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Written by: Darlene D'Altorio-Jones (1959-2015) on Thursday, December 15, 2011 Posted in: Inpatient Rehab

Often I receive information from my professional organization APTA at the local or national level coaxing me to a call to action.  Although I wish I could say I was responsive with every nudge, that wouldn’t be truthful.  However, this past week is different.  H.R.1546 to preserve access to beneficiaries is a call to action for the entire rehabilitation profession, NOT JUST OUTPATIENT.  I’ll tell you why.

Whether we like to believe it or not, we as a continuum of health care need to be more mindful of the entire flow of care available to a patient.  If  for one moment we believe that our niche is the most important niche, it’s time to face reality.  I encourage everyone to  follow this link,  GovTrack.us.  Become familiar with health care issues and discuss them often with your state representatives.  They are OUR VOICES in Washington.  This particular item needs attention before they recess in 2011!

I found out that  my particular representative in Ohio is already a sponsor of H.R. 1546.  I wanted to thank him and educate him on the importance of supporting rehabilitation issues like this one.  Outpatient access is important because inpatient timelines are critically short.  If you are a facility, CAPS have probably not meant much to you. But there are patients that hospitals discharge who cannot access their post acute care at a hospital and must rely on services outside that umbrella.  Our advocacy must always be about the patient.  This is an excerpt of the letter I sent to my state representative:

“I was reviewing bill sponsorship and noticed that you are a co-sponsor for The Medicare Access to Rehabilitation Services Act of 2011 (H.R. 1546).  I wanted to take a moment to thank you for protecting access to your constituents.   Too often, the press provides detailed progress on improvements for persons like U.S. Rep. Gabrielle Giffords,  yet there are so many more without her status that are affected by similar circumstances or unfortunate health problems that do not get the time nor attention they deserve to return to productive lifestyles.”

As an education moment,  the government publishes each year a health insurance prospective payment system code (HIPPS) for persons receiving inpatient rehabilitation at a certified rehab facility/unit. In the 2012 IRF regulations,  the HIPPS code B0207, which is the highest acuity (2.70) for traumatic brain injury, provides, on average, a 35 day inpatient rehabilitation stay.  Had Congresswoman Giffords been a Medicare recipient,  the facility would have been hard pressed to perform the outcomes they did for that type of brain injury in so few ‘average’ days. Last years regulations were 37 days in the published HIPPS average lenth of stay.

Although H.R. 1546 is NOT about inpatient stays,  and is geared for outpatient,  it is clear to see that the recovery of persons permitted so few days on inpatient rehabilitation rely heavily on the outpatient continuum of our professions (PT, OT and Speech Language) to produce desired results for your constituents.  The CAPS process must be halted and the plan of care must demonstrate results and outcomes as the focus for payment.  I presume DOTPA (Developing Outpatient Therapy Payment Alternatives) will hold some promise for the future of outpatient services payment modeling.  That CMS sponsored study is just gearing up.   I strongly encourage you to share this story and support the rehabilitation professions so that we can take arbitrary caps away to bring focus on appropriate care and outcomes driven performance.”

Please visit the link to H.R. 1546.  See if your state representative is on board with preserving access to rehabilitation.  Either way, comment so that our representatives continue to hear our voices on legislative issues.   Going to the polls is powerful, but once a person is seated it is as important to influence actions in ways you wish for them to act.  Start NOW!

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