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Written by: Bob Habasevich, PT on Friday, October 21, 2011 Posted in: Inpatient Rehab

Connecting the dots in healthcare delivery continues to frustrate patients, payors and providers.  Linking the resources across a continuum of care and ensuring effective and efficient transitions poses threats to clinical and financial outcomes.

Alternative delivery models or Accountable Care Organizations (ACOs) are on schedule to begin January 1, 2012. And while the specifics of how this is going to work are still very vague, the concepts driving the plan are clear.  Do more with less, replace volume with value, emphasize prevention, align workforce with care needed requirements, use technology to achieve effectiveness and efficiency improvements.  The inpatient rehabilitation facility (IRF) will play an important role in the new delivery model only if it’s aligned structurally and culturally with other providers within the ACO.

IRFs will be sought out for their value in providing post-acute short stay rehabilitation. Relationships with the C-suite office holders of local hospitals will need cultivation. This is not the usual case finding relationship currently performed by liaisons, but rather the business of negotiating mutual successes within the ACO delivery model. This is a CEO to CEO conversation about relationships based on IRF strengths in providing care value that others cannot.  Now is the time to reach out to external consultation or management services to assist you in correctly positioning your business.

Scot A. Park recently posted a review of this evolving post acute care world in which he positions the IRF with the acute hospital in a partnership (Examining Acute/Post-Acute Care Partnerships Under Healthcare Reform)  His comments end with a structured self assessment of the IRF’s ability to meet the future expectations of integrated care delivery and serve to guide IRFs through the considerations of the developing relationships.

IRFs need to prepare for an impact upon reduced volumes as post acute patients may be referred based upon a value based purchasing guarantee of performance and outcome particularly those at-risk for re-admission to the acute care setting. The IRF’s leadership’s role as a post-acute care provider is to work with community physicians to identify opportunities now while the concepts are taking shape.  IRF leaders must bring data to support their positions with ACO leaders, clear description of  how important metrics are monitored and reported will be necessary.  The primary metric to be measured and managed is unplanned re-hospitalizations.  In the new world of healthcare reform, the IRF “report card” changes; FIM™ change and satisfaction survey results will have less meaning.

ACO relationships will change the way IRFs currently practice at all levels of the organization.  These expectations will carry over to the clinical and business practices of the IRF and its relationship outside the ACO.  The freestanding IRF will quickly become a misnomer as these relationships both formal and informal will require integration of the IRF with all providers within the care continuum.

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