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Written by: Bob Habasevich, PT on Tuesday, June 19, 2012 Posted in: Inpatient Rehab

If this question is not currently asked in your practice, it soon will be. Reuters, the news agency, published a report that makes a point about healthcare spending in the U.S. with current estimates at more than $8,000 annually for every person. Moreover, that amount nowhere reflects the question, “Are patient needs being met?”

The Reuters article by Sharon Begley, Is high spending on cancer care ‘worth it’? focuses the issue on cost and treatment for cancer. With reference to the study by Tomas Philipson at the University of Chicago, it may be concluded that patients with cancer live longer in the United States than in Europe and that comes at an average cost of $61,000 per patient for each additional year survived. Definitely worth it.

The article points out the study immediately drew criticism of the medical community as being “completely misguided and dangerous.” With flawed analysis the wrong conclusions are reached. The use of data to communicate and argue the pros or cons of any issue must be scrutinized for appropriateness prior to becoming convinced. The choice of metrics or measures of improvement has significant potential to mislead. The support or disclaim for the conclusions drawn are influenced by one’s interests will ultimately determine credibility.

Financial gain is at the heart of the U.S. economy and is a primary motivation for success. Healthcare is challenged to improve quality and lower costs with hope that greater value will be realized. Survival rates are important in determining the value of cancer treatment. However, without consideration of how survival is measured and analysis of all the contributing variables, a wide interpretation of results are possible- some of which may impede progress toward improvement in cost-effectiveness of healthcare delivery.

The rehabilitation sector of healthcare has been targeted for its costs and clarification of its benefits. Our position has always been the justification of cost with improvement in functional ability and return to greater independence and self-sufficiency. The FIM™ has served as the de facto reference for functional activity measurement. Attempts to describe a difference in FIM™ ratings before and after treatment offers a comfort to those who have interests in relating FIM™ change with care effectiveness. Providers who state their FIM™ gain is better than others are hoping that no one scrutinizes what that exactly means, because the attempt to explain the metrics and analysis will certainly challenge their credibility.

Without an established measure of value for function, i.e., “What is it worth to be able to get on and off a toilet?” we will not succeed in justifying the costs in attempting to deliver it regardless of how we measure it.

Convincing someone other than the patient to bear that cost is where we are now in healthcare reform. Given a patient’s choice in deciding, how much it’s worth should certainly influence the decision of how much to spend. In addition, if a care provider cannot deliver the outcome, should there be a discount?

These discussions of value and worth are important considerations in formulating policy for healthcare reform. As a rehabilitation provider, you must scrutinize every claim of outcome and determine value based upon the cost to deliver. That means it is not sufficient to simply collect measures, it requires meaningful analysis to demonstrate worth.

Now try bundling that into an accountable care payment.

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