
SNF: Licensed as a SNF.
IRF: Daily physician visits.
SNF: Required physician visit during first 30 days; one visit every following 60 days.
IRF: Receive specialized training in rehab nursing, pain management and medication, skin integrity and self-care training.
Provide 24-hour nursing care; intervention, assessment and monitoring of: VS, IVFs/antibiotics, ostomy, catheter, trach, NG care; routine labs & diagnostics and respiratory equipment.
Average nursing hours per patient day (NHPPD): 6+
SNF: Must have at least one RN for eight straight hours/day, seven days/week, and either an RN or LPN/LVN on duty 24/7; intervention, assessment, and monitoring of: VS, IVFs/antibiotics, ostomy, catheter, trach, NG care; routine labs & diagnostics and respiratory equipment
Average NHPPD: 4.1
Rehab Therapy and Admission Criteria
IRF: Available to patients requiring intensive rehabilitation therapy (minimum requirement of two therapy disciplines). Patients participate in therapy three hours/day, five days a week or 15 hours over seven days.
SNF: Patients must have a qualifying hospital stay for at least three patient days and a physician determines the patient requires daily skilled care from nursing or therapy.
PT/OT/ST available with a nondisciplinary approach to care. Level of participation, type and amount of therapy varies based on medical needs and functional potential.
IRF: Interdisciplinary approach between physician, therapy team, social work and nursing to facilitate recovery. Physician-led weekly team conferences required.
SNF: Interdisciplinary approach between therapy and nursing to facilitate recovery.
IRF: Services on site: pharmacy, lab, radiology, and all other hospital services.
SNF: Services available, but not on site: pharmacy consultant, lab, radiology.
IRF: Patient demonstrates sufficient potential to participate in rehab and make significant functional gains with the goal to return home or a community-based setting. Common admission patient description:
Stroke or other neurologic disorder.
Multiple major traumas to brain, spinal cord, or amputation.
Arthritic and pain syndromes.
Orthopedic fracture or bilateral joint replacement.
SNF: Medically complex patients demonstrating a potential for significant functional gains. Common admission patient description:
CHF, post-COVID-19, COPD and diabetes exacerbation requiring monitoring.
Wound care > stage 2.
Orthopedic surgery, surgery with complications or stroke requiring mobility and activity of daily living recovery (tolerates less than three hrs. therapy/day).
Infections requiring ongoing IV antibiotics.
Importance of Partnership in Post-Acute Recovery
While the benefits of inpatient rehabilitation are clear, running a rehabilitation unit or hospital is complex and highly regulated.
Many hospitals are finding joint venture or contract management partnership as a key strategy to help optimize their rehabilitation program and relieve the burden of self-management.
Lifepoint Rehabilitation’s decades of focused experience and national footprint has enabled hospital partner facilities to keep up with shifting care needs, while also improving outcomes and delivering greater patient access.
Visit LifepointRehabilitation.net to learn about Lifepoint’s customizable partner solutions that can help your hospital meet the unique needs of your patients.
As financial strain continues to impact hospitals across the country, health leaders are seeking partnership to increase financial stability amid an ever-changing healthcare landscape.
Partnership can help hospitals effectively obtain additional resources to provide high-quality patient care, strengthen service lines, and improve access and the overall patient experience.
Read this guide to discover how hospital leaders can overcome today’s unique challenges and make the most of the growing opportunity through joint-venture or contract management rehabilitation partnership – ultimately benefitting your hospital’s financial performance.
With the help of an experienced partner, hospitals can enhance their post-acute strategies in five key ways:
Improved Performance Under Value-Based Care
The shift to value-based care has pushed hospitals to reduce spending while improving quality and outcomes. In a study of value-based trends, it was found that more than a third of national reimbursement contracts are now value-based. This percentage has trended upward every year since 2015.1
A post-acute partnership strategy helps equip hospital staff and leadership with the resources to increase care quality and efficiency, make more timely transfers to post-acute settings, reduce readmission risk and generate long-term cost savings for the entire health system.
Increased Care Efficiency to Reduce Readmissions
Re-hospitalizations and other transfers in the post-acute continuum can lead to poor patient satisfaction and care quality, ultimately creating negative financial consequences. Research shows that some of the lowest-performing hospitals around the nation can experience readmission penalties two to three times higher than those performing at an average rate.2
Through specialized expertise, access to national resources and data, and a team with a focused ability to recruit and retain top talent, a rehabilitation partner can greatly expand a hospital’s ability to provide excellent patient care in an efficient manner. Further, a rehabilitation partner can help produce faster recovery times, reduced care costs and can create a more positive overall patient experience.
Supports Medicare’s “Triple Aim”
Successfully managing all aspects of a rehabilitation unit has become more challenging due to the growing complexity of patients treated, readmission risks and the expansion of value-based care integration. However, if a health system is able to achieve an effective post-acute strategy they can better manage the intricacies of the program.
Rehabilitation partnership supports Medicare’s triple aim, helping to:
Enhance care. Provide exceptional care to individuals through high-quality programs aimed at improving a patient’s health and independence.
Improve community health. Experienced partners have access to the latest national trends and resources beyond the data available to individual facilities. This allows local programs to be equipped with best-in-class treatment plans to effectively treat a wider variety of complex conditions.
Lower care cost. Greater patient access, expertise and quality lead to better outcomes, lower length of stay and lower readmissions. Additionally, facilities are able to more effectively deploy resources and improve operational efficiency, further lowering costs.
An effective partner will also have a well-organized system for efficiently transitioning patients through phases of care. This helps lower per-patient costs, improves regulatory compliance and enables patients requiring specialized care to receive high-quality care.
Specialized Care for COVID-19 and Medically Complex Patients
Throughout the pandemic, specialty hospitals have played an invaluable role in the public health response. Research notes that 20 percent of patients recovering from COVID-19 require facility-based rehabilitation.2 This value was shown through the interdisciplinary rehabilitation teams who helped patients recover from severe clinical presentations of COVID-19.
Hospitals that partnered with experts to operate their inpatient rehabilitation program prior to the pandemic were often better prepared to take on the fluctuations in care, including patient volume, recruitment challenges, advanced safety protocols and new therapies for COVID-19 patients.
Streamlined Patient Care Path
Rehabilitation therapy services are expected to continue to grow through 2028.3 With this expected growth, it is important to evaluate where patients are going to receive rehabilitative care and where there is an opportunity to keep patients within the system.
Expanding post-acute services within the hospital’s care continuum helps the hospital to have more control over outcomes, reduce care transitions and help maintain patient satisfaction throughout the care journey.
How Partnership Can Help with Hospital Financial Performance
Partnering with a focused rehabilitation expert can ease the burden of managing inpatient rehabilitation, increase patient access, and help improve clinical quality and operational efficiency – all of which will ultimately help the hospital achieve greater financial performance.
To stay ahead of the curve and adapt to the rapidly changing healthcare landscape, providers are finding success by pooling together their strengths and resources, notes Lifepoint Health CEO, David Dill.1
Partnership has become a leading strategy to efficiently improve quality while continuing to meet the needs of the growing medically complex patient population. However, every hospital and community is different. A one-size-fits-all partnership strategy does not exist. Partnerships can vary in model, stage of the care continuum and facility type.
Discover key hospital partnership models that can meet growing medically complex patient needs, and the service lines that can most benefit from partnership.
Benefits Of Dual Specialty Integration for The Overall Hospital
Specialty hospitals, especially those with multiple care offerings, have historically earned the highest levels of patient satisfaction.2 This makes specialty hospitals “attractive partners for health systems, physician groups, and general hospitals, particularly for those in established or emerging value-based payment markets.”3
Specialized service lines are important as the number of patients with multiple comorbidities increases. Two rapidly growing service lines that can benefit from partnership and play a pivotal role in patient outcomes when integrated together are:
Spurred further by the increasing medically complex population, patient preferences and skilled nursing closures, the need for inpatient rehabilitation is rapidly growing. Healthcare executives have found rehabilitation partnership allows them to more easily add and optimize this needed service to their care continuum.
Not having a dedicated behavioral health program has shown to contribute to the growing capacity issues within emergency departments (ED), leading patients to forego the necessary and timely care they need. However, behavioral health integration is complex and requires specialized expertise that can take away from the hospital’s core service lines.
Through partnership, hospitals can efficiently address a full range of behavioral health issues including mental health, psychiatric care, addiction treatment and counselinghospitals can improve patient outcomes, reduce cost and improve community health.
Behavioral health and rehabilitation program integration are important programs independently, but when paired together as a dual integration strategy, can provide substantial benefit to the entire care continuum.
Patients suffering from both behavioral health and inpatient rehabilitation needs can experience improved outcomes simply due to having all their care needs meet under the same roof – devoid of transfer.
Once a hospital determines that their community would benefit from enhanced services such as specialized behavioral health or inpatient rehabilitation– or co-locating both – identifying the partnership model best suited to meet the hospital’s unique needs is an important next step.
3 Most Common Partnership Models
Often, merger and acquisitions are the most commonly referenced partnership types, but there are other proven models based on the hospital’s specific needs and opportunities.
Joint-venture (JV): This option presents local hospitals with the opportunity to leverage the unique strengths, specialized expertise and resources of a national provider. All of which are designed to help the local hospital elevate its offering and expand patient access. This was the case for one community health group that was able to grow its average daily census of less than 100 to over 500 through a JV partnership model.4
Contract management agreement: This is an ideal option for hospitals wanting to maintain full ownership while also tapping into the expertise of a focused partner. Contract management can also be a great place to start when considering a long-term partner. It gives both parties time to confirm that the organizations are a strong fit before moving into a joint venture.
Hospital merger and acquisition (M&A): Since 2021, M&A activity has seen a 25 percent increase and is expected to continue to grow for years to come.5 M&As may be best for hospitals that lack the resources necessary to optimize complex processes, including revenue cycle, supply chain and productivity. They may also be appropriate for hospitals lacking expertise in operating highly specialized service lines such as behavioral health.
Each model offers its own unique benefits to the hospital, its patients and the community as a whole. Together, the right partners can identify the model and structure that best leverages each partner’s strengths and meets the opportunity.
From meeting medically complex patient needs to improving financial performance, post-acute care integration has never been more important for a hospital’s overall strategy.
Learn the top trends in rehabilitation for 2023 and hear from Lifepoint Rehabilitation and Behavioral Health President Russ Bailey on how these trends are expected to impact hospitals.
1. Combating the ongoing workforce crisis
Recruiting and retaining clinical talent remains a top priority, according to a recent healthcare executive survey. Three key factors fueling this ongoing shortage include:
- Elevated staffing costs
Due to various COVID-19 surges, labor costs have grown 25% since 2019.1 “It has become increasingly difficult for hospitals to keep up with service demands with a drastically declining workforce,” shared Bailey. Support from a focused partner with local and national reach helps hospitals to identify and retain specialized talent.
- Worsening experience-complexity gap
Another shortage among the clinical workforce is experience.2 “Not only are we seeing a large gap in experienced labor, the patient population is becoming older and more complex. This has pushed hospitals to seek support from an industry expert to help alleviate this labor-patient imbalance,” stated Bailey.
- Capacity constraints
A lack of clinical labor, treatment supplies and bed space has heightened the healthcare labor crisis. Bailey said, “These compounding factors cannot be taken on by a single hospital. Partnership allows hospitals to focus on quality care while the partner provides specialized resources and expertise to overcome challenges such as capacity constraints.”
2. Scaling chronic disease management
Research notes that more than 655,000 people in the U.S. die from heart disease each year, while nearly 800,000 experience a stroke annually.3 “Seeing cases like heart disease and stroke drastically rise each year is just one of the many reasons hospitals are including elevated chronic disease management into their overall strategy,” stated Bailey.
“When Lifepoint partners with hospitals, we bring in specialized technology, training and expertise to help equip staff with resources to succeed with their patients, no matter their condition.”
3. Leveraging flexible care models
Now more than ever, hospitals are reviewing the scope and scale of their care continuum – leading to service line expansions, and an increase in ambulatory sites, digital health, and post-acute care.4
Co-location continues to see substantial growth as patients with both physical and mental illnesses want to receive high-quality care in the same setting. This model, also referred to as the Hospital-in-Hospital (HiH) model, helps streamline a hospital’s care approach while improving outcomes and flexibility.
“When you pair post-acute services under the same roof, you enable patients to reap the benefits of multiple specialty offerings without having to transfer them outside of the system,” stated Bailey.
4. Focus on financial stability
Eighty three percent of healthcare executives note financial stability is one of their top priorities for 2023 strategic planning.5
“Successfully managing all aspects of a rehabilitation unit or hospital has become more financially challenging due to growing patient complexities, readmission risks and the integration of value-based care,” stated Bailey. “If a hospital can achieve an effective post-acute strategy they can better manage the intricacies of the program and increase care quality in a cost-conscious way.”
5. Growth of strategic partnerships
Throughout the pandemic, health leaders turned to innovative solutions to meet the growing demand in their community. Contract management and joint-venture partnerships emerged as a proven strategy to expand care in a high-quality and cost-effective manner.
“Partnership offers access to new capabilities, increased speed to market, and greater efficiencies in capital, scale and operations,” stated Bailey. “Lifepoint Rehabilitation helps local hospitals access a national database of quality data, greater operational efficiency and industry-leading best practices. Through this, we are able to relieve the burden of running a complex service line, enabling hospitals leadership to focus on what really matters – the patient.”
To learn how Lifepoint Rehabilitation can help your hospital meet growing opportunities and stay ahead of future trends, visit LifepointRehabilitation.net