What customers want to know about your program

Here's what the experts say

The bottom line for any successful program is pleasing the customer, whether it be the payer, a referral source, patients, or their families. You should be compiling outcomes data that will help you provide the information all those entities want.

Rehabilitation Continuum Report asked a group of experts in the rehabilitation field to name the most important outcomes you should track. Here's what they said:

o Discharge rate to the community.

This shows payers and patients alike how many patients attain a better quality of life through rehabilitation than they would if they were confined to an institution.

o Productivity of the patients.

All customer groups want to know if patients are able to get back to work, go back to school, or resume their family obligations.

o Durability of the outcomes.

"Whether you're talking about living in the community or returning to age-appropriate activities such as school or work, the panel put a huge emphasis on whether the gains made during the rehab stay will last," says Deborah Wilkerson, MA, director of research and quality improvement at CARF...The Rehabilitation Accreditation Commission in Tucson, AZ.

Providers should be able to demonstrate that for a certain number of dollars upfront, payers get a patient who stays in the community instead of being readmitted or spending two months at home then going to a nursing home, she says.

The standard follow-up in inpatient medical rehabilitation is three months. Some providers are tracking outcomes at a year or more after discharge, particularly for seriously injured patients, such as those with spinal cord injuries. Partici pants in a working group on performance indicators facilitated by CARF in 1997 indicated that all providers should consider the possibility of additional follow-up questionnaires or phone surveys at longer intervals after discharge, Wilkerson says.

o Improvements in functional independence and performance of typical activities of daily living.

"This demonstrates the rehabilitation process has had the desired effect," adds Carl Granger, MD, director of the Uniform Data System for Medical Rehabilitation (UDSMR) in Buffalo, NY.

Family members and referral sources want to know the level of independence a patient can expect to attain so they can plan for the future. That information can be attained by tracking the functional level at admission and comparing it to the functional level at discharge for patients with similar diagnoses.

o Where the patient can expect to go after discharge, whether it's back to the community, a subacute unit, or an assisted living facility.

"We can no longer just say that the patient can walk up and down staircases, but we need to be able to demonstrate in what environment can this patient walk that will allow him to stay as independent as possible without being in danger to himself or others," adds Colodia Owens, MA, principal of Interface Health Care Services, a firm in El Sobrante, CA, that consults on managed care and other reimbursement issues.

o Expected length of stay in rehab vs. patient gains.

The Functional Independence Measure (FIM) efficiency statistics compiled by the UDSMR show the independence gained per unit of time during the rehab stay. "Over and over, the payers insist that they aren't looking for the cheapest care, but the most valuable," Wilkerson says.

o Value of the outcomes.

That is, how much it costs for the rehab stay and what outcomes the stay provides. That shows cost-effectiveness of care. "I hear over and over from payers during these brainstorming sessions that what they are really interested in is durable outcomes. They say that the value of the outcomes is more important than the initial outlay of funds," she says.

o The length of stay in acute care.

That statistic is important to track so rehab providers can show payers and referral sources the value of getting patients to rehab as soon as possible after the onset of the injury or illness, Granger explains. "Studies have shown that the shorter the time between the onset of the condition and the admission to rehab, the lower the total cost of that episode of care," he says.

o How long it takes injured patients to return to work.

In workers' comp cases, employers want to know how long patients will be away from work, whether they can return to their old positions, and whether they can return to a modified-duty position, says Kenneth Wells, MD, medical director for Tenneco, a Greenwich, CT-based automotive parts and packaging corporation.

"Where the challenge comes in is that when you're dealing with people, it's not like widgets. You can't say unequivocally how long an individual will be out of work or what his outcome will be," Wells says.

However, based on historical outcomes data and experience, health care professionals can give an estimate of how long it will take for a patient to be back at work, and that information is valuable to employers, he adds. (For more on what kind of information workers' comp payers want, see story at right.)