AHA Stat Blog: Provide better care by embracing changes in rehabilitation

More than 40% of Americans over age 65 live with a disability. And, it is likely that many of these individuals have had at least one experience receiving rehabilitation services. 

National Rehabilitation Week was created in 1996 to celebrate and recognize those who dedicate themselves thanklessly and tirelessly to this work. As a physical therapist, I can attest that rehabilitation is among the most unique and rewarding segments in the health care system. Many professionals share my philosophy and have chosen to commit themselves physically, intellectually and emotionally to patients who require intensive rehabilitation services. 

Whether rehabilitation therapy is delivered in long-term acute care hospitals, inpatient rehabilitation hospitals, skilled nursing facilities or at home, all settings share a set of commonalities. These include: a team approach to care; deep and empathetic relationships between patients, families and clinicians; expertise in managing disability and chronic illness; and an almost superhuman “know-how” in the ability to overcome complex family situations, gaps in social and community services and limitations in health benefits, with the goal of ultimately transitioning a patient back home and on the right path for the best possible long-term recovery.

While the foundation of rehabilitation has remained relatively unchanged over the years, the world in which we work has. Understandably, referral partners have greater expectations around the cases we share, and patients expect and deserve the highest level of quality available. 

Another constant is the steady drumbeat of payment policy changes that affect rehabilitation services, which can initially feel threatening to practitioners. But I suggest that we look past all of this to see that these changes also represent opportunities to strengthen the role of rehabilitation and to grow the acknowledgement of its vital contributions toward recovering from serious, and sometimes catastrophic, injuries or illnesses.

Under the new payment systems, or alternative payment models, we’re expected to ensure that the care we deliver has a sustained benefit for our patients. No longer can success just be measured by what happens in some number of days, visits or episodes rather it must be measured over time. But this makes sense. Our patient’s recovery occurs over time in a non-linear manner with an outcome that is improved through our ability to create and facilitate a plan that sets a patient on the course for future success. 

At Brooks Rehabilitation, we’ve looked upon these new programs as a form of taking “risk” in a literal way or taking “risk” through different analogues. Specifically:

• Participation in programs like the Medicare Bundled Payment for Care Initiative, where the financial risk is real, and the responsibility was ours
• Risk associated with value-based programs that exist in Skilled Nursing and Home Care. Some might view as trivial, but might it be better to view it as opportunity to drives deep change?
• Market risk as more and more hospitals in urban and metropolitan areas develop  narrow networks of post-acute care providers that demonstrate top performance and a strong willingness to collaborate and evolve. The risk is exclusion.

Preparing your organization for risk and adapting the organization for change is clearly complex. From our experience at Brooks, change has positively transformed how we think, talk, organize, create and plan for just about everything. It has given us the opportunity to provide care it in a manner that will be sustainable over time. It aims to garner longer term success. More continuity of life. Why not be open minded and embrace the inevitability of change ahead, be it expected by patients, families, partners or others? The challenge is not how to overcome what is new but rather to remember why rehabilitation is so unique and rewarding, and to draw on our historical roots to position us for what’s ahead.

Michael Spigel is the president and COO of Brooks Rehabilitation in Jacksonville, Fla.