The Post Acute Continuum Understanding differences between IRFs, LTACHs, SNFs, LTC, AL/IL and other facilities, part 1 Charlotte H. Smith MD, Chief Clinical Officer

Topics of Discussion What are the levels of care where physiatrists are needed? What are the differences between these levels of care? How does the PMR role differ? What are success strategies for each of these levels of care?

Post acute Rehabilitation Settings Although you most likely received excellent training during your PMR residency or fellowship, there are probably post-acute rehabilitation settings where you may not feel fully prepared to jump in. The majority of physiatrists currently receive little to no training in these environments. Examples of these post-acute rehabilitation settings include: Skilled nursing facility (SNF) Long term acute care (LTACH) Assisted/independent living (AL/IL) Memory care (MC) Long term care (LTC)

Differences between Post-acute facilities There are differences in how physiatrists function in these environments including: Different goals Different lengths of stay Different rules related to how rehabilitation services can be provided Different rules related to billing & reimbursement Different rules related to documentation Different resources available within the various levels of care

Strategic Differences : In addition to how you do your duties, there will be other strategic differences in: How you obtain referrals How you work with other physician specialists How you help your facility achieve success How often you see your patients The focus of your visits Your role and how you support the team

Challenges in working throughout the post acute continuum of care (PACC) Current regulatory environment with the maze of Medicare regulations and rules, this can feel overwhelming. Learning how to navigate through and provide optimal care in all of these different environments could easily require a fellowship. Since nothing like this exists, it is our job at US Physiatry to help you learn this information and conquer these new skill sets.

WHY should Physiatrists be available in ALL of the post acute environments? Becoming an expert in these arenas will allow you to provide the highest level of care possible to your patients. In addition, you will have expertise that is critically needed in our current health care environment. There is currently no arena of healthcare with a higher variation in both cost and quality than the post-acute continuum. Physiatrists are in a unique position to impact outcomes as they become leaders in managing patients throughout the healthcare continuum, including post-acute care environments

US Physiatry’s Strategy: US Physiatry’s strategy is to provide physiatry services in all aspects of the healthcare continuum. It is our belief that patients benefit from having physiatrists involved in all levels of care: Acute care hospitals Inpatient rehabilitation Skilled nursing facilities Assisted living/independent living Long term care facilities Home health care Outpatient care Wellness/prevention

The Focus of Rehabilitation in the PACC The focus of rehabilitation varies depending upon the setting but includes: Improving function related to disabling conditions Prevention of secondary complications Managing disabling conditions across the patient’s lifespan Disease/disability prevention

Opportunities within the PACC: Increasingly, rehabilitation services are being shifted to less intensive and lower cost settings. Due to the tremendous shift from inpatient acute care rehabilitation facilities to skilled nursing facilities, SNFs now provide the majority of facility based rehabilitation. There has been tremendous growth in the volume of home health services and it is anticipated that there will be additional scrutiny and regulation related to home health care.

Cost Issues in the PACC: In ACO environments, healthcare networks are attempting to control all aspects of patient care throughout the continuum. Currently the cost of post-acute care is often equal to the acute care hospitalization cost but has the highest variation in quality and outcomes. Post-acute care is considered the ‘black box’ of the healthcare continuum

Providing VALUE vs QUALITY: Hospital networks are increasingly attempting to choose post- acute care partners that perform well by providing high value services: High quality care (good programs, comprehensive services, high patient/family satisfaction) Short length of stay Low cost of services Low readmission rates to the acute care facility Good outcomes (to community rather than long term care) Remember the definition of value: VALUE = HIGH QUALITY --------------------- COST

How do physiatrists provide VALUE? Managing all types of patients throughout the continuum Preventing complications Optimizing function Decreasing length of stay Navigating patients to the correct level of care Preventing readmissions Optimizing patient/family satisfaction

RISKS for Physiatrists in ACO environments: Being at the ‘end of the food chain’ Not being invited to the party

Opportunities in ACO environments: Being involved from the beginning of care Becoming patient navigators throughout the continuum of care Becoming program development champions Leading healthcare systems in managing patient populations Facilitating team building Becoming an essential part of every phase of healthcare

Q & A