With all the discussion of the CMS value-based purchasing initiatives, many in our industry still don’t see how this relates to the tasks of rehabilitating patients and improving functional abilities. The value of improving a patient’s ability to brush his teeth or dress her lower body is different for each patient and thought to be as the ad says, “priceless.”
In a recent AMRPA presentation by Dr. Marlee Dyson, the lifetime cost of care for a brain injured child was predicted to be in excess of $54 million during the course of expected lifetime. Attendant care is a sizeable portion of that total. The role of rehabilitation is to significantly reduce that care cost burden. To date, no one is willing or able to put a dollar value upon what that reduction could or should be given the application of our state of the art rehabilitation programs. In short, rehabilitation providers may still be in the “we will do what we can and see what happens” mode when predicting what effect rehabilitation will have in overcoming impairment and improving function. And, the business model remains, there is no guarantee.
This may change as care bundling and accountable care take effect upon providers who will realign within an integrated care continuum with a contractual agreement to “do what they can” for a price. Delivering a plan of care with specified outcome and expectation will be a new business model for rehabilitation providers. Failure to deliver upon what was planned and paid for will cut short future opportunities. Repeated failure to fulfill contracted agreement will leave providers looking elsewhere for patients.
Managing patients beyond admission and discharge from any care venue will be the requirement with an assessment of each provider’s contribution to the outcome. Providers who deliver the outcomes they predict will be preferred over providers who offer a low cost alternative and achieve less.
Accountable care places this expectation upon every provider and clinician. Value is defined as delivering the outcome expected for the price paid.