Competitors merge; LOS, costs slashed
More patients improve efficiency, outcomes
The merger of three competing Spokane, WA, rehab units and the development of a new model of care have resulted in a 36% decrease in inpatient costs per day at the new entity, St. Luke’s Rehabilitation Institute.The length of stay for all diagnoses was 22 days when St. Luke’s opened in 1994. It has decreased to an average of 17 days in two years, while outcomes have stayed constant or improved. (For more information about the merger, see story, p. 94.)
Part of the savings has resulted from spreading overhead expenses among a greater number of patients, says Debra Hanks, administrator of St. Luke’s.
The merger has eliminated the need to buy duplicate pieces of expensive equipment. It also has enabled the hospital to develop community programs, such as a rural rehab program, without duplicating efforts.
"The merger has been very positive because it has brought competing hospitals together at the table to look at health care and see what we can do differently," says Nancy Hughes, director of inpatient and day rehab programs. (For a look at some of the new ways to treat patients, see story, p. 99.)
Combining the rehab programs also gives the hospital enough volume to allow staff to become experts in treating certain types of patients, rather than rotating among programs, Hanks explains.
"Our combined resources have given us the ability to develop clinical experts," she says. "For instance, when we were competing head-to-head, none of our facilities had enough patients in the spinal cord unit to allow staff to specialize in that area. Now we have two spinal cord teams who have developed their expertise."
Since the staff can specialize, they know what care the patients need, what equipment they’ll use, and what post-discharge resources are required.
Staff have increased their productivity through innovations such as interdisciplinary therapy groups and evening therapy. (For details on these programs, see story, p. 99.)
A new model of care, which organizes staff around programs rather than discipline-specific departments, helps account for the savings, she says. The reorganization task force created a model of care based on service lines. Each service line has a manager who also does clinical care.
The new model of care also keeps the administration lean. There are five administrative team members and a medical director. Including staff with joint supervisory and clinical roles, a total of 15 full-time-equivalent managers for 480 employees work within a budget of $35 million.
There were not enough management positions for all who previously had been managers in their respective programs, but no one who wanted to work at St. Luke’s lost a job in the merger.
The number of staff, however, has increased from 298 to 480 since the facility opened in September 1994.
Inpatient rehab includes service lines in stroke, orthopedics, spinal cord injury, brain injury, pulmonary rehab, and general rehab.
The hospital operates a day rehab program, an adult and pediatric outpatient program, a pain clinic, an industrial rehab clinic, an alternate care program, and a home-based rehab program. Some of the hospital’s employees are subcontracted to three acute care hospitals, a hospice, a home health agency, two long-term care facilities, and a vocational rehabilitation organization.
Standardized care
Staff who work for St. Luke’s have the same standards of practice across the continuum.For instance, patients are educated in the same manner on transfer techniques, whether they’re in acute care, outpatient care, or home health.
All standards, policies and procedures, and protocols are accessible through the hospital information system for all locations. All programs are on the hospital’s information system. Care paths are being developed that start with trauma and go through the entire continuum.
The standards of practice set the minimum standards for a particular staff member, such as a physical therapist, who is treating a particular diagnosis. They set the modality and treatment the patient requires and the level of expertise and education the staff must have.
"Whether the patient is in the acute care hospital, acute inpatient rehab, the nursing home, or in home health, he receives the same quality of care," Hanks says. "If an agency contracts with us, they can be assured their patients are getting the hospital standard of care."
Because the hospital does not have discipline-specific departments and managers, the standards of practice have been developed by councils from each discipline.
The councils, composed of employees from all sites, also decided on baseline entry-level qualifications, job descriptions, and performance evaluations. They meet every two weeks for about an hour.
Administrative liaisons work with each council, but they do not make decisions.
"We get a lot more buy-in through the councils," Hanks says. "They are held accountable for maintaining the standards of practice for their discipline and communicating information to their colleagues."
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