Rehab Beds a Key Consideration

Managing change is not a simple task. In addition to the pace of advances in health care, there is the continually shifting uncertainty of what will happen next in coverage. Combine that with a growing and changing population already dealing with challenges to access, and it isn't surprising that the list of requested changes in the Alabama Health Plan is getting longer.

After reviewing the situation, Governor Kay Ivey decided that, rather than trying to address issues in a patchwork fashion, the state really needed a comprehensive update to the Alabama Health Plan.

One revision that is being closely watched involves changes in how additional rehabilitation beds are approved. In contrast to facilities that are not regulated by the State Health Planning and Development Agency (SHPDA) and do not have to file for a certificate of need before adding rehabilitation beds, hospitals and rehabilitation hospitals are regulated by multiple agencies. They have to file for a certificate of need in a process they contend takes too long to allow them to respond to patient needs, is too expensive and too unpredictable.

A current case in point is Spring Hill Medical Center in Mobile. Attorney David Belser has been representing the hospital in an attempt to add seven inpatient rehabilitation beds to its 11-bed unit.

"For some time now, we've been forced to turn away 30 percent of the patients seeking inpatient rehabilitation due to lack of beds," Belser said. "Many patients are sitting in our own emergency room or in an acute-care bed, but they must be transported to another facility due to lack of capacity. There are only three hospitals in Region Six that offer inpatient rehab and are qualified to care for more complex cases that require hospital-level services. Both the Mobile Infirmary and Thomas Hospital agree that there is a pressing need for more inpatient rehab beds."

Another concern is that patients may have to stay in an acute care bed longer while waiting for placement, which could add to their costs and reduce the number of beds available to other patients. In some cases, depending on health coverage, patients with needs that qualify for inpatient rehabilitation with costs at least partially covered worry about having to choose between a facility not covered by their insurance, or going home until they can find an alternative.

"After the lengthy application process, we met with regulators in the fall to discuss our request for adding more inpatient rehab beds," Belser said. "At that time they tabled the request pending revisions to the Alabama Health Plan that are underway in the Health subcommittee. We had planned to attend the March meeting, but that was canceled due to lack of a quorum. We hope they will meet in April and we will be able to learn more about our request and any progress on revising the state health plan."

Even after the effort and expense of staff time and legal fees, if additional inpatient rehab beds are approved for Region Six, that doesn't mean Spring Hill will receive any of them.

"Additional beds are granted by region, not by hospital, so the process begins again," Belser said. "We have to apply for those beds, and other hospital can apply for them, too. We have to hope we are granted enough beds that we will be able to care for the patients we are now turning away."

April Weaver

Representative April Weaver chairs the House Health Subcommittee that is working to revise the different aspects of the Alabama Health Plan to write updates they will recommend.

"We have completed the revisions for several sections," Weaver said. "The committee is still working on a few sections, including inpatient rehab. Representatives from related industries have been present at our subcommittee meetings and have been given the opportunity to offer comments. We are working with SHCC (Statewide Health Coordinating Council) to receive updated data. The committee members will have an opportunity to review the data when it becomes available. At the last meeting the subcommittee requested that they meet to discuss and report back. I expect that update will also be given at the next meeting."

Understandably, other facilities that offer rehabilitation services are likely to want to see their concerns reflected in revisions that are under consideration.

John Matson

Alabama Nursing Home Association spokesman John Matson said, "There are more than 100 community-based rehab centers operated by nursing homes in Alabama and there are rehab beds available in every state health planning region. We are proud of the work our physical, speech and occupational therapists do to treat thousands of patients every year. The Alabama Nursing Home Association is on record supporting inpatient rehab beds for patients who need hospital-level acute care combined with intensive therapy. Because Alabama already has more inpatient rehab beds than called for in the State Health Plan, we're working with members of the State Health Coordinating Council and the Alabama Hospital Association to gather data needed to better understand future patient needs so that we can make an informed decision."

Belser said, "For inpatient rehabilitation beds, a 60/40 rule applies. A requirement is that at least 60 percent of our beds must go to patients who have a condition or co-morbidity that requires an inpatient level of care during rehabilitation. For up to 40 percent of the other patients, choosing a hospital setting may be a matter of personal preference, convenience in location or in not having to transfer by ambulance or personal car, or for some, possible health coverage requirements that may apply.

"We're hoping that the updated Alabama Health Plan will help to remedy current shortages and streamline the process for growing demand in the future as our population grows."

Proposed changes to the CON process, which are yet to be considered, would allow hospitals with rehab bed occupancy of 80 percent or more for 90 consecutive days to request approval of up to 10 additional beds to expedite response to shortages.

When all aspects of the health plan have been addressed by subcommittees, they will be reviewed by the full SHCC. Any edits will be made and the plan will be sent to the governor for review. When the governor approves the updated plan, it will be sent out for public comment. After comments are returned, SHCC will finalize the revisions and the new Alabama Health Plan will take effect.