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Crozer Keystone Health System in Upland, PA, has a unique problem when it comes to the proposed prospective payment system (PPS). The health system’s Nathan Speare Burn Treatment Center provides a direct continuum of care to burn patients. The hospital cares for patients in the acute care setting and immediately after the burn, and then continues to provide rehab care as patients recover.
Under the cost-based reimbursement system, the hospital was structured as the setting in which burn patients could receive the initial intensive care with staff that included rehab nurses. "Then the patient can progress closer to home for less burn-related care, or the patient will move literally to our other standard rehab unit," says Bonnie Breit, BS, MHSA, administrative director of rehabilitation services at the hospital system, which has 85 rehab beds and four physically distinct rehab units.
However, this type of structure will be a financial detriment under PPS, because the Health Care Financing Administration assumes that burn patients enter rehab care after receiving intensive care from a separate acute care hospital, Breit says. "With PPS, the cost associated with the combined intensive care and rehab time with those patients is not going to be there because they have not considered the uniqueness of burns."
The advantage of the burn hospital’s structure is its superior quality, Breit says. "We have a very good recover rate and a very low morbidity rate from the burn center," she adds. "We’ve had patients with burns over 90% of their body leave our center, although they might have been here for one year with costs exceeding well over $500,000."
Moreover, the burn center focuses on rehabilitation from the start and this improves the patient’s long-term quality of life and outcomes, Breit states. "The burn will change the person’s life but we have a structure set up to make the person the most independent."
The way the burn center’s structure works is as follows:
• Upon admission: A patient goes into the intensive care unit of the burn center and has one-on-one or one-to-two nursing, along with treatment by a team of physicians and therapists. Surgery and other options are explored and employed when necessary. The patient’s wounds are treated daily and therapy is administered each day. There is round-the-clock staffing.
Therapists work with other team members to make sure the patient is being groomed for independence. For example, the therapist might make sure the patient’s hands are positioned correctly, and this could help speed future rehabilitation outcomes. Also, the team of a dietitian, nurse, therapist, and physician meet daily to talk about the patient’s medical and social status. They may consult with a social worker, case manager, or psychiatric liaison, and this is a feature that may not be present in the typical intensive care unit setting.
• Comprehensive care: Once a patient is stable, she is moved to the comprehensive care side where she may stay for a week, a month, or longer. The nursing care is now one-to-four and the patient receives three hours of therapy each day. The wounds are still being managed, and the team has a nutrition consult. The patient is given extensive education on managing the wounds and rehabilitation.
Breit estimates that the burn center may lose up to $60,000 per case because the proposed PPS does not cover outliers during the initial seven days. "So immediately, we’re going to be behind the eight-ball because that’s where and when our surgeries occur, and there’s no way that we can recoup those costs with the new PPS structure," Breit says.
• Bonnie Breit, BS, MHSA, Administrative Director of Rehabilitation Services, Crozer Keystone Health System, One Medical Center Blvd., Upland, PA 19013. Telephone: (610) 447-2429.