CITALI Healthcare Solutions is the premier PM&R hospital-grade Managing Service Organization (MSO) redefining how specialized rehabilitation care is accessed, delivered, and scaled. Through licensed clinical leadership, operational precision, and a fully integrated flat-fee model, we help stand-alone Inpatient Rehabilitation Facilities (IRFs) and hospital-affiliated Acute Rehabilitation Units (ARUs) unlock capacity, streamline workflows, and achieve sustainable growth, particularly in underserved and underperforming markets.

We don’t simply support PM&R operations—we engineer transformation. Our compact, licensed clinicians serve as Clinical Strategy Officers (CSOs) & these high impact medical process engineers are embedded directly into rehab environments to drive performance, expand access, and elevate strategic alignment. CSOs are supported by Clinical Strategy Specialists, functioning as IRF and ARU scribes. They ensure documentation precision, accelerate admission processes, and reinforce data integrity, strengthening compliance and daily execution from the inside out.

This clinician-led, BAA compliant infrastructure equips rehab establishments to overcome systemic barriers, activate community-based referral pipelines, and improve regulatory and financial outcomes—all delivered with one predictable, flat-rate partnership.

Stand-Alone IRF Landscape Core Issues Include:

• Overdependence on Acute Referrals: Most IRFs still rely heavily on internal hospital floors for admissions—missing high-value patients from SNFs, outpatient, and home health settings who qualify but remain untapped.
• Workforce Capability Gaps: Staff often lack the specialized training, tools, and workflows required to facilitate transitions from non-acute and community sources, limiting reach and efficiency.
• Payer Conversion Failures: Inadequate payer strategy, especially with Medicare Advantage, TRICARE, and commercial plans, leads to missed admissions and lost revenue due to denial risk and misaligned pre-admission workflows.
• PAS Process Breakdowns: Poorly executed Pre-Admission Screening (PAS) including inaccurate transcriptions or non-clinical interpretations—leads to case rejections, lost throughput, and provider frustration.
• Compliance Misalignment: CMS audits consistently reveal gaps in key performance metrics such as the 60/40 rule, putting some IRFs at risk for penalties and reduced public trust.
• Clinical Scope Limitations: Facilities often restrict admission diagnoses to a narrow band of conditions, missing clinically appropriate cases and diminishing their market position in comprehensive PM&R delivery.
• Underutilized Bed Capacity: Many IRFs operate far below their licensed or optimal capacity—leaving revenue on the table while contending with rising labor costs and shrinking margins.
• Turnover in Business Development Roles: High attrition in outreach roles disrupts referral consistency, reduces Average Daily Census (ADC), and weakens strategic growth trajectories.
• Joint Venture Risk Sensitivity: Hospital-IRF partnerships frequently underperform due to poor alignment, high risk aversion, and breakdowns in strategic execution—leading to financial exposure and missed impact.

ARU Landscape Core Issues Include:

• Overly Narrow CMS-13 Interpretation: Many ARUs fail to leverage nuanced clinical documentation to support compliant admissions, excluding patients who meet criteria but require more advanced querying or interdisciplinary input.
• Referral Source Limitations: Dependence on acute care floor referrals narrows patient pipelines and stifles community benefit, especially in regions with limited hospital volume.
• Payer Complexity & Admission Delays: Staff frequently struggle with authorization protocols for non-traditional payers, resulting in unnecessary denials, admission lags, or abandoned referrals.
• PAS Documentation Gaps: Inconsistent or incomplete documentation continues to delay care, reduce throughput, and damage internal confidence in admission workflows.
• Compliance Vulnerabilities: Many ARUs fall short of regulatory benchmarks (e.g., 60/40 rule), exposing programs to reimbursement risk and compromising long-term viability.
• Limited Diagnostic Scope: Narrow admission practices prevent ARUs from treating the full range of qualifying PM&R conditions, reducing perceived value within integrated care systems.
• Chronic Underperformance: Operating below capacity not only forfeits revenue—it burdens the mission-driven hospitals that host ARUs, eroding their ability to reinvest in high-need community services.
• Insurance Knowledge Deficits: Staff often misunderstand insurance authorization timelines, allowable stays, and benefit utilization—resulting in avoidable care delays or inappropriate denials.
• Fragmented Care Coordination: Siloed communication between referring providers and ARU staff leads to duplicated efforts, missed clinical information, and poor handoff execution—ultimately harming outcomes.

These challenges aren't isolated, they are symptoms of systemic breakdowns that require clinical, operational, and strategic realignment. Without targeted intervention, IRFs and ARUs will continue to fall short of their potential, while patients especially in vulnerable populations remain disconnected from life-changing rehabilitative care. We assist with increasing the referral base beyond the acute care hospital floors. The leaders have a combination of more than 20 years’ experience procurement of successful PM&R admissions from LTACH, SNF, HHC, ER, surgical hospitals, home, hospice, and from diverse clinics.

As part of our mission to support equitable, efficient, and sustainable healthcare delivery, CITALI Healthcare Solutions advances the following public welfare objectives through our work with IRFs and ARUs:

• Expand Community Health Access: Facilitate the delivery of specialized rehabilitative care in regions with limited access to board-certified practitioners by utilizing IRFs and ARUs as central access points within the continuum of care.
• Reduce Health Disparities: Address gaps in healthcare delivery—particularly helping current PM&R entities to vamp up operations or aid in establishing a program in underserved urban and rural communities—by enabling more consistent, progressive care through scalable post-acute PM&R strategies.
• Improve Healthcare Outcomes: Support a measurable reduction in mortality and morbidity related to chronic and complex conditions by connecting patients to higher-acuity care settings at the right time through improved referral models.
• Minimize System Waste and Protect Patient Benefits: Mitigate preventable loss of insurance coverage and reduce inefficiencies that contribute to waste, fraud, and abuse—ensuring patients receive the full value of their entitled benefits.
• Advance Workforce Equity and Representation: Address inadequate diversity in clinical training and workforce development by promoting inclusive practices and equitable representation in the rehabilitation sector, particularly in regions where disparities are most acute.

PALACE Framework – Strategic Overview

• Tailored Framework for Stand-Alone IRFs: Designed specifically to address the unique operational and strategic needs of stand-alone inpatient rehabilitation facilities, optimizing patient flow, compliance, and resource utilization.
• Consultant-Led Execution: Utilizes expert consultants to implement and guide the strategic framework effectively.
• Engineered Process System: Underlying, scalable processes designed to enhance Post-Acute Level Active Community Engagement within regional post-acute care networks.
• Optimizing Patient Transitions: Facilitates smooth admission of patients into IRFs from a broad range of settings including residential, non-residential, urgent/emergent care, non-emergent, and outpatient clinics.
• Bridging Intermediate Care Levels: Supports transitions from home health, subacute facilities (SNFs), LTACHs, physician offices, ER, surgical hospitals, home, assisted living facilities, and hospice into IRFs, improving continuity and care appropriateness.
• Promoting Cost Efficiency: Aligns with Project 418.54 goals to reduce wasteful Medicare hospice expenditures and optimize resource use.
• Ongoing Education & Awareness: Provides consistent, targeted education to practitioners and providers to advance understanding of PM&R as the preferred next level of care.

RESURGENT Framework – Strategic Overview

• Focused Support for Rural ARUs, CAHs & FQHC Hospitals: Tailors frameworks to enhance or create PM&R access and care transitions specifically for ARUs in rural regions, Federally Qualified Healthcare Centers and Critical Access Hospitals, addressing unique challenges of geographic isolation, resource limitations, and population health needs.
• Consultant-Led Execution: Employs expert consultants to implement and manage the strategic framework effectively.
• Accelerated Patient Transitions: Facilitates timely transitions of patients into ARUs from emergency rooms, observation units, and outpatient clinics, enabling rapid delivery of specialized PM&R care.
• Cost Containment Initiatives: Supports Project 418.54 efforts aimed at reducing wasteful Medicare hospice spending.
• Ongoing Clinical Education: Delivers consistent education to practitioners and providers on PM&R as the next level of care.
• Enhanced Care Coordination: Strengthens provider communication, care coordination, and interdisciplinary collaboration to improve patient outcomes and reduce preventable loss of healthcare benefits.
• Addressing Disparities: Emphasizes strategies to correct healthcare disparities by ensuring equitable access and improved care pathways across diverse patient populations.

Stand-Alone IRF Key Deliverables

• Accelerated Referral Growth & Market Positioning: CSOs unlock untapped channels and revive partnerships to rapidly grow and diversify your census, strengthening your facility’s market presence.
• Innovative Community Admissions: Engineer new clinical pathways with our PALACE Framework to admit appropriate patients from diverse settings beyond hospital floor and increase ADC metrics.
• Optimized Post-Acute Networks: Build robust, compliant referral networks linking IRFs with SNFs, LTACHs, SNFs, HHA, surgical hospitals, and specialty providers—solidifying your role as a regional rehab leader.
• Expert Scribe Integration for Compliance & Revenue: Streamline PAS documentation and clinical data review to reduce denials, accelerate admissions, and increase compliant revenue.
• Targeted PM&R Referral Education: Empower providers with focused training that drives consistent, high-quality referrals and enhances care transitions across the continuum.

ARU Key Deliverables

• Accelerated Referral Growth & Market Positioning: CSOs unlock untapped channels and revive partnerships to rapidly grow and diversify your census, strengthening your facility’s market presence.
• Innovative Community Admissions: Engineer new clinical pathways with our RESURGENT Framework to admit appropriate patients from diverse settings beyond hospital floor and increase ADC metrics.
• Optimized Post-Acute Networks: Build robust, compliant referral networks linking rural and nonprofit ARUs with FQHCs, and specialty providers from the ER—solidifying your role as a regional rehab leader.
• Expert Scribe Integration for Compliance & Revenue: Streamline PAS documentation and clinical data review to reduce denials, accelerate admissions, and increase compliant revenue.
• Targeted PM&R Referral Education: Empower providers with focused training that drives consistent, high-quality referrals and enhances care transitions across the continuum.

CITALI’s hospital-grade MSO model embeds licensed clinical experts to drive scalable growth, maximize compliant revenue, and expand market share but without adding internal burden. Request your free demo now and see how we turn underperformance into strategic dominance.