Case Study I
A leading national health system with over 100,000 acute care discharges annually requested assistance to improve the integration between its acute care and post-acute services, and to develop a replacement strategy for one of its specialty hospitals.
Project Scope
Walter Consulting staff developed detailed demand and financial projections for multiple scenarios aimed at determining the best strategy for both increasing penetration of post-acute programs, maximizing throughput from acute care hospitals and assuring the best use of capital.
Project Results
As a result of the planning activities, the health system transitioned its LTCH to an acute rehabilitation certification to better meet the needs of the system. Parallel to this, a joint venture with an existing LTCH was created to ensure appropriate access to these high-acuity, specialty services. Several facility replacement options were identified and modeled, and these options are presently under consideration. In addition, multiple opportunities for increased capture into home care were identified throughout the system.
Case Study II
A large, multi-hospital integrated health system located within a major metropolitan market was evaluating the potential to expand its clinical services through the acquisition of a top-ranked academic acute rehabilitation hospital.
Project Scope
Walter Consulting staff were engaged by the acute care system to manage the extensive Due Diligence process, including:
- Completion of an operational assessment of the rehabilitation hospital
- Management of the internal evaluation process to assess the ability for successful integration into the acute system
- Development of comprehensive five-year financial projections for the facility assuming integration into the acute care system
- Provision of recommendations regarding IRF operational changes required following the potential acquisition
Project Results
IRF acquisition finalized within 12 months of project completion, with multiple operational recommendations implemented and positive financial improvements achieved.
Case Study III
Los Angeles County Board of Supervisors, the governing authority for the county-owned Rancho Los Amigos National Rehabilitation Hospital, voted on several occasions to close the hospital because of ongoing financial constraints within the county health departments. Due to community concerns, alternatives to facility closure were sought to ensure continued operations.
Project Scope
Walter Consulting staff was engaged by the County to identify alternatives to closure, including various non-governmental organizational structures. The planning process included a top down operational assessment and benchmark analysis, community demand projections for inpatient and outpatient catastrophic services, evaluation of multiple governance options, and financial projections to reflect the recommended strategies. (Extensive collaboration required with County staff regarding state and local reimbursement models.)
Project Results
Comprehensive financial projections were developed by Walter Consulting staff and validated by the Department of Health financial staff. The recommendations for alternative organizational structures were accepted as potential options for Rancho Los Amigos National Rehabilitation Hospital, although no decision has been made at this time to formally move forward with any alternative structure. However, a separate county-owned acute care hospital is presently transitioning to a similar model as the one recommended for Rancho Los Amigos National Rehabilitation Hospital.
Case Study IV
A local acute care health system initiated planning activities to prepare for Medicare payment changes to the post-acute continuum, including Pay-for-Performance, Bundling, Re-admission penalties, etc. The efforts included assessing both short-term and long-term post-acute opportunities as the national environment continues ongoing change.
Project Scope
Walter Consulting staff was engaged by the health system to complete comprehensive post-acute bed need and demand projections for each level of care, for each of its seven acute care hospitals. The project activities included demand and financial projections, as well as the identification of short-term opportunities and long-term strategic options for the health system’s post-acute continuum.
Project Results
Short-term opportunities identified included over $5.0 million in additional Net Income through more effective placement of potential post-acute patients following discharge from the acute care setting. Additionally, new programs identified for consideration represented another potential $2.5 million in Net Income for the health system.
Case Study V
A 90-bed freestanding IRF that is a sole community provider for these services initiated a turnaround plan to improve financial performance and strengthen its relationships with acute care referral sources and local medical staff.
Project Scope
Walter Consulting staff was engaged to complete a comprehensive operational and financial assessment, focusing predominantly on patient care and professional support services (excluding dietary, housekeeping, laundry/linen, etc.) The review included a combination of on-site and off-site activities, along with benchmark comparisons for similar providers and industry leaders.
Project Results
Following review, the IRF was provided with 20+ specific recommendations regarding its patient referral process and Case Mix Index, medical staff support, staffing, expense management, documentation, and other areas. Activities are ongoing, and began to generate a positive financial return to the organization within six months of project completion.