The Future Is in Our Hands but What Are We Doing about It?

Transcription

1 The Future Is in Our Hands but What Are We Doing about It? Carl V. Granger, MD Executive Director, UDSMR Director, CFAR Professor of Rehabilitation Medicine, University at Buffalo 2012 Uniform Data System for Medical Rehabilitation. FIM, LIFEware, UDSMR, and the UDSMR logo are trademarks of Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc.

2 Welcome! We are delighted with this opportunity to share information and stories and by our first-ever Rehabilitation Physician Conference The information we present will help doctors who are being bombarded with an increasing array of regulations and mandates from CMS and the insurance industry We offer our support to inpatient and outpatient rehabilitation practitioners doctors, nurses, therapists, social workers, and other team members 2

3 Mission, Vision, and Values Each year at UDSMR, we review our stated mission, vision, and values We are proud that our mission remains relevant as stated: to enable healthcare providers and related entities to document and improve the outcomes, processes, and perceptions of care in uniform ways 3

4 My Background and History Early in my career, physiatrists were treating soldiers with severe physical and mental impairments who were returning home from WWII and the Korean War Additionally, we cared for many, many thousands of people paralyzed by the polio epidemic After the enactment of Medicare in 1965, physiatrists were charged with caring for the elderly, with their unique and multiple debilities Today, the field of physiatric rehabilitation is faced with a number of challenges caring for persons impacted by war, terrorism, chronic and infectious diseases, natural and man-made disasters, accidents, aging, obesity, developmental disabilities, and many more, all with very finite and dwindling resources 4

5 Anticipated Needs In 1976, my presidential address at the American Academy of Physical Medicine and Rehabilitation Epidemiology, Disability, and Physiatric Practice anticipated the direction and needs for the rehabilitation field Much of what I discussed remains highly relevant today I will share the future of rehabilitation as I saw it over three decades ago, discuss the progress we have made, and examine the unfulfilled needs that remain today 5

6 1976 AAPM&R Presidential Address: Progress/Accomplishments 1976: The rehabilitation industry needs to develop standardized terminology and evaluation methods to describe functional limitations 2012: We have made much progress with the development of the FIM instrument for inpatients and other tools for outpatients and children 1976: Measures to show the impact and general benefit of rehabilitation to society on an ongoing basis 2012: Development and implementation of the FIM instrument, the LIFEware SM System, and the UDSMR program evaluation model (PEM), plus UDSMR data aggregation and reporting 6

7 1976 AAPM&R Presidential Address: Progress/Accomplishments 1976: The design and execution of collaborative scientific studies using epidemiologic principles and methods to measure disability and show the favorable impact that rehabilitation programs bring to society 2012: CFAR, the Center for Functional Assessment Research, has been doing this for several decades and will continue the efforts 1976: Research to identify patterns of patient behaviors associated with each impairment to better manage disability and predict outcomes 2012: CFAR has been participating in collaborative investigations and publishing its findings, and it will continue to do both 7

8 The Bad News Government Report: Health Cost Relief Only Temporary, by Ricardo Alonso-Zaldivar Chronic illness eats up 75% of the $2.6 trillion that the US now spends annually on health care The number of physically unhealthy days has risen slightly, from 3.3 days in 2000 to 3.6 days in 2009 Those who reported 14 or more mentally unhealthy days rose from 9.6% of the population in 2000 to 10.6% in 2009 About 30% of healthcare costs are wasted due to unnecessary tests and procedures (Berwick, JAMA, 2012) 8

9 The Bad News Government Report: Health Cost Relief Only Temporary, by Ricardo Alonso-Zaldivar By the next decade, healthcare spending will grow roughly 2% faster than the overall economy By 2021, healthcare will account for nearly 20% of the US gross domestic product, up from 14% in 2000 The rate of growth in healthcare costs during the past three years was about 4% This has coincided with a shift to paying hospitals and doctors for better quality, not just for the sheer volume of tests and procedures 9

10 The Bad News Government Report: Health Cost Relief Only Temporary, by Ricardo Alonso-Zaldivar Other cost drivers include an aging baby-boom population and the spread of expensive new medical technologies From 2015 to 2021, healthcare spending will grow 6% a year, which is about 2% faster than the expected economic growth This is unsustainable The government s proportion of healthcare spending will rise from 46% in 2011 to 50% in

11 The Good News The Simple Idea That Is Transforming Health Care, by Laura Landro A focus on quality of life helps medical providers see the big picture and results in healthier, happier patients A very simple new question is changing the delivery of medical care: How is your health affecting your quality of life? 11

12 The Good News The Simple Idea That Is Transforming Health Care, by Laura Landro For decades, the medical model has driven the use of numbers to treat diseases Public health officials focused on reducing mortality rates and hitting targets like blood-sugar levels or cholesterol levels Doctors still monitor such numbers, but healthcare providers are now adding a more subjective bio-psychosocial model that measures how people feel about their well-being and the life they are seeking to fulfill 12

13 Well-Being Noreen Clark, director of the Center for Managing Chronic Disease at the University of Michigan: People aren t motivated to follow their clinical regimen if in fact it doesn t improve the way they function and get along with others and manage day to day Numerous studies show that people with a higher sense of well-being have fewer hospitalizations and emergency-room visits, miss fewer days of work, and use less medication 13

14 Challenges Still Remaining 1976: Function had to be the foundation of what I called the science of rehabilitative measurement ; I also said, Disease descriptors and clinical terminology are insufficient to describe frequency, severity, longevity, and consequences of impairment 2012: Function is captured by the FIM instrument and should remain the core of any instrument moving forward 14

15 Challenges Still Remaining 1976: We need to conduct latent trait analysis to construct patient measurement systems to document and measure all of the systems within a person (i.e., functional health) 2012: The LIFEware SM System was created to fill this need for outpatients for longitudinal tracking for outcomes; unfortunately, the healthcare system still does not focus on holistic treatment 15

16 Challenges Still Remaining 1976: A critical resource for obtaining the optimal result for disabled patients is the inpatient rehabilitation hospital ; in addition, the number of inpatient rehabilitation beds in the US has been decreasing, and during the next 20 years, aging baby boomers could be denied intensive rehabilitation 2012: More than ever, we must ensure access to this precious resource 16

17 Challenges Still Remaining 1976: Realizing the ideal of a continuum of care measuring outcomes across time and settings requires the ability to measure and manage outcomes and predict which types of patients benefit most, in which settings, and at which times during their illness, along with the durations of services and costs 2012: The FIM instrument and its derivatives measure function and burden of care and can fill this need 17

18 The Response from Physiatrists Murray Brandstater, MD: A major and important advance in rehabilitation care was the introduction of systems to measure disability, notably the... [FIM instrument], which has provided the tools to record patient progress and measure functional outcome. The quality of rehabilitation care also improved as nursing and allied health professionals brought a higher level of knowledge and skill to the rehabilitation process through enhanced education. 18

19 Challenges Still Remaining 1976: Patient-centered care must overtake all other care approaches so that outcomes how well the patient does drive medical decisions, not economics or available technology 2012: This is still an urgent issue in today s healthcare system 19

20 The Response from Physiatrists Elizabeth Sandel, MD: We will need to provide expert care across many settings... [Our work] will provide optimal functional and medical outcomes for the most complex populations we serve. Kurt Hoppe, MD: Because technology will be subjected to comparative analysis research, it is proper that physiatrists provide the best evidence for treating disabling conditions to patients and their families as unbiased as possible from undue outside interests. 20

21 UDSMR s Goals We at UDSMR desire to design and execute collaborative scientific studies with physiatrists and other rehabilitation practitioners We propose using epidemiological principles and methods to measure our national disability problem We want to demonstrate the ways in which rehabilitation programs improve functional health and lower costs on an ongoing basis 21

22 The Future of Rehabilitation Will the progress made in the field continue as the US healthcare system remains seriously underfunded, costly, and disorganized? The field must rise to the challenges ahead by: Using functional assessment data in new ways to provide the most effective and most efficient care Working closely with other medical specialties to treat the whole person Implementing a seamless continuum of care that meets the needs of the patient, rehabilitation facilities, providers, and payers 22

23 UDSMR Systems UDSMR systems quantify functional health as experienced by the person We call it precision case management with decision support tools, and it helps facilitate a life of wellness and fulfillment for the patient For more information, see The Future Is in Our Hands, Physical Medicine & Rehabilitation, 3,