The IRF s Future Depends Upon the Ability to Deliver Unique Rehab Value
Targeting Better Coordination of Care, Fewer Errors, Lower Costs and Improved Outcomes
The Rehab Model of Care (problem oriented, goal directed, coordinated, team delivered) is being replicated across all healthcare. These models target improved coordination of care, fewer errors, lower costs and improved patient outcomes. The demand for cost-effective and preventive care that also reduces overuse and misuse has providers turning to the structure and processes of the team delivered collaboration models. While functional impairment and the restoration of activity-participation remains the purview of IRFs, other healthcare organizations adopt this model and venture to provide a therapeutic approach to functional restoration. The cost to deliver that care is now a primary determinant for rehabilitation purchasers. When the effectiveness of care as demonstrated by goal attainment or outcome fails to discriminate providers, the ability to deliver care at lower cost gets immediate attention. The challenge to an IRF is the requirement to structure and operationalize all systems and resources to quantify and communicate the value of the specialized rehabilitative care they provide. The IRF’s strategy must provide management with the insights to operate effectively while fending off the challenges from payers and the providers who attempt to compete in the rehab space.
The IRF provider must first meet the conditions set forth by CMS to demonstrate both the structure and process by which patients receive treatment. Nowhere else in healthcare is there a mandate to deliver care by team approach, with specified intensity of resource use, and time based requirements to perform specific tasks. IRF providers must comply with these specific criteria to be paid; this is the price of admission for participation in the Medicare prospective payment system for inpatient hospital rehabilitation. While these expectations are not new, providers still find difficulties organizing workflow and patient care to stay abreast of meeting all regulations and providing fertile ground for RAC auditors to pick through clinical documentation looking for compliance deficits.
For the most part IRFs do not have the data to be able to know where they have the problems. Therefore, to start the process, they need technology and middleware so they do not have to manually collect data on where the high-risk problems exist. My biggest concern is that organizations will not have the wherewithal to absorb this much technology and change to do it well.
A prioritized patient problem list is the basis for communication and coordination of all patient care. The IRF puts the patient and his/her problems front and center of the delivery model. Clinicians addressing the patient will immediately recognize where their efforts will focus, where resources must be applied, and in what order should they occur as dictated by the patient’s problems. The IRF will make the patient problem list readily and usefully available at each clinician-patient encounter such that any change in problem status is known by all; decisions and delivery of care are coordinated with updated priority.
The outcome of IRF rehabilitation is predicted and established uniquely for each patient in a goal-directed care plan. The plan incorporates the best of the team’s knowledge to resolve patient problems with available resources and time considerations. Managing the process by which the plan is delivered is the primary determinant of outcome variance and subject to what information is available to influence decisions. It will be apparent to all; each model of care is perfectly configured and managed to produce the outcomes achieved.