Hospitals In Focus

Better Data, Better Outcomes: New Data is Changing Care at Inpatient Rehab Facilities


COVID has drastically changed the health care delivery system, perhaps even permanently. Inpatient Rehabilitation Facilities (IRFs), like those operated by Encompass Health, stepped up during the pandemic by partnering with acute care hospitals to help patients recover from the virus. It once again showed how critical IRFs are to the care continuum by making sure patients received the right care in the right setting.

Encompass Health President and CEO Mark Tarr discusses the impact of COVID-19 on IRFs, as well as the innovative ways his company is using new sources of data to inform clinical decisions and improve patient outcomes. Additionally, Chip and Mark touch on the importance of relevant, up to date data on implementation of the IMPACT Act and the Review Choice Demonstration.

Learn more about post-acute care providers in the time of COVID by listening to The Role of Long-term Acute Care Hospitals During COVID-19 with Ben Breier.

Speaker 1 (00:05):

Welcome to Hospitals in Focus from the Federation of American Hospitals. Here’s your host, Chip Kahn.

Chip Kahn (00:15):

The COVID-19 pandemic is affecting healthcare for Americans in so many ways. It is demonstrated the need for superb post-acute care, such as that offered by inpatient rehabilitation facilities, otherwise known as IRFs and the potential resilience of patients who get the right care in the right setting like an IRF. IRFs have also been proving themselves in other ways, as we see with Encompass Health that is using big data to better target the most effective post-acute rehabilitation for their patients.

Chip Kahn (00:47):

Today, we will learn more about IRFs in the time of COVID-19 and advances in IRF care being adopted from our new digital world. Joining us is president and CEO of Encompass Health, Mark Tarr, to discuss COVID-19, post-acute care, the role of IRFs and advances in the use of big data to improve patient outcomes. Thank you for joining me today, Mark.

Mark Tarr (01:15):

Hello Chip. I’m delighted to be here.

Chip Kahn (01:17):

Well, we’re glad to have you. I usually start off with asking a bit about our guests’ company and their role. So I’ll start off with, will you tell us about Encompass Health, its mission and scope, as well as your role as president and CEO?

Mark Tarr (01:34):

Sure, I’d be happy to. Encompass is one of the nation’s largest providers of post-acute care. We have two operating segments at Encompass, one being the inpatient rehabilitation hospitals. We’re the largest owner operator in this space. We currently have 139 hospitals spread across 38 states, 51 of those hospitals are operated as joint venture partners with major acute care hospital systems. So we’re happy to provide that component to our partnerships, and that’s a business model we’ve had in place now for over 30 years.

Mark Tarr (02:12):

The second segment of our company is home health and hospice. We’re the fourth largest provider of home health services in the US, and collectively we’re very proud to have 54,000 amazing staff members that make up our company and provide high quality care every day to our patients.

Mark Tarr (02:32):

I’ve been in this role for five years now, but I’ve been in this industry for almost 30 years. The vast majority of that being provided with Encompass Health or its predecessor name, HealthSouth, and very proud as the CEO to be responsible for the overall execution on our strategy of the establishment of a strong, positive culture, and ultimately the returns for our shareholders and investors.

Chip Kahn (03:01):

Mark, that’s really helpful. Now, let’s get into the substance. Can you give us a sense for Encompass Health how the treatment of current COVID-19 patients has affected your facilities, especially in areas where there are surges? Can you talk about the challenges you have faced and the advantages to the COVID-19 patients of receiving their post-acute care in your IRFs?

Mark Tarr (03:27):

Sure, I’d be happy to, Chip. First of all, I’m very proud of the way our organization responded to the needs of the healthcare community. Early on in the stages of COVID, we determined, with the help of our physicians and hospital-based clinical staffs, that we can not only treat COVID patients, but we could do a really good job in terms of the quality of outcomes. We also felt a strong obligation to provide a service for our leading referral sources. 90% of our patients come directly from acute care hospitals.

Mark Tarr (04:04):

As you know, early on the acute care hospitals were very concerned about a major surge in COVID patients, so they were looking for post-acute providers downstream that they could work collaboratively with in terms of either having discharges to open up and free up beds at the current time, or once they started getting COVID patients in the acute care hospitals to have post-acute providers that were willing, capable, and very positive about taking COVID patients. We did this from day one.

Mark Tarr (04:37):

So we never turned down a COVID patient, either in our hospitals or our home health agencies. We’re very proud to have treated almost 12,000 COVID patients to date, nearly 80% of those patients were able to go back home back to their community. So, we feel like we played a very vital role and continue to play a vital role in terms of post-acute being a very site-appropriate discharge placement for COVID patients and servicing the acute care hospitals that we have in our marketplaces.

Chip Kahn (05:12):

Mark, would you give us an update on how your hospitals are doing today and are you getting back to some kind of new normal?

Mark Tarr (05:20):

Yeah, we’re very happy to say that we are seeing trends that would indicate that we are starting to get back to a new normal. We still are treating COVID patients, but we have far fewer COVID patients than we did even two or three months ago. So, we’re starting to see upstream that the acute care hospitals are starting to open up their elective procedures. The types of patients that we’re seeing referred to our hospitals are starting to be much more similar by diagnostic categories to what we saw pre-COVID, and we have far fewer staff that are in quarantine.

Mark Tarr (05:58):

So yeah, the world does seem to be getting back to a pre-pandemic mode, although, like I said, we still have certain marketplaces that have a higher occurrence of COVID than others and we’re responding accordingly.

Chip Kahn (06:15):

Moving beyond COVID-19, you have been developing the use of artificial intelligence with big data to treat patients at your hospitals. How is this improving post-acute care and effecting your approach to patient care?

Mark Tarr (06:31):

So Chip, several years ago we made the decision that we’d commit several hundred million dollars to develop with Cerner and implement a clinical information system in all of our hospitals. Part of the outcome of that is a substantial amount of data on our patients. Matter of fact, now we’re working currently with a data of over 80,000 discharges for our patients.

Mark Tarr (06:56):

So, we have tried to use that in a very constructive way and most primarily in terms of predictive modeling and artificial intelligence to help us establish certain clinical protocols once we’ve identified risk factors of certain patients that ultimately allow us to take clinical interventions and decrease the occurrence or likelihood that these patients that are at risk and have been identified at risk, so that we can intervene and reduce the likelihood of them returning back to the acute care hospital.

Mark Tarr (07:34):

It’s in the best interest of the patients, it’s in the best interest in providing value to our referring acute care hospitals and to the payers. So, we are using this not only on identifying patients that may be at a high risk of the return back to the acute care hospitals, but we’re also piloting this now in identifying patients that may be a greater fall risk once they have been discharged to home. So, we have the data and we’re using it to our best advantage in terms of providing a better quality outcome for our patients.

Chip Kahn (08:10):

Mark, let’s do a deeper dive on the use of big data. Why is it so important from your perspective to not use general data, but use the data from Encompass Health? Can you give us some examples of how with this data and artificial intelligence you are helping improve patient care, and frankly, protecting patients and patient safety?

Mark Tarr (08:35):

Sure. So Chip, I alluded earlier that we made the decision to have pretty substantial spend in developing our clinical information system. We did that, because there was really nothing out there in the marketplace that was specific to what is done in an inpatient rehabilitation hospital, is most of clinical information systems were specific to acute care hospitals and applicable in that setting, but were not specific to the needs of rehabilitation patients. So, our database of over 80,000 inpatient admissions now is specific towards rehabilitation patients and their needs.

Mark Tarr (09:15):

So, when we look at the data that we have and we use it for artificial intelligence or modeling and predictive modeling for our patients to their benefit, we have chosen three specific areas at this point and these areas could expand over time. But the first is to reduce the occurrence of acute care transfers from our hospitals on patients that may have some medical difficulties and have setbacks that require them to be transferred from our hospitals back to the acute care hospitals.

Mark Tarr (09:49):

We are in the current process of piloting a fall risk indicator for patients that would have indications that they would have a greater likelihood of a potential fall once they’re back at home, and that we’re also using our information to identify patients, that once they’re sent back home may have a greater chance to have a setback and potentially be sent back to the acute care hospitals within 30 days after they have been discharged home.

Mark Tarr (10:25):

So, those are really three critical areas that we think by using our predictive modeling and the data set that we have available to us that is specific to rehabilitation patients, that we can impact care, we can impact the outcomes in a very positive way and create a better experience for our patients and payers.

Chip Kahn (10:47):

That’s really remarkable, Mark. Now, let’s sort of turn to payment issues and talk about Medicare for a moment. I wanted to ask you about a mandate under a congressional act from 2014, the IMPACT Act, which CMS is authorized to use to develop and submit to Congress a prototype, unified post-acute care prospective payment system.

Chip Kahn (11:14):

This mandate is now seven years old, and so much has changed since then. I know a bill has recently been introduced that acknowledges the profound changes in the post-acute world and updates the data requirements accordingly. Can you talk about that and why it is so important to refresh the IMPACT Act that passed so many years ago in 2014?

Mark Tarr (11:36):

Sure, Chip. So, I think certainly Encompass Health and the industry as a whole feels a responsibility to make sure that we’re using the most appropriate data and most effective data, that the end result of the pack PPS will be a good model that will be in the best interest for the patients and ultimately in the best interest for CMS as well. But to do that, we think it’s very important to have data that is timely.

Mark Tarr (12:05):

Currently, the data that they’re using is from 2017 through 2019. It doesn’t really accurately reflect the changes that have gone in in the industry around the various settings, whether that is IRFs or SNFs or home health, as well as the patient mix. We’ve seen a change in our patient mix during that timeframe. So to go back to 2017, ’18 or ’19, you’d be using stale data that is not really representative of where the providers in the IRF space are right now and other post-acute settings. So, we want to make sure that CMS uses the most up-to-date relevant data that would apply to the patients and reflect the types of care that is being provided now in the post-acute settings.

Chip Kahn (12:55):

Finally, and still on Medicare policy, I understand that CMS is in the process of developing a new program integrity demonstration that would require either 100% pre-claim review or 100% post-payment review for all IRF patients to prevent and identify potential fraud for all IRFs in Alabama, Pennsylvania, Texas, and California. This approach looks like it would be very far-reaching and has many implications that could not just impact IRFs, but also a broad swath of Medicare patients. What are your thoughts on this program and how it would affect patient care moving forward for these Medicare beneficiaries?

Mark Tarr (13:44):

Yeah, Chip, let me start by first saying that certainly Encompass Health and the industry as a whole are very supportive and all for eliminating fraud that could be out there, but what we do want to make sure is that RCD is established and implemented in a manner that is not detrimental to the patients. What we don’t want to have happen is we have a circumstance or a system where you would have nurse reviewers, many of which may not have any rehabilitation training or experience, are in a position to go in and second guess those rehabilitation trained physicians that have determined that patients would be appropriate for the IRF setting.

Mark Tarr (14:33):

So, if you have that and then you get into a situation where you have a lot of denials and the appeals process is long and arduous, ultimately what you’re going to have are providers that are then reluctant to accept and take rehabilitation patients, and you’re going to have patients that need good rehab care that don’t get good rehab care. That would be detrimental to the Medicare beneficiary population. So, we want to make sure that the design and implementation of RCD is done in a manner so that you don’t have those inherent conflicts that ultimately are detrimental to patient care.

Chip Kahn (15:17):

Mark, this conversation has been so illuminating for our audience. Where can our audience connect with Encompass Health online and learn more about IRFs and the kind of care that you provide?

Mark Tarr (15:29):

Yeah, so our listeners can connect with us at encompasshealth.com and on Facebook, Twitter, LinkedIn, and Instagram.

Chip Kahn (15:38):

Well, that covers the waterfront. Thank you so much for joining us today.

Mark Tarr (15:41):

All right, Chip, thank you. Happy to be here.

Chip Kahn (15:43):


Speaker 1 (15:49):

Thanks for listening to Hospitals in Focus from the Federation of American Hospitals. Learn more at fah.org. Follow the Federation on social media at FAH hospitals, and follow Chip at ChipKahn. Please rate, review, and subscribe to Hospitals in Focus. Join us next time for more in-depth conversations with healthcare leaders.

Mark Tarr has served as President and Chief Executive Officer for Encompass Health since Dec. 29, 2016. Prior to assuming the role of President and Chief Executive Officer, Tarr served as executive vice president and chief operating officer for Encompass Health, formerly HealthSouth, from 2011-2016, having served as executive vice president of operations since Aug. 1, 2007, and as president of the company’s inpatient division since September 2004. He joined HealthSouth in 1993, and has held various management positions within the company. Tarr earned his bachelor’s degree from Ball State University and his master’s in business administration from the Goizueta Business School at Emory University.