The year 2001 was a landmark year in many ways, but for rehab hospitals it was a year that, in a manner of speaking, liberated them. The Center for Medicare and Medicaid Services implemented a Prospective Payment Services (PPS) for rehabilitation hospitals, removing them from a cost-based payment system with a facility-specific limit. The difference has allowed many rehab hospitals across the country to expand services and programs.

“The government provided a patient-centered reimbursement system, which leveled the reimbursement playing field for all rehabilitation hospitals,” said Jim Ball, chief operating officer, Catholic Health Services (CHS), a management company that manages post-acute care facilities for the Archdiocese of Miami in Miami-Dade and Broward Counties. “In response, the CHS hospitals developed and implemented plans to expand programs and services which, most importantly, have increased access to our facilities.”

Currently, CHS facilities include two rehab hospitals, St. John’s Rehabilitation Hospital in Broward and St. Catherine’s Rehabilitation Hospital in Miami-Dade.

The CHS rehabilitation hospitals have significant expansion plans from FY04 through FY 06. St. John’s Rehabilitation Hospital, soon to be renamed St. Anthony’s Rehabilitation Hospital, will increase beds to 26, relocated to a new 27,000 sq. ft. facility having primarily private rooms, two transitional apartments and an aquatic center. St. Catherine’s in North Miami has obtained approval to build a 40 bed satellite hospital in Hialeah Gardens, which will also have private rooms, transitional apartments and an aquatic center.

Ball, for his part, has 30+ years experience in both the administrative and clinical aspects of rehabilitation. He was educated and trained as a physical therapist, and – at various times – has been a past president of the Florida Physical Therapy Association, a member of the APTA board of directors for six years, and a member of CMS’s technical expert panel for rehabilitation hospitals.

“My clinical expertise in rehab, coupled with my business background helps me to be a bridge between both,” he said. His background enables him to understand the changes in the reimbursement patterns and implement strategies that benefit both the patients and the hospitals.

“Because of more appropriate funding, we have been able to expand our services,” he said. “CHS has made a major commitment to people in need of comprehensive rehab by also adding outpatient specialty programs for balance and vestibular problems and spasticity management.”

Ball also says that the community has responded well to CHS’ expansion. They have experienced a 10-20 percent annual increase in demand for services in the past five years. While much of this can be credited to the expanded services, the quality of care provided at CHS hospitals is the significant factor. CHS facilities have all the necessary accreditations by CARF and JCAHO, including special certification for Traumatic Brain Injury at St. John’s, but Ball believes there is something more that sets CHS apart.

“We are a non-profit faith-based organization and are committed to our mission, which meshes well with being all about what’s good for the patient,” he said. “This, coupled with the incredibly dedicated staff is what makes us special.”

“CHS is unique in that we are developing a comprehensive rehab continuum that supports persons with disability,” he said. “We have recruited top-notch therapists and physicians to develop programs to manage the disabilities our patients are confronted with and bring “cutting edge” interventions directly to the community.” The balance and vestibular program directed by Dr. Pedro Cardich and the spasticity management program developed by Dr. Bruce Rubin are recent examples reflective of this commitment.”

“We believe many falls are preventable. We also believe individuals do not have to lose function due to spasticity,” Ball says.

St. Catherine’s and St. John’s have recently opened wound care clinics. At first blush, it may seem unusual for rehabilitation hospitals to have wound care clinics, but Ball explains that many of the rehab patients they care for are more prone to skin breakdowns due to sensory deficiencies and mobility issues and, consequently, may need wound care.

“In addition, the CHS nursing homes admit a large number of patients with wounds. Our nursing home patients have access to hospital level wound services by physicians who are experts in wound care,” he said. “Our integrated wound care program has been very successful and our patients do not have to leave the campus.”

While all these additional services and changes in reimbursements to rehab hospitals have been good, Ball believes more can be done. The new “75 percent” rule published by CMS continues to be antiquated and now that it will be enforced, rehab hospital access will be denied for people who do not fall within the thirteen specific diagnoses. Ball points out that this often excluded patients who underwent a total hip or knee replacement. Patients with cardiac, pulmonary, cancer and transplant conditions will have to seek alternative lower levels of care such as nursing home or outpatient therapies. Additionally, Medicare’s $1,500 cap on the amount of outpatient physical, occupational and speech therapy a patient can receive is currently under a moratorium, but is another looming risk for patients in need of rehab.

The final challenge rehab hospitals will face is the demand for qualified professionals – rehab nurses, physical therapists, speech pathologists, and occupational therapists – will outpace the supply in the future. Implementation of the Balance Budget Act of 1998 created a surplus of rehabilitation professionals. “That surplus is being absorbed,” Ball says. “I fear we are on the verge of significant shortages once again.”

But such challenges will be faced by CHS in the same manner that everything else is: mission driven, focusing on the needs of our patients/residents. After all, CHS provided $4.4 million in uncompensated care last year for no other reason than the fact that people came to them in need. CHS has been able to accomplish this through the leadership of its CEO, Joseph Catania, and the support of the CHS Board of Directors and Archbishop Favalora.

“We believe our focus is disability management, enabling our patients to achieve an optimal level of function,” he said. “We believe that we bring dignity and quality back to life in a spiritual and nurturing environment.”