Business proposal for IPR
Leslie Burgy, RNSt John Macomb Hospital Health care systems managementLDR 609October 28th,2013
Executive summary
Healthcare is transforming and there will be effects to Inpatient Rehabilitation (IPR) units
Executive summary:Current proposed Medicare reductions to IPR:
Reduction of payment updates for IPRs by 1.1 percentage points beginning in 2014 through 2023
Adjusting the standard for classifying IPR patients that are currently admitted under the designated severity codes from 60% to 75%
Equalized IRP and SNF payments on three conditions: hips, knees and pulmonary conditions
Implementation of bundled payments in 2018 (McCurdy, 2013, para 2).
Executive summary:
There has been a steady decrease in IPR admissions over the past five years changing the average daily census (ADC) from 26 to 19.
Proposal: decrease the number of IPR beds from 30 to 24 with an average daily census of 19.
How: By taking a total of 6 beds or 2 rooms off line and make a nursing associate lounge/locker room and storage room.
Project description and background information:Rationale: Changes in CMS regulations and intense work by the SJPHS
Readmission Reduction team has decreased the overall admissions to the acute care hospitals.
85 % of St John Macomb’s IPR admissions come from within the hospital.
The FY’12 IPR occupancy rate was 59% Decreasing the IPR beds from 30 to 24 and having ADC of
19 would give the unit about a 79% occupancy rate. Research indicates that occupancy rates over 85% have a
negative impact on patient safety and efficiency Compliance with TJC in keeping egresses clear and safe
medication storage Nursing WES statement consistently talk about the
aesthetics of the unit
Risks and barriers:
Current facts: ADC= 19.4 LOS= 10.375 days Two other IPR units in SJPHS which all
provide the same basic services SEMCOG reports decrease in population in
SE Michigan and the population is shifting towards Livingston and Northern Macomb counties
Risks and barriers:
Two competitors within a ten mile area: Henry Ford Health System and Beaumont Health System and both have IPR units
2012 overall market share Beaumont – 19.5 % Henry Ford- 21.4 % SJPHS- 27.8 %
Risk and barriers:
SJPHS Acute Care Asset Team looking at many areas which includes Rehabilitation Services
SJPHS not sure how Rehab services will look in the future but they will be looking at the model of care delivery but it will include systemizing rehab services
St John Macomb physicians not on board with regional department concept.
Risk and barriers:
Considerations of the ACA Bundled payments IPR units reimbursement higher than
nursing home placement. Facilities perspective: Nursing staff keeping personal
belongings (purses) in the med room Halls are cluttered with equipment
Fundamental Assumptions
Must continue to follow the current CMS guidelines for participation
Must maintain and staff a minimum of 10 beds to meet CMS criteria
Qualifying IPR criteria: 60% of the facilities total patient population must meet at least one of 13 medical conditions
Failure to comply with the 60% criteria will decrease reimbursement of the IPR current prospective payment system to that of a critical access hospital
Operations Continue to operate at the same FY’14 budgets for Rehab
Services Needs: lockers, table and chairs and keyless pad entry. Nursing FTEs will remain the same:
Job Title Job Code FTEs
RN 20206 17.00
RN Preceptor 20251 0.90
HUC 30408 1.90
PCT 70764 13.40
CNM 80947 1.0
34.20
Financials:
FY’14 budget will continue to be utilized
Total Operating Expenses for nursing cost center :
Actual: $1,907,999Flexed: $1,921,855
Implementation plan
Room 445 – 2 bed room and room 450 – 4 bed ward will be taken off line only
Room 445 will be made into a nursing associate lounge/locker room
Room 450 will be a equipment storage room
Implementation plan Plan could be implemented within a two
week time period Stakeholders in favor of project: nursing associates, therapy associates, EVS
and facilities departments Stakeholders that are currently neutral or
against project – Macomb physicians Compliance with TJC guidelines
Evaluation criteria
Subjective information from nursing associates and physicians
Decreased work environment statements regarding the aesthetics of the IPR unit
Standing agenda item on monthly IPR Macomb leadership meetings
Exit strategy
If the amount of admissions should have a sustained increase than Room 450, the four bed ward can be converted back to an operable room within 24 hours
References: CMS Manual System, Transmittal 119 Medicare Benefit Policy §
110-2 (January 15th, 2010). Inpatient rehabilitation facility prospective payment system.
(2012). Retrieved from http://www.cms.gov/Outreach-and-Education/Medicare-learning-network-MLN
Jones, R. (2011). Hospital bed occupancy demystified and why hospitals of different size and complexity must run at different average occupancy. British Journal of Healthcare Management, 17(6), 242-248.
McCurdy, D. A. (2013). Obama’s administration’s proposed FY 2014budget includes a $401 billion in health program savings. Retrieved from www.healthindustrywashingtonwatch.com-rehabilitation-facility
SEMCOG. (2012). www.semcog.org Shay, P. D., & Mick, S. S. (2013, January/February). Post acute care
and vertical integration after the patient protection and Affordable Care Act. Journal of Healthcare Management, 58(1), 15-27.
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