Wednesday, December 16, 2015

Mom and Dad ready to skip rehab?; bundled payments

This week's article published in the Philly papers about knee and hip replacements ....

discussed the trends in rehabilitation after a knee or hip replacement, highlighting decisions to bypass in-patient rehabilitation after the knee or hip is replaced, incorporating the use of technology, going home the day after surgery, bypassing in patient rehab and home care.
AlterG;  mixing technology and therapy to restore function.

Discussions focus on the seemingly healthy folks that elect knee and hip replacements, leaving out a segment including perhaps your Aunt or Uncle, Mom or Dad;  folks with other co-morbidity issues that limit recovery (some doctors say up to 60% of these patients have co-morbidity problems that may require patients to go to rehab units or get home care).

Facilitating these actions is the insurance industry, as Medicare has chosen to begin "bundled payments" for  an  "episode of care", paying one source  (hospitals or accountable care organizations) one payment to take care of the entire process (including surgery, anesthesia, diagnostic studies,  in patient rehab, home care, outpatient rehab, follow up visits to surgeon, etc).

This comes fresh off the news this spring from the Hospital of Special Surgery, citing in-patient rehab is as effective as going home after surgery:

If this is the case, then why not send home all patients the next day after a knee or hip replacement?

Over the years, I clearly see Physical Therapists involvement with total hips replacements has diminished, where now only occasional hip replacements need our services.  The largest role we now play is educating, either before or after surgery, and having frank discussions about joint conservation and functional expectations.  Surgeons and their staff in general spend a shorter period of time in this arena.   PTs are educators and enablers, helping you understand limitations and expected abilities after surgery, so a few weeks of strengthening and education make a huge difference.
Conversly, Knee replacements have a larger degree of difficulties, where outpatient Physical  Therapy can have meaningful difference.  Scar tissue buildup, inflammation, and pain in most cases can be resolved quicker with skilled Physical Therapists using their hands, modalities, and a multitude of specialty equipment.  Physical Therapist are designed by education to become educators and enablers, finding opportunities to help patients with joint pain to improve their lifestyles.  A seasoned Physical Therapist is empathetic enough to understand the patients expectations and goals, has time in their day to educate, and offers solutions to restore function and performance; skills no one else in the healthcare chain offers.

Interestingly, what motivates a patient to get the surgery is loss of motion, pain, of loss of quality of life, all areas Physical Therapist are experts in.

At PTW, we are proud that outpatient Physical Therapy offers evidence driven care to help restore motion, reduce pain, and to improve quality of life, to remain part of the post operative surgical management team.

The question to ask is bundled payment strategies to reduce costs right for the other 60% of our Moms, Dads, Aunts, or Uncles?