Extra Step’ helps increase rehab patient compliance
Program is a hit with referral sources
The absentee rate for industrial rehabilitation clients has dropped from 25% to less than 10% at Company Care, an industrial rehabilitation program of Good Samaritan Health System in Kearney, NE, almost immediately after the center began its "Extra Step" program to increase patient compliance.
"It’s not enough just to have all the components in place for a comprehensive industrial rehabilitation program. We have to go the extra step’ to get injured workers back to work," says Jeff Montag, MS, CWA, CCM, industrial rehabilitation program director for Good Samaritan Health Systems.
Instead, Montag advises looking in advance at all the reasons why injured workers fail to show up for their rehabilitation programs and taking proactive steps to overcome them.
The industrial rehabilitation program at Good Samaritan Health Systems developed the program three years ago with input from the center’s community advisory committee a cross section of patients, payers, industry representatives, and referral sources.
(For more on the community advisory committee, see related story, p. 84.)
"The results were amazing. Every time a patient has an excuse for being absent, we have a remedy," Montag says.
The staff began by listing every excuse they had heard from patients who were absent from the program. They lumped similar excuses together and came up with ways to overcome them.
The hospital allocated $10,000 the first year to pay for some components of the program, such as taxi fare for patients whose transportation fell through. The program didn’t use the entire amount the first year. Now $5,500 is budgeted for the Extra Step program annually.
Increased revenue from better patient participation has more than made up for the cost of the Extra Step program, Montag says.
"We charge a daily rate and don’t charge the insurer if the patient doesn’t show up," Montag says. "If the patients are there, we make the money. If they are absent, we don’t."
A ripple effect
In addition, the Extra Step program has had a ripple effect, generating referrals from payers and company rehab nurses who know that Company Care will take the extra effort to get the patients back to work, Montag says.
"We know that if patients attend therapy on a regular basis they get better," he says. "We take the extra steps to see that they come in. Being proactive in handling excuses for absenteeism is actually an extension of our marketing program."
No excuses!
Company Care’s Extra Step program includes a variety of mechanisms to deal with and overcome the reasons why clients don’t show up for their therapy.
Some of the common excuses given and the methods used to combat them are as follows:
• Money problems.
A petty cash fund provides money to help patients overcome financial obstacles to program participation. For example, the center will loan patients money to pay for gas, a baby sitter, or lunch when their disabilities checks are late. Patients are asked to sign an agreement indicating that they will repay the loan when they get their checks.
"We’ve found this to be a useful tool to ensure continuous attendance for clients who have a variety of compliance problems," Montag says.
• Too far away.
The hospital has negotiated agreements with two hotels close to the industrial rehab center to provide discounted room rates for patients who otherwise would have to travel long distances to come in for rehab. Many patients live in rural areas as far as 250 miles from the center. They stay at the hotel and attend rehab sessions during the week and return home on weekends.
Third-party payers pick up the tab for the hotel rooms but having the arrangement is a convenience for them, Montag says.
Proximity encourages compliance
"If patients are nearly on-site, it dramatically increase their chances for better attendance," Montag says.
In addition to cutting down on driving time, lodging patients nearby avoids exacerbation of their symptoms that long car trips can cause, Montag says.
• Transportation difficulties.
The hospital has made arrangements with a local cab company to pick up industrial rehab patients from as far as 50 miles away. The cost of the service is based on distance and is paid for by the insurance company or the hospital, depending on the clients’ coverage.
The center uses the cab service for clients staying at the hotels or for those who call to cancel their appointments because of car trouble.
• Lack of follow-through.
Patient compliance is heavily stressed in orientation sessions and throughout the rehabilitation process.
For example, during orientation the staff review the rehab process step by step, stressing the patients’ responsibilities, such as attending therapy sessions and complying with home exercise programs. Patients receive a package of written information outlining expectations, goals, rules and regulations, and safety issues.
The information stresses that the center monitors absenteeism, and if patients fail to show up for therapy, they may jeopardize their ability to come back to the program.
Agreement put in writing
Patients must sign an agreement to comply with the expectations set out in the orientation packet. If they have perfect attendance in the rehab program, they receive a free T-shirt.
When a patient misses a session, the rehab team takes steps to see that it doesn’t happen again. The team telephones all parties involved in the worker’s case, including company representatives, case managers, and payers.
The center sends out an absentee verification form to the patient, requesting a reason the absence occurred. The reason is logged into the patient’s chart.
Letters are sent to the insurance company and the rehab nurse at the patient’s company notifying them in writing of the absence.
The team also sends a letter to the patient’s home stressing the importance of attendance and offering to help the patient avoid further absences.
Patients who aren’t making good progress after two weeks and begin having absenteeism are referred to an internist to determine if they have other physical problems. In two recent cases, participants who had reported having low back pain were diagnosed with diverticulitis and ulcers.
[For more information on the Extra Step program, contact Jeff Montag at (308) 865-2727.]
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