the future of medical rehabilitation bruce m. gans, md
TRANSCRIPT
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The Future of Medical Rehabilitation
Bruce M. Gans, MD
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Predicting the Future
Past Performance Leading Indicators Threshold and Pattern Analysis Consensus Processes Patterns in related domains Speculation
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Patterns of Change
Stability Evolutionary Disruptive
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Factors that Lead to Societal Change
TechnologySocial-Political Forces
Economics
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Emerging Technical Innovations
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Diagnostic and Prognostic Tools
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Musculoskeletal Ultrasound
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fMRI
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qEEG
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Genetic Markers of Rehabilitation
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Neural Interfacing
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DBS
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TCMS
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TCDS
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Brain-Machine Interfacing
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Human Augmentation
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Cardiac Augmentation(LVAD)
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L/E High Performance Prosthetics
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DARPA Hand
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Enhanced Exoskeleton
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Powered Orthotics
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Innovative Therapies and Programs
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Hyperbaric Oxygen Therapy
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Vestibular Rehabilitation
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Better Living Through Electricity
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Pain Management
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Strengthening
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Function
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Sensation
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Respiration
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Tele-Rehabilitation
Video calling Tele-presence Sensory Data Transmission Haptic Data Transmission Motor Data Transmission
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Replacements for Staff
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Robot Professionals
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Robotic Arm Therapy
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Robot-Assisted Gait Training
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Transfer Robot
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Fall Prevention Alarms
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Drug Vending Machines
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3D Drug Printing
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Virtual Reality
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Virtual Reality
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Augmented Reality
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Social-Political Factors
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Human Resources
Declining physiatrist interest/availability for inpatient care
Aging caregiver workforce Trend towards more autonomous
practitioners (DPT)
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Demand Growth
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Turning Problems into Opportunities
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Bariatric Rehabilitation
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Diabetes
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Wounded Warriors
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Health Care Political Issues
Health Care Reform (ACA) Partisan Politics Disability Rights Veteran and Active Military Concerns IMPACT ABLE PIMA SGR - MPPS
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Healthcare Reform Legislation
Quality Measurement and Reporting Electronic Health Records Interoperability Value Based Purchasing Bundling of payments to acute care
providers Innovation Programs Market Basket Cuts
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Healthcare Reform Legislation (continued)
Continuing Care Hospital Pilot Accountable Care Organizations Medical Home Expanded Insurance Coverage Definition of Rehabilitation Benefits for
Health Insurance Plans
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Regulatory Trends
Stricter enforcement of medical necessity Rehabilitation Therapy Intensity and
Staffing Patterns Recovery Audit Contractors Office of the Inspector General False Claims Act use by the Department of
Justice ALJ Backlog
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Litigation Trends
Interaction among safety, quality of care and risk management
Failure to enact “tort reform” Economic incentives to file and sue Jimmo vs. Sibelius Settlement
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Accreditation Standards and Enforcement
CARF The Joint Commission Others
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Globalization of Healthcare
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Globalization of Health Care
Transmissible Illnesses Economic growth increases demand
for health care Import/export of health care Nationalistic desires to become
autonomous delivering health care Examples: China; Middle East
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Economic Factors
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The Macro Economy
Governmental spending for health care
Employment related health insurance Global economic pressure Deficit Spending and the Federal
Debt Inflation
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The Micro Economy
Deferring the expensive Delaying the discretionary Shopping for cheaper options Shifting insurance coverage landscape Price Transparency Narrow Network High Deductible
Insurance
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Reimbursement pressures
Medicare rates Medicaid rates Commercial rates Self-pay/bad debt
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Behavioral Economics
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Creating our Future
Adopting the best of new technologies
Focusing on Programs Continuous quality improvement Marketing our Services Forming alliances and relationships
with referral sources, other segments of the health care continuum
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Embracing Innovation
Capital Investments• Facilities (single occupancy rooms)• Equipment• Information technology
Program Adoption and Development Managing with measures and data Focusing on efficiency and
effectiveness
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Final Observations
Moving into a time of “interventional rehabilitation”
Demand will start skyrocketing in about 10 years Care givers will be in very short supply Expectations for interventions will be higher Dollars will be more scarce Confusion about the distinction among the PAC
settings will be even greater
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We Make our Own Future
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Time for Discussion