Achieving Optimal Patient and Hospital Outcomes: Why Care Settings Matter

All post-acute settings are not created equal.¹ The growing rate of skilled nursing facility (SNF) closures has only reinforced this gap in care quality, leaving patients and hospitals straining to find care settings equipped and available to meet their unique needs.

This article highlights the benefits of inpatient rehabilitation and how its level of specialized care and excellent patient outcomes compare to SNFs.

Unique Benefits of Inpatient Rehabilitation

No other care setting offers inpatient rehabilitation’s specialized programming for hospital-level patients requiring intensive physical, occupational, and speech therapy.² This distinction sets inpatient rehabilitation facilities (IRFs) apart from SNFs across key outcome measures.

2023 Performance: SNF vs. IRF³

• Inpatient rehabilitation operations maintain a 70% discharge to the community rate - 37% higher than SNFs on average.
• SNF average length of stay (ALOS) was 2X higher than IRF ALOS.
• SNF 90-day readmission rate was 500,000 patients higher than IRF rates. 
• SNF 30- and 90-day mortality were nearly 2X IRF mortality.  

But what enables IRFs to produce these exceptional outcomes? Here are 7 unique IRF attributes:

License/Certification    

• IRF: Certified as acute level of care. Licensed as freestanding inpatient rehab hospital or distinct rehab unit within a host hospital.
  
  

• SNF: Licensed as a SNF.

Physician Involvement 

• IRF: Daily physician visits.
  
  

• SNF: Required physician visit during first 30 days; one visit every following 60 days.

Nursing

• IRF: Receive specialized training in rehab nursing, pain management and medication, skin integrity and self-care training.
  • Provide 24-hour nursing care; intervention, assessment and monitoring of: VS, IVFs/antibiotics, ostomy, catheter, trach, NG care; routine labs & diagnostics and respiratory equipment.
  • Average nursing hours per patient day (NHPPD): 6+      
    
    

• SNF: Must have at least one RN for eight straight hours/day, seven days/week, and either an RN or LPN/LVN on duty 24/7; intervention, assessment and monitoring of: VS, IVFs/antibiotics, ostomy, catheter, trach, NG care; routine labs & diagnostics and respiratory equipment.
  • Average NHPPD: 4.1

Rehab Therapy and Admission Criteria 

• IRF: Available to patients requiring intensive rehabilitation therapy (minimum requirement of two therapy disciplines). Patients participate in therapy three hours/day, five days a week or 15 hours over seven days.
  
  

• SNF: Patients must have a qualifying hospital stay for at least three patient days and a physician determines the patient requires daily skilled care from nursing or therapy.
  • PT/OT/ST available with a nondisciplinary approach to care. Level of participation, type and amount of therapy varies based on medical needs and functional potential.

Team Treatment          

• IRF: Interdisciplinary approach between physician, therapy team, social work and nursing to facilitate recovery. Physician-led weekly team conferences required.
  
  

• SNF: Interdisciplinary approach between therapy and nursing to facilitate recovery.

Ancillary Services         

• IRF: Services on site: pharmacy, lab, radiology, and all other hospital services.
  
  

• SNF: Services available, but not on site: pharmacy consultant, lab, radiology.

Patient Characteristics 

• IRF: Patient demonstrates sufficient potential to participate in rehab and make significant functional gains with the goal to return home or a community-based setting. Common admission patient description:

• Stroke or other neurologic disorder.
• Multiple major traumas to brain, spinal cord, or amputation.
• Burns.
• Arthritic and pain syndromes.
• Orthopedic fracture or bilateral joint replacement.
  
  

• SNF: Medically complex patients demonstrating a potential for significant functional gains. Common admission patient description:
  • CHF, post-COVID-19, COPD and diabetes exacerbation requiring monitoring.
  • Wound care > stage 2.
  • Orthopedic surgery, surgery with complications or stroke requiring mobility and activity of daily living recovery (tolerates less than three hrs therapy/day).
  • Infections requiring ongoing IV antibiotics.
  • Neurological illnesses.

Importance of Partnership in Post-Acute Recovery

While the benefits of inpatient rehabilitation are clear, running a rehabilitation unit or hospital is complex and highly regulated.

Many hospitals are finding joint venture or contract management partnership as a key strategy to help optimize their rehabilitation program and relieve the burden of self-management.

Lifepoint Rehabilitation’s decades of focused experience and national footprint has enabled hospital partner facilities to keep up with shifting care needs, while also improving outcomes and delivering greater patient access.

Visit LifepointRehabilitation.net to learn about Lifepoint’s customizable partner solutions that can help your hospital meet the unique needs of your patients.

References:

1. Nickels, T. (2020, June 24). AHA Letter on Resetting the IMPACT Act in Next COVID-19 Relief Package: Retrieved June 29, 2020, from https:// www.aha.org/lettercomment/2020-06-24-aha-letter-resetting-impact-act-next-covid-19-relief-package
2. Fact sheet: Inpatient rehabilitation facilities – a unique and critical service: AHA. American Hospital Association. (2019). Retrieved February 2, 2023, from https://www.aha.org/fact-sheets/2019-07-09-fact-sheet-inpatient-rehabilitation-facilities-unique-and-critical-service

3. Skilled nursing facility (SNF) quality reporting program (QRP) public reporting. CMS.gov. (2023). https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/nursinghomequalityinits/skilled-nursing-facility-quality-reporting-program/snf-quality-reporting-program-public-reporting