As hospitals face rising demand, staffing shortages and overcrowded ERs, how can America's health care system keep up? In this conversation, Scott Edelman, executive director of Burke Rehabilitation, shares how post-acute care hospitals are helping relieve pressure on acute care facilities, and how these rehab centers act as a critical safety valve to improve patient flow, reduce length of stay and deliver better outcomes.

Tom Haederle

Welcome to Advancing Health. An aging population. Nursing shortages. Overcrowded emergency departments. These all led up to an intense demand on acute care hospitals, where inpatient days are projected to rise by 9% in the coming decade.

Tom Haederle

Hi everyone. I'm Tom Haederle, senior communication specialist with the American Hospital Association, and very pleased today to welcome Scott Edelman to our podcast. Scott is executive director of Burke Rehabilitation that has 18 locations, mostly spread across Westchester County, New York. And he joins me today to talk about ways we can alleviate the growing stress on acute care hospitals.

Tom Haederle

Scott, thank you so much for joining me on advancing health today.

Scott Edelman

Oh, thank you so much. It’s just thrilled to be here. I listen to every podcast. And you know they all serve a tremendous purpose.

Tom Haederle

Maybe we can frame this at the start by talking about acute care hospitals in general in terms of the demand for their resources right now and their ability to meet that demand. Where is the disconnect there? Are there more people that need the services, than they really have the capability to deliver on?

Scott Edelman

So let's just talk about the strategic role we play. The role we play is decompress acute care hospitals. We are a safety valve for acute care hospitals and improve the whole patient flow. One of the main contributors to the entire system right now is post-acute care. Where does someone go after a traumatic event? Burke, we have being 150 bed inpatient hospital.

Scott Edelman

We are seeing a shrinkage of IRF inpatient rehab facility beds in the tri-state area because of how busy the hospitals are, and they need to create capacity. So we become the safety valve. So it's a critical point that all acute hospitals that we have fantastic relationship with. Use us, use us as a safety valve to remove and reduce the number of people in an emergency rooms that are in the hallway waiting for beds.

Scott Edelman

So to answer your question, I feel right now at 150 beds, we have enough beds. And when it becomes where we need more, we will petition the state for more.

Tom Haederle

So if a patient goes to an acute care hospital and is told we are really crowded, can't deal with you right now, they know to refer that patient to Burke.

Scott Edelman

So the rules to the game about being referred to an acute rehab hospital, you have to have a three day inpatient hospital stay. So a patient goes to White Plains Hospital for a traumatic event, a stroke. They're there 3 to 4 days, stabilize. Then they're referred to Burke, and then the journey continues. Another valve is a skilled nursing facility because they might be too sick for Burke or not sick enough.

Scott Edelman

But we're here to treat the patients in the right setting at the right time.

Tom Haederle

Doesn't Burke deal with some of the same capacity management and workforce challenges that many of the other hospitals do?

Scott Edelman

So right now, we don't have a capacity issue, right? So we're 150 bed hospital. Today's census is, I think, 142 so, you know, the myth that Burke is full or IRFs are full. I always tell the acute hospitals just refer the patient. Let us go through the clinicals. Let us go through the insurance approval. Right now because of the culture at Burke, we have one of the lowest turnover, employee turnover rates in the tri-state area.

Scott Edelman

We had made some changes to our compensation philosophy, to our retirement plan, to a medical plan, and we're seeing less than a 5% turnover. And as far as the Tri-State area that's seeing and RN crisis, we're almost fully staffed with RN's.

Tom Haederle

That is really impressive, because all we hear about today, of course, is workforce challenges. And it's so hard to recruit and train and keep people. But you're really, sounds like you're really doing it right.

Scott Edelman

Yeah. Tom, on the recruitment side, you know, we're always looking for the best and the brightest. You know, we want to hire a lot more physical and occupational therapists and speech because of our rapid and aggressive expansion plans. You know, we have 15 outpatient sites. I think the number is 50 that we need, but we're going to need a lot more qualified PTO, OT and speech therapists.

Scott Edelman

We have a great, complement of physicians. We have one of the biggest teaching programs in the country. We have 20 residents and four fellows, and we train our physicians to go out and do amazing things.

Tom Haederle

Well, let's drill down into that a little bit. The hands on if I have the number right. I think I read that Burke Rehabilitation receives, more than 200,000 patient visits each year in total across all of your facilities. I know you offer both hospital based rehabilitation and an extensive menu that you talked about at the beginning of our conversation.

Tom Haederle

An extensive menu of outpatient therapy programs. What is Burke doing differently in both of those settings to support and treat clinically complex cases more efficiently and more economically?

Scott Edelman

Scott Edelman

Last year, we admitted over 100 patients that needed rehab and on dialysis. We've added TPN, total parental nutrition. We're looking at disorders of consciousness. We want to make sure that if there's a neurological or traumatic event, the entire country knows that Burke is the right place to get better.

Tom Haederle

Well said. And it's just so impressive, the sheer breadth of the different services and therapies that you offer. Which kind of leads me to the next question. What kinds of care or medical procedures seem the most promising in terms of delivering care and new ways that that do put less stress on acute care hospitals?

Scott Edelman

Right. So what we're seeing is neurological diagnosis are on the uptick. We're seeing a lot more strokes, especially in young people. And a lot of hospitals aren't equipped to deal with, stage one or trauma one. And what we're doing in our Montefiore Health System is making sure from any initial diagnosis that we have everything in the health system, from your first admission to your discharge to home for continuum of care and follow up.

Scott Edelman

We're seeing a lot less orthopedic admissions because they're going more to skilled nursing facilities or to home. And as a product of this term, 90 of our 150 beds are focused on neurologic conditions, and we might have to expand that more of our 150 beds. We do a lot of transplant patients. We do a lot of cardiac.

Scott Edelman

We do pulmonary patients. Our patients average length of stay is 14 to 15 days. Once they check in to our beautiful 61 acre campus, they really get settled in. Understand what recovery is. Three hours plus hours of therapy per day. We also do ancillary therapy that's not really required of an acute rehab. We do neurological music therapy.

Scott Edelman

We do pet therapy. And this is all to help the patients get better.

Tom Haederle

It struck me that maybe one of the secrets to your success so far has been what patient needs are where they're moving. As you pointed out, we're seeing growth in this area, some declines in that area. You're really just sort of tracking what's going on in health generally in this country, isn't it?

Scott Edelman

I think you hit the nail on the head, but it all starts with the patient. Everything we do is focused on how can we get the patient back to maximum functional recovery. When we look at a product or service, it doesn't necessarily have to have direct ROI, return on investment, but it has to speak to patient quality, patient safety.

Scott Edelman

How do we get patients back home, back to the life they love and how after discharge do we stay connected? Right. So it's constant follow up in phone calls and being part of the Burke family. We actually, all patients that are admitted, we give a card on admission and says, “Welcome to the Burke family.” We want to keep everyone connected.

Scott Edelman

We’re nationally recognized U.S. News and World Report, we're on Newsweek's list of best physical medicine rehab centers in the country. We're also our employees voted us best places to work. That has to say volumes.

Tom Haederle

It really does. I guess I would conclude then, and you've touched on some of these things already, but what advice would you have for your peers out there? You know, in the in the health care field who look at Burke and say, “my gosh, you're just doing so many things right. We'd like to follow their example.” What what what would you share?

Tom Haederle

What are your thoughts about that?

Scott Edelman

So Tom, I would go twofold. On the clinical end, listen to the acute care hospitals challenges. Help with reducing length of stay. That is what acute hospitals want to hear. It's better for the patient. It's better for the hospital. It's better for everyone. In addition, don't be afraid to swing big and fall hard. Not everything is going to work, right.

Scott Edelman

When we did our strategic plan, we threw spaghetti at the wall and see what stuck. Right? And we had 53 initiatives. Not every one of them are going to be home runs, Grand Slams, but we're hoping some base hits there. And leadership is everything. I start and end my day on the patient units, talking to patients and families and employees.

Scott Edelman

Sometimes you could find me at the front desk welcoming visitors. You could find me at the admissions center welcoming new patients. It's really all about presence, visibility and being humble and caring about your organization and the people we serve.

Tom Haederle

That is just a great summation of everything that you guys are doing right. Thank you so much for what you do on behalf of your patients. Thank you for your time. Joining me on Advancing Health today. And best of luck in everything you're doing and good luck in the future.

Scott Edelman

Thank you. It's been my pleasure and thrill.

Tom Haederle

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