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Client Situation: A large metropolitan hospitalís rehabilitation services division was losing money and market share.

Solution: To implement a solution that raises the quality of patient care, while increasing personnel efficiency, and thus turning the Rehab Division into a profit center for the hospital.

The Story Ė As Told By Ron Cram, CEO and P.T.

Within the past year, we have worked on a major hospital project at a large metropolitan hospital in Maryland. We converted all areas of the hospitalís rehabilitation department from an in-house program to a contracted service.

We personally negotiated the terms of the contract with the hospitalís administration to design a win-win-win for the hospital, our management company, and the hospital therapists - which converted to our employees.

We then negotiated with each therapist individually to retain them at the hospital. Through these negotiations, we were able to increase their pay and keep their benefits relatively unchanged.

In November 2005 we converted the operations to the new contract. Our initial project was overhauling the operations of the large outpatient clinic. Before our arrival the clinic was losing market share and money due to increased competition in the area. Because it was hospital-based, the registration process was cumbersome. We were able to change that into a single form that the patient had to fill out - thus reducing the registration process to mere minutes.

The scheduling process was difficult to use and the therapists had no motivation to treat more patients resulting in a 2-week wait for new patients. By replacing the schedule with our unique system Ė which we devised for another clinic, and implementing an incentive plan for the therapists, we were able to start treating walk-in referral patients within the first month of operation. We then hired a Site Manager for the clinic, and worked with him to instill a customer service-based attitude among all employees - starting with the front desk personnel, all the way to the site manager himself.

After turning the clinic over to the Site Manager, we then went on to the Acute Care unit at the hospital. Again, we inherited a situation where not all the referrals to Rehab were getting addressed. Poor practice efficiency was the main reason for the situation. We started by modeling our efficient practice techniques which have worked successfully for all our clients. We did this by utilizing support personnel in an appropriate manner, documenting treatment in the presence of the patient, and assigning therapists to be responsible for certain units and floors. Within weeks, 100% of the referrals were being addressed, and the hospitalís revenue increased 60% for acute care with a decrease in length of stay.

From acute care, we went on to the Transitional-Care unit based in the hospital. By instituting our tracking tools, we increased the length of stay from 7 days to 11 days and increased the RUGs category 2 grades. Revenues improved by almost 100%, and patient satisfaction rose to over 95%.

The final area we had to address was Home Health. Again, we inherited a situation where not all of the referrals were being addressed, and the unit was rarely hitting the 10-visit threshold. We changed the composition of the therapistsí pay from a per-hour rate to a per-visit rate. We did this because our statistics were showing a visit-length of over 90 minutes, with therapists averaging about 5 visits per day. By changing the pay structure, having educational peer reviews, and practice discussions, we reduced the visit length to 60 minutes, increased the visits per day to 6.5, eliminated the referral backlog and increased the hospitalís revenue for home health by over 30%.

The entire project lasted 7 months with Rehab Strategies Principal P.T. Ron Cram working on-site personally before handing it over to local managers.