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Behavioral Health Frequently Asked Questions
- Is it realistic to operate a financially viable
behavioral health program and meet our community’s needs in today’s
healthcare climate?
- Yes. This is one of two healthcare niches in which
Signet Health specializes. Our hospital clients have clinically
excellent psych programs that contribute significantly to the
hospital’s overall financial health.
Contact us
today for a no cost financial, market and competitive analysis.
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- What impact has the implementation of IPF-PPS for
inpatient psychiatric programs had on the financial outcomes in
inpatient behavioral health at our hospital?
- The Prospective Payment System for Inpatient
Psychiatric Programs (IPF-PPS) changed reimbursement from a cost
based system to a per-diem rate system for distinct part units (DPU)
in hospitals. Since it was designed to be budget neutral,
reimbursement for psychiatric services for some hospitals have
improved while other hospitals will receive less reimbursement than
they would have under the former cost-based system. Signet Health
assists client hospitals with strategy adjustments to benefit from
IPF-PPS reimbursement as compared to the out-dated strategies
utilized with the old cost-based revenue system.
Contact us
today for a complimentary analysis of the full revenue potential
your psychiatric program could be providing for your hospital
facility.
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- What impact will we have on our disproportionate
share revenue if we change our behavioral health strategy?
- Disproportionate share revenue (DSHPRO) is an
important revenue stream for many hospitals. When developing a new
strategic direction for mental health services, Signet Health
provides expert DSHPRO estimates while coordinating bed-space
strategy recommendations. While opening a distinct part psychiatric
program that is exempt from acute PPS will generally have no impact
on disproportionate share revenue, there are instances where opening
a DPU would have an adverse impact. Conversely, if beds are
de-exempted from an existing psychiatric program (deducted from the
distinct part unit exemption), patients treated in these non-exempt
psych beds could have a positive impact on your disproportionate
share revenue. Let Signet provide the complimentary analysis
necessary to develop a strategy that may maximize disproportionate
share revenue for your hospital.
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- We may or may not need help with recruiting
psychiatrists? What are Signet’s capabilities in recruiting
physicians?
- Signet is very flexible with our client hospital’s
physician needs. We will assist you or fully recruit psychiatrists
or other professional positions as the needs of your hospital
dictate.
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- Our hospital is seeing more psych patients through
our emergency department. Can you help us develop a strategy to
benefit the patient and the hospital?
- Yes. Treating psych patients in a med/surg bed is
generally not the best treatment for the patient neither is it the
best utilization of the hospital’s resources. Establishing,
developing and effectively managing a sound behavioral health
strategy to admit and provide quality treatment for psych patients
who present in the ER will improve your hospital’s efficiency and
financial outcomes. If you would like to find out more about how we
can assist you with the management of psychiatric patients in your
ER contact us
today.
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- When can we open a new psych distinct part unit? And
how long does it take to develop a new psych program?
- New DPU’s can only be opened on the first day of your
Medicare cost reporting year IF you wish to be exempt from acute PPS
reimbursement and eligible for IPF-PPS reimbursement. Regulatory
hurdles, construction issues, CON requirements, and staffing needs
are just a few of the many variables that affect the amount of times
it takes to develop a program. Two of the most critical time
elements are CON and construction related. While Signet has
successfully worked with hospitals to open programs in extremely
short time-frames, in general the process should begin 6 to 9 months
prior to the projected opening date. If a CON or major construction
is required, the timeline for program development could be even
longer. We would be happy to analyze your specific circumstances and
promptly provide you with an estimate of the time and tasks
necessary to properly develop a program.
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- What about the timeline for opening a non exempt
psych unit?
- A non-exempt psychiatric program can be opened at
anytime during the year. However, it can only be exempted from acute
PPS reimbursement at the beginning of a fiscal year. Therefore, if
the unit is opened at anytime other than the beginning of the fiscal
year it will be reimbursed under DRG’s from the date of opening
through the end of the fiscal year. There can be a significant
impact on disproportionate share revenue from a non-exempt psych
program. For more information and a timeline estimate
contact us
today.
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Acute Rehab Frequently Asked Questions
- What is the “75% Rule” and why does it matter?
- The “75% Rule” is a hotly debated CMS regulation that
requires a defined percentage of all discharges from the physical
rehabilitation unit to fall into one of 13 diagnostic categories.
The “75% Rule” was being phased in over time and is currently frozen
at 60% (12/29/07). Currently, 60% of all patients admitted to an
acute rehab unit must fall into one of the 13 CMS categories. For
more information on the “60% Rule” click
here. The reimbursement for acute rehab patients from CMS can
change dramatically should a unit fail to meet the requirements. If
a unit fails to meet the “60% Rule” CMS can retroactively pay by DRG
in lieu of CMG’s for the existing cost report year. The following
year would also be paid under DRG until qualification can be
re-established and the unit could lose its DRG exemption.
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- How can our hospital best adhere to the 60% Rule?
- Signet has a proprietary internet based marketing
system (SigNetwork) that provides hospital clients with live,
real-time data. This live data allows customized tailoring of rehab
data to hospital leadership tied to the annual strategic marketing
and business plan. The SigNetwork database allows constant
monitoring and instant access (password protected) from any internet
connection at any time. Consequently, Signet’s community education
efforts will be actively managed and adjusted on a real-time basis
to the current patient mix and annual marketing plan.
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- What is a Recovery Audit Contractor and what do they
want from our rehab program?
- The Medicaid Modernization and Improvement
Act mandated a pilot project to utilize Recovery Audit Contractors (RAC’s)
in an effort to provide additional oversight for acute
rehabilitation programs. For more information, click
here.
For assistance in preparing for a RAC audit, please
contact us
today.
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- We may or may not need help with recruiting
physicians? What is Signet’s recruiting capability?
- Signet is very flexible with our client hospital’s
physician needs. We will assist you or fully recruit physiatrists or
other professional positions as the needs of your hospital dictate.
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- If we contract with Signet to manage our physical
rehabilitation program, who controls the program?
- The hospital remains in control of the program at all
times. Signet is responsible for executing the goals of the program
while the hospital maintains ultimate decision making authority in
all instances. The Signet program is transparent as a hospital
service and any Signet employed staff function as agents of the
hospital.
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- Do acute rehabilitation programs still make money?
Or are they on their way out?
- Yes, Signet client hospitals have varying positive
contribution margins from acute rehab programs. The variability of
staffing, overhead, ADC, volume, and patient diagnosis coupled with
a complex CMG payment per Medicare discharge payment system (IPF-PPS)
make each hospital’s financial outcomes unique. Under IRF-PPS,
since it is a budget neutral payment system, there are hospitals
that have prospered and hospitals that are struggling financially.
Let Signet help your hospital by providing complimentary financial
analysis for your facility, please
contact us
today.
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- Assuming there is a positive financial benefit, what
other benefits would the professional development of an acute
rehabilitation unit (ARU) bring to our hospital?
- Acute rehab services generally provide a better
alignment of patient needs with IPF-PPS reimbursement.
Additionally, hospitals can expect better management of ALOS
outliers as a result of patients in need of physical rehabilitation
being transitioned out of medical/surgical beds more quickly. The
appropriate development of hospital based physical medicine services
also provides a needed service to the hospital’s service market area
while adding an additional revenue source to the hospital’s bottom
line. To find out more about the benefits your hospital could
receive from offering a physical rehabilitation program
contact us
today.
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- How long does it take to develop an ARU program?
- New DPU’s can only be opened on the first day of your
Medicare cost reporting year IF you wish to be exempt from acute PPS
reimbursement and eligible for IRF-PPS reimbursement. Regulatory
hurdles, construction issues, CON requirements, and staffing needs
are just a few of the variables that affect the amount of times it
takes to develop a program. Two of the most critical time elements
are CON and construction related. While Signet has successfully
worked with hospitals to open programs in extremely short
time-frames, in general the process should begin 6 to 9 months prior
to the projected opening date. If a CON or major construction is
required, the timeline for program development could be even longer.
We would be happy to analyze your specific circumstances and
promptly provide you with an estimate of the time necessary to
develop a program.
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- I have heard that if we open a physical
rehabilitation unit we have to go through 12 months of payment under
DRGs? Is that right?
- If developing the unit involves new construction, the
re-licensure of skilled beds or a change in ownership it may be
possible to exempt the program without operating for a full year
under DRG reimbursement. Let Signet provide your hospital a sound
strategy for opening a program without operating for 12 months under
DRG’s by calling us or completing the form on the “contact
us” page today.
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- Does your company assist with the CON process?
- Yes. Signet will assist the hospital in completing
the CON process by providing market analysis complete with
demographics, bed need, and competitor analysis.
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- We have a busy SNF and are not sure about the
necessity of acute rehab. Why should we look at an ARU?
- It is possible that a significant number of your
patients in the skilled unit could benefit by receiving a higher
level of care and the hospital would also benefit financially from a
higher level of reimbursement as a result of providing the more
intensive treatments prescribed in acute rehab settings. Let Signet
analyze and contrast the differences between skilled and acute
rehabilitation financial outcomes by
contacting us
today.
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- What types of patients are appropriate for inpatient
rehabilitation?
- Individuals appropriate for treatment in an acute
physical rehabilitation program include those patients disabled as a
result of chronic illness such as post-stroke conditions, congestive
heart failure, acute arthritis, multiple sclerosis, Parkinson’s and
other degenerative diseases; those disabled as a result of major,
multiple trauma including people with complex orthopedic conditions,
burns, brain and spinal cord damage and amputation and those
disabled by premature birth or congenital defects.
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