NEWPORT BEACH, Calif. — Using more physical medicine and rehabilitation services and tapping into those services earlier in the care delivery process resulted in $1.4 million in savings and added to the quality of care for one hospital system. A presenter at the Interdisciplinary Conference on Orthopedic Value-Based Care indicated similar value can be added to orthopedic-based care by enlisting the services of a physical medicine and rehabilitation team.
According to Steven R. Flanagan, MD, professor and chair of rehabilitation at Rusk Rehabilitation and New York University (NYU) Langone Health, the savings from the program he discussed, which J.R. Corcoran and colleagues studied, came about by increasing expenditures at NYU Langone Health.
Steven R. Flanagan
“The $1.4 million accounts for the added staffing needed to make that program work,” Flanagan said.
Physical medicine and rehabilitation (PM&R) was used in the ICU, which ensured patients had early physiatry consults. Physical therapy, occupational therapy and speech therapy visits were increased to up to 1 hour per day, among other steps taken.
Length of stay (LOS) in the ICU was reduced by 1 day “because they were leaving the ICU in better condition because we were up-and-walking them. Even if they were on a ventilator, they got to the acute care floors in better shape and they left the acute care service 2 days early. So, we basically chopped off close to 3 days of the LOS when we compared it to historical controls.”
Flanagan reviewed other advantages of enlisting the PM&R services for orthopedic patients and discussed some challenges to be prepared for.
“Ultimately, I believe PM&R ... can have a positive impact on quality of care and by decreasing costs, and we do that largely in the acute inpatient setting by decreasing LOS,” Flanagan said. “I am not talking about inpatient rehab. I am talking about the acute inpatient stay when we can improve outcomes, we can decrease LOS and hopefully decrease readmissions.” – by Susan M. Rapp
Corcoran JR, et al. PM R. 2017;doi:10.1016/j.pmrj.2016.06.015.
Flanagan SR. Adding value to orthopedic value based care: The role of physical medicine. Presented at: Interdisciplinary Conference on Orthopedic Value-Based Care; Feb. 9-11, 2018; Newport Beach, California.
Disclosure: Flanagan reports he receives grant support from the NIH and the Brain Injury Association of America and is a member of the board of governors of the American Academy of Physical Medicine and Rehabilitation.