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Written by: Darlene D'Altorio-Jones (1959-2015) on Sunday, September 30, 2012 Posted in: Inpatient Rehab

It’s budget time of year and the annual challenge begins. Do more with less! ”You can do it, you did it last year.” Sound familiar? Sure it does! And in this past year, while operating with less, you examined every process, squeezed out as much waste as possible so your unit would be the leanest, meanest operational unit possible. You can squeeze more, right? Probably NOT!

Each year, the specialty units that take the highest concentration of patients with both medical and functional impairments are left to operate on budgets very similar to their med/surg counterpart units. Why? As an exempt unit with highly specialized-needs patients in concentration, the rehabilitation unit can often be perceived as the “step-child” or “second class citizen” to optimal staffing. I did not say that, I have heard that from many others. A budget is a budget and when you’re squeezing dollars, all beds look the same. Or do they?

There is a mound of information and regulation you can gather to demonstrate your rehabilitation unit is a step above a med/surg unit when staffing, and thatby cutting staff, you actually harm future payment. Your first due diligence is that you have accurate information to base this argument. So here it is. Rehab units classify each patient within the first three days through their IRF-PAI process. The “acuity” derived from that measurement tool is shared with CMS. Each year, your facility also files cost reports denoting the staffing and costs of that care. The question is, do your patient acuity measures and cost report information make sense? CMS uses this information to guide payment policy. In the 2013 Notice under “Area Wage Adjustment,” it states, “ The Secretary is required to update the IRF PPS wage index on the basis of information available to the Secretary on the wages and wage-related costs to furnish rehabilitation services.”

The information gathered from cost reports and analyzed by IHS GLOBAL INSIGHT, INC, 2nd QTR, 2012; Historical Data through 1st QTR, 2012, revealed in Table 3, of the 2013 IRF Notice the FY 2013 labor-related share as 69.981 percent for IRF care. Each year, this information is utilized to update reimbursement and is factored back into the facility adjusted payment and labor wage formulas by area.

Now lets’ ask, does the acuity of your patients match the staffing you provide? Are your patient safety and patient satisfaction scores commendable? Are your outcomes in line with where you need to be? If you continue to cut staffing to points that do not allow you to manage well in these areas, will you even be able to provide rehab care to the level your patients deserve?

We are not very smart to plan a realistic budget for the patient types we serve and therefore, we are paid accordingly.We perpetuate this nightmare. You need to analyze all your past numbers, see the patient acuity you manage and then manage staff to that acuity. If you don’t, your cost reports will provide the “real data” that is then pushed into the formulas that just keeps cutting your reimbursement. Each year, you are expected to do more with less. Why? You planned it that way and your cost reports validate what you provided nothing more. It’s a cost neutral system and you keep robbing yourself more neutrally!

At what point do you act responsibly and project payments that are in line with real costs to operate effectively and efficiently? You can start this budget cycle by educating your hospital on why it makes sense to staff to your excluded specialty unit to actually furnish rehabilitation services at a level the Secretary will have enough information to pay you accordingly based on the updated information available to provide that unique, intense interdisciplinary service. Your future and your budget depend on you!

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