The levels of care provided by rehabilitation facilities vary significantly based on their scope of services. Each IRF or IRU is expected to provide comprehensive rehabilitation services for conditions ranging from catastrophic injuries to post surgical and post acute medical care related impairments.
Each provideru2019s rehabilitation care delivery model is a complex set of functions dependent upon the effective coordinated interplay of interdisciplinary interactions all centered upon resolving a patientu2019s impairment problems. Effective patient and system management requires continuous information and feedback to make timely decisions if things are not going as expected. This intelligence comes from the tools management has available to define and monitor clinical practice standards at the patient and provider levels. It should be expected that the tools we use to keep us informed are the best match for the job.
This is the existing world of patient care, but something is changing. Everyone knows that the status quo is not sustainable, that some forms of payment and delivery system reform are inevitable, and changes to Medicare have a way of influencing all providers and payers. The recently proposed concepts and objectives of Accountable Care Organizations (ACO) seem very logical and achievable, and the anticipation of additional revenues from performance-based shared savings and promise of the patient and provider freedoms inherent in traditional fee-for-service are especially welcome. While it may appear that these provisions are applicable only to primary care providers, their carryover to post acute care rehabilitation providers is linked through the parallel initiatives of ACO contracted providers and bundled care payment plans.
The keyword is u201caccountabilityu201d for the patients the provider takes care of; significantly, this is not just another tweak in the payment model for Medicare beneficiaries. The change in how and how much providers will be paid is minor in comparison to the change in how care is delivered and to whom. Patients, as well as providers, are accountable for outcomes in the proposed shared savings program. Rehabilitation providers and their patients require information and technology to collaborate and coordinate care to enhance treatment quality and efficiency within the economics of the payment model.
The ACO proposed rule identifies sixty-five quality performance measures that extend the reporting of effectiveness and efficiency to areas of clinical process as well as outcome. The expectation that quality is patient centered shifts the focus from population to the individual patient for care effectiveness. A clinical information tool set should provide the ability for the rehabilitation program to meet, document and report its care management goals.
While the rehabilitation industry debates and proposes a set of quality measures to CMS for future use, providers would be wise to begin preparing for the inevitable and start asking the questions before the reporting requirement axe falls. Answers may not be apparent but the exercise will begin the process and focus expectations for future performance accountability. The problem exists however, should providers be accountable to the federal government for the care provided or perhaps should accountability also be patient centered?