Building the Business Case: Securing Funds for Rehab Unit Expansion

Daniel Webel, BSN, RN, CRRN

This story traces back to 2019 — just before the COVID-19 pandemic — when a 22-bed inpatient rehabilitation facility (IRF) was relocated from Northwestern Medicine (NM) McHenry (Ill.) Hospital to nearby NM Woodstock (Ill.) Hospital, just 10 miles away. This move aimed to free up acute care beds at McHenry and utilize Woodstock’s long-vacant second floor, which was then renovated to accommodate the IRF. With only 22 of the 30 available rooms in use, the potential for future expansion was clear.

From 2019 to 2022, the primary goal was to increase average daily census (ADC). In 2020, the average census was 18; by 2022, it had grown to 20. This growth was driven by strong departmental reputation, excellent quality metrics, high patient satisfaction and limited competition from other IRFs in the region.

By focusing on core metrics — patient functional gains, community discharge rate, acute care transfer rate, infection prevention, fall rates and care profitability — the team saw an uptick in patients being referred but not admitted due to lack of space. In the rehab world, these cases are termed “referred, not admitted” (RNA). However, the RNA volume wasn’t yet enough to justify additional beds. To make the case, more referrals needed to occur.