Rehabilitation and Recovery
At the 2018 Insurance Rehab Synergy Group Annual Conference, a panel was a “fireside chat” on the past and future of rehabilitation and recovery. The panel included:
- Mark Ashley, SC.D, CCC-SLP, CCM, CBIST – President/CEO Centre for Neuro Skills
- Gary Ulichny, PhD – President/CEO GRU Health Care
- Kenny Hosack – Craig Hospital
- Natalie Hefner – Workers’ Compensation Reinsurance Association
Highlights:
- Rehabilitation tries to minimize impairment, disability and the handicap.
- We need to do a better job encouraging people to get back in the community. The World Health Organization definition of disability is a good one but we need to emphasize the engagement aspect.
- As a society, we are doing a better job embracing people with disabilities and understanding how the physical disability does not prevent them engaging in many activities. We are doing better focusing on ability not disability.
- Capitalism discovered rehabilitation in the mid 1980s and that led to an explosion in rehabilitation facilities and resources. People like Christopher Reeve gave the effort of rehabilitation from spinal cord injuries a known face that people could identify with.
- Years ago people with severe injuries were hospitalized for 6-8 months routinely. The focus on managed care changed that for the good. Lengths of stay are much shorter now and the outcomes are much better.
- We have learned that the sooner rehab starts the better the outcomes. Therapy often begins the day after surgery for many conditions.
- We have made tremendous strides in technology which is improving the survival rates from serious injuries and those people are not only living but having a good quality of life.
- We have very good information now about what rehabilitation works and what does not. This has greatly improved the quality of care.
- Data is enabling us to do a much better job treating patients. For example, Cleveland Clinic using data has algorithms which can predict cardiac arrest in the ICU. Because of this their survival rate for cardiac arrest is more than three times greater than the industry norm.
- Too often the payment methodology has driven the treatment choices. The CMS models are very regimented and they create fragmentation by forcing a single way of treating all patients. An example of this is the CMS “three hour rule” where a patient cannot be admitted to a rehab hospital until they are able to participate in three hours of activity. There is no medical basis for this, it is just an arbitrary number.
- Payment models creates challenges as some of the payment models do not allow for adequate treatment of the patient based on their individual needs. They put too much focus on length of stay instead of the progress a patient is making and what their prognosis is for additional improvement.
- We do not treat rehabilitative medicine like other medicine. You don’t have treatment time limits on cancer or cardiac care, but it exists in rehabilitative medicine.
- Some of the advances in acute care technology are resulting in better outcomes. Patients are getting to the rehabilitation hospitals much faster than ever before.
- Assistive technology in particular has advanced rapidly, but is it worth the money? Some types of assistive technology are extremely expensive compared to the gain in function.
- We need to do a better job convincing society that getting someone back to work is not a cost to society, it is a benefit. Other companies are well ahead of the United States when it comes to investing in rehabilitation.
- We need to come to agreement on what outcomes are important. There is a lot of data out there but little consensus in what outcomes are important.
- We are experiencing disruption right now, not change. Genome sequencing has become so affordable that it will become part of everyone’s health records. That will allow for customized medicine and disease prevention.
- IBM Watson has incredible potential to increase our diagnostic capabilities. The computer can accurately use radiological imaging for diagnostics far beyond what humans can do.