Medical Directorship: Governance with Formal and Informal Structures-Addressing Administrative Challenges with IRF Admissions

Video Transcription

Video Summary

The first lecture of the series focused on addressing the administrative challenges related to Inpatient Rehabilitation Facility (IRF) admissions featuring three speakers: Lauren Shapiro, a new Medical Director at Brooks Rehabilitation, Dr. Craig DiTomasso, Clinical Chief Officer from US Physiatry, and Medical Director of PAM Rehabilitation Hospital, and Dr. David Steinberg, Executive Medical Director at Craig H. Nielsen Rehabilitation Hospital. Dr. Shapiro started by discussing the importance of the appropriateness of patient admissions to protect the five P's: patients, programs, professional reputations, the broader physiatrists community, and payment for care. She emphasized recent scrutiny on IRF admissions stemming from the 2018 Office of Inspector General report, leading to initiatives like the Review Choice Demonstration (RCD) which employs stricter criteria for patient admissions.<br /><br />The lecture highlighted CMS documentation requirements for IRF admissions, stressing the need for interdisciplinary therapy and regular medical supervision. Lauren also pointed out that navigating ambiguous situations often involves ensuring comprehensive documentation and considering the times when it is appropriate to accept patients even if criteria aren't entirely met.<br /><br />Dr. DiTomasso elaborated on understanding the broader systemic forces at play (like insurance trends and hospital metrics), viewing admission decisions from multiple perspectives (hospital administrator, payer, and the rehabilitation center), and stressed creating no-lose scenarios to align the interests of all parties involved. He shared examples of innovative program development (pulmonary and vestibular programs) that can mitigate conflicts and enhance patient care.<br /><br />Dr. Steinberg rounded out the discussion by providing strategies for navigating conflict and difficult conversations. He emphasized the importance of maintaining professionalism, understanding different viewpoints, collaborating, and preparing thoroughly when facing administrative resistance. The lecture concluded with a Q&A session where practical challenges like handling denials, prior authorizations, and specific patient scenarios were discussed. <br /><br />The audience was encouraged to further engage through the PhysForum for ongoing discussions about IRF admissions and related concerns.

Keywords

Inpatient Rehabilitation Facility

IRF admissions

Lauren Shapiro

Craig DiTomasso

David Steinberg

Review Choice Demonstration

CMS documentation requirements

interdisciplinary therapy

insurance trends

program development

PhysForum