Almost two years ago, York, Pa.-based WellSpan Health set an annual goal to cut its total costs in post-acute care. It started by auditing its inpatient rehabilitation and referral system.
“It started with a hyper focus on looking at appropriateness of referrals for inpatient rehabilitation and then getting a little more upstream in the patient’s stay, so that the determination is made earlier,” Tim Switaj, MD, vice president and chief population health officer, told Becker’s. “That has the ability to reduce length of stay, make getting authorizations from our payers easier and reduce some of the administrative burden on staff.”
In the past, the system saw an overutilization of acute rehab services in its central region in York County, Pa., which is served by its largest Level 1 trauma academic medical center. Leaders found the trend stemmed from a focus on throughput and relying solely on therapy to determine where patients would go. Patients were receiving conflicting information about where they could receive care next, and the system was issuing referrals regardless of whether they met qualifying criteria.
“We were throwing spaghetti at the wall,” Marlene Crouse, DNP, RN, vice president of care management at the system, told Becker’s.
This caused a pileup of referrals, many of which didn’t qualify for inpatient care, for York, Pa.-based WellSpan Surgery and Rehabilitation Hospital. The effects of the inefficiency trickled onto the shoulders of patients and families too — many patients had aversions to skilled nursing facilities, so when therapy or the care management team said they could refer them to the rehab hospital, they jumped at the opportunity, only to later be denied, Ms. Crouse said. In some cases, families appealed the denial, which in turn led to longer lengths of stay.
“That’s where we looked to redesign our process and put more into the care team as a whole to assess the patient — the right people assessing the patient for the level of care,” Ms. Crouse said.
The changes
In July 2024, leaders implemented changes to the post-acute referral process. They started with establishing very clear criteria for who was appropriate for care at the rehabilitation hospital.
“Identifying patients before having that conversation with them was probably the biggest cultural shift for our team,” Ms. Crouse said. “We did not present a patient with choices for where they wanted to go until after we knew the appropriate level of care — and that was key.”
Once patients were identified, patient information was sent to the rehab hospital team, which speedily reviewed and authorized patients. The time between referral and acceptance or denial was shorter than before, thanks to the lower volume.
The system also implemented technology that flags a patient for an automatic consult with a liaison, physiatrist and admissions team if they meet certain criteria, Carol Smith, MSN, RN, president of Wellspan Surgery and Rehabilitation Hospital and vice president of patient care services, told Becker’s.
“What we found from these processes is that our internal integrity strengthened,” Ms. Smith said. “That continuity of care between the inpatient setting and a WellSpan post-acute setting became as seamless as possible.”
The results
The program has excelled far beyond its primary metric of cost-of-care cuts. Total inpatient rehabilitation facility referral volume went down 43.3%, while referral acceptance by internal rehabs went up 21.8%. The percentage of patients who met intensive medical necessity rose from 62% in July 2024 to 80% in February 2026. Adherence to clinical guidelines also went up 16.7%.
From fourth quarter in 2024 to fourth quarter in 2025, WellSpan experienced a 14% reduction in rehab spending while the national average grew by 8.5%, showing a net improvement of 21.5%.
Patient experience also improved as patients were no longer given referrals to facilities they did not qualify for. Plus, “having the physiatrist work hand in hand with the care management team, we’re really able to break down barriers for patients who might not have been able to go to acute rehab previously,” Ms. Crouse said.
Having logged such success, the system is taking these processes to other acute care hospitals. And next fiscal year, leaders said they plan to apply them to patients going to skilled nursing facilities.
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