The Future of Rehab: Q&A with Medline’s Brian Garner

The U.S. Department of Health and Human Services estimates 70 percent of people turning age 65 can expect to use some form of long-term care and of those people they will rack up $138,000 in future long-term services and support which can be assistance for both daily living activities to chronic disabling conditions.

What are the biggest changes or obstacles taking place in rehab today?

Payment reform. For many years our customers have been paid on a Fee-For-Service model. To garner higher reimbursements, you have to justify more therapy time, and the focus of those payments has never been on quality. Bundled payment trials, Accountable Care Organizations (ACOs) and new quality measures put in place in 2016 are not only changing the game, but leading the way to the outcome-based pay model. In the near future, the government will no longer pay by time, but outcomes. In December, the Government Accountability Office published recommendations for a five-star quality rating system. The quality measures I referenced are a big deal. For the first time, nursing facilities are being judged on the functional ability and mobility of residents. These metrics are now part of the Minimum Data Set (MDS) and they affect their five star rating.

When it comes to mobility and outcomes, what advice would you give to facilities in order to be effective and competitive in this space?

In my experience, facilities have focused on “rehab minutes” and how to occupy time with patients. While I am not suggesting they are getting bad outcomes, many have not had a focus on improving their patients’ ability to perform activities of daily living, and certainly not regaining mobility. The focus has to shift to functional rehab, meaning helping residents get back to mobility or at least improved levels of function and there are some tools that can help facilities achieve those results.

What are facilities overlooking when it comes to rehab and how can Medline help?

I think the challenge of getting low functioning patients moving again is daunting, and equipment that enables this type of rehab can be very expensive. On top of that, facilities want to retain qualified and experienced staff. One of the issues coming up in healthcare is the risk for injury for those healthcare workers. One solution could be Medline’s exclusive line of Neurogym equipment. It enables patients to get moving in a safe environment. This conversation of staff safety and overall patient mobility should be happening with every single nursing home and Skilled Nursing Facility (SNF). We should be asking them how they are addressing the new therapy quality measures. Do they have a plan to address the future outcomes based pay model? While we are not all therapists, we have the tools to have intelligent discussions and provide much needed guidance in these areas.

Where do you think rehab will be in five years and why?

There have been many significant changes in the last ten years. A physical therapy degree was once a four year degree. Then, it became a Masters, and now programs are at the Doctorate level. According to the U.S. Department of Labor, occupational therapy will likely follow the same path. Employment of occupational therapists is projected to grow 27 percent within a ten year period. In addition to ease of entry to the professions, there has been vast consolidation in the market due to all the reimbursement changes and decreases. Small rehab facilities struggle to be profitable without economies of scale. Add to all of that, ACOs, bundled payment trials and the looming threat of outcomes-based payments, and you have an industry that is rushing to catch up with itself. I think in five years we are likely to actively be past the change and over to outcome-based pay. This could mean providers who have not prepared to meet these changes and make that paradigm shift will find themselves struggling for referrals and being swallowed up by a larger and smarter player. I think that home health will definitely continue to gain popularity as a prime referral source for therapy patients as they are demonstrating good outcomes at a much lower cost than SNFs. To ensure agencies are being patient-focused to drive those positive outcomes, the Centers for Medicare & Medicaid Services (CMS) just finalized rules that will help improve the quality of care within home health agencies. Now, patients and caregivers will get written instructions and other documented information for clinical managers at these agencies.

We should start to have discussions with our clients now regarding recent changes and trying to understand their struggles moving forward. We are in a unique position to ease some of the burdens and help our friends get ahead of some of the changes coming.