Shepherd Center Expanded Admissions Focus Beyond Georgia as Hospital Grew

As the number of beds and rehabilitation services at Shepherd Center have grown, so, too, have efforts to ensure trauma centers outside of Georgia are aware of the hospital's premier services for people with spinal cord or brain injury.

“It’s an interesting part of Shepherd Center’s history,” says Mitch Fillhaber, senior vice president of corporate development and managed care. “We’ve had to keep up with the expansion of our facility and stay responsive to changes in the health marketplace.”

Today, many hospitals that refer patients to Shepherd Center see the facility as an invaluable resource for rehabilitation for people with spinal cord injury (SCI) and acquired brain injury (ABI). Efforts to streamline the hospital’s admissions process have enabled quicker initial evaluations of prospective patients. Meanwhile, Shepherd Center has become more responsive to the urgency in trauma centers to move patients to the next level of care. The most recent expansion of Shepherd from 120 beds in 2008 to 152 currently, has been a big motivator for these changes.

Expanding Its Geographic Reach

Shepherd Center relies on patient referrals submitted by other hospitals. But, increasingly, inpatient rehabilitation programs are either embedded as units in trauma hospitals or located across the street from one, Fillhaber explains.

“It means admissions considerations are principally local,” he says. “The challenge for us has been how to cast a wider net and educate referring hospitals about catastrophic injuries and the specialized expertise and equipment that’s needed for rehabilitation.”

In 1990, roughly 80 percent of admissions to Shepherd Center were from cases within Georgia. The hospital’s efforts to increase visibility regionally began in the mid-1990s and involved placing admissions liaisons outside of Atlanta. Their locations were based on referral patterns. This gave Shepherd Center feet on the ground and also cut down on travel and response time. The goal has been to unburden referring hospitals and give patients – often in the prime of their lives – greater access to aggressive, cutting-edge rehabilitation.

Research shows the sooner someone with SCI or ABI gets to rehabilitation, the better their functional outcomes, says Heddi Silon, the former director of admissions at Shepherd Center who now directs the Workers' Compensation referral program.

All told, efforts to strategically place case managers outside of Atlanta seem to be helping. Today, half of all cases admit from out-of-state, and some are international.

Giving a Face to Shepherd Center Beyond State Lines

Fourteen access care managers (ACMs) as they are called, are now working in the field for Shepherd Center; some have multi-state responsibilities. For example, one ACM in Pittsburgh covers western Pennsylvania and the Mid-Atlantic states.

“They’ve really become an extension of our inpatient staff,” Silon says. “They have a wealth of knowledge and are often the first person to describe the injury in detail to the family and provide an accurate picture of what they might be capable of and the goals of rehabilitation.”

In many ways, the ACMs are the initial face of Shepherd Center. They provide value to referring hospitals through:

• Clinical education about spinal cord and brain injuries and how to prevent secondary complications and new developments
• Enhancements in care options
• Timely evaluations and assessment of readiness for transportation
• Answering questions and reassuring family members

“They often provide a sense of hope and optimism about the future, that as horrible as this all seems right now, the patient will be on a different road once they begin rehabilitation,” Fillhaber says.

Streamlining the Process

Over the years, the admissions team has tried to improve the process overall by:

• Adding two nurses who scan all of the cases, only giving the most appropriate ones to the ACMs
• Being granted read-only access to patient records by some referring hospitals to speed processing
• Dedicating someone to do all insurance pre-certifications
• Talking about discharge planning up front to make sure the strides made during rehabilitation can be reasonably sustained
• Providing tools, for example, online education and a virtual tour of the hospital for families who are considering Shepherd, but are unable to visit in person

But for every one admission, three or four people do not meet the criteria to admit to Shepherd Center. For example, they may have insufficient insurance coverage or may not be ready to take part in three hours of aggressive rehabilitation therapy every day.

“These are complicated cases, and we have to remind people that the average age of our patients is 32 years old,” says Julie Leighton, clinical access manager. “We don’t want to set someone up for failure.”

She and the team also aim to provide answers quickly. The goal is to evaluate a patient within 24 hours of referral, but it can vary based on the patient’s health status and if surgeries are needed.

“In the past, it could have taken a week to figure out if someone wasn’t appropriate, which can be nerve-racking for families,” Fillhaber says. “Now, it’s usually a matter of days.”

For more information, visit shepherd.org/admissions.

Written by Amanda Crowe, MA, MPH