Marketing Strategies and Non-Admission Review 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 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 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.

Questions? Lisa Bazemore