Transcript The Role of PM&R in Managed Care: PowerPoint 97 format

UNDERSTANDING
PM&R
THE ROLE OF PM&R IN MANAGED CARE
Understanding the
Role of PM&R:
Controlling Healthcare Costs,
Improving Quality
MCO
Challenges
Growing elderly
population
Higher trauma survival rates
Cost of disabling /chronic illnesses
70% of healthcare expenditures
Older, sicker populations joining
managed care plans
What is PM&R?
Restore or
maximize function
Integrates elements of:
orthopedics/musculoskeletal care
neurology
rheumatology
“Quality of Life” specialty
What Conditions Do
PM&R Physicians Treat?
Acute and chronic conditions
Musculoskeletal conditions
Severe disabilities
Conditions
Low back pain
Sports-related injury
Birth defect
Trauma recovery
Spinal cord injury
Conditions
Brain injury
Stroke
Amputation
Cancer
Multiple sclerosis
Conditions
Neck pain
Arthritis
Tendonitis
Work-related injury
Repetitive stress injury
Education
& Training
Must understand
all major body
systems and their impact on function
4 years graduate medical education
4 years postdoctoral PM&R residency
Subspecialty training
Advanced
Diagnosis
and Treatment
Electrodiagnosis skills:
EMG, nerve conduction studies
Treatment modalities:
 therapeutic
exercise
 heat and cold
 electrotherapies
 manual medicine
 biofeedback
 prescription
medication
 injection
techniques
Specialty Facts
AAPM&R founded in 1938
5,600 members - 9 in 10 practicing
PM&R physicians in the U.S.
Board certification available
Supply not likely to exceed demand
through 2015
The PM&R Approach
Whole care
Case management
Prevention
Nonsurgical treatment
Team orientation
Goal-directed care
Ideal Rehabilitation Process
Begins immediately in acute care
Continues through various levels of care
Restores function and quality of life
Cost-Effective PM&R
Minimizes resource consumption
Utilizes continuum of care
Achieves durable outcomes
Maximizes function and independence
Cost-Effective PM&R (cont’d)
Case management
Nonsurgical approach to treatment
Interdisciplinary team leader
Measurable goals
Outcomes - Injured Workers
NWNL study - Rehab saves $35 for
every $1 spent
UC-Davis wellness program saves
55.8% in direct workers’ comp costs
Low Back Pain
(LBP) - Statistics
60% - 90% prevalence
Most frequent cause
of disability for people under 45
Estimated annual cost to society
$20 - $50 billion
Second most common reason for primary
care visit
Low Back Pain: A case study
35-year-old male; out of work for 18 months
Symptoms: constant pain, deconditioned,
depressed, overweight
Previous treatment: physical therapy,
ultrasound, hot packs, massage, OTC
pain medication
LBP: PM&R approach
Comprehensive clinical exam
Assessment of patient lifestyle,
occupational risks
Potential for future complications
Goal setting
LBP: PM&R treatment plan
Pain and sleep medication
Physical therapy program
Patient counseling and education
Measure progress
LBP: Results
Pain relief
Return to work in 33 days
Patient practicing self-management,
prevention techniques
PM&R Success
in Treating LBP
Back Pain Survey in New York
magazine
Patients report greater relief from LBP
when treated by PM&R physicians
Stroke - Statistics
Leading cause of disability among
the elderly
3 million Americans have strokerelated disability
Estimated annual cost to society
$30 billion
Recovery typically involves multiple
care settings
Stroke Rehabilitation:
A case study
78-year-old female with diabetes
Left side weakness and numbness
Patient discharged to home
Given medication to prevent recurrence
of thrombosis
One week later, patient falls; readmitted
for knee injury
Stroke Rehab:
PM&R approach
Interdisciplinary team care
Patient assessment
Focus on continuity of care
Patient and family involvement
Stroke Rehab:
PM&R assessment
 Patient’s living environment somewhat
isolated; frequent stair-climbing required
 Diabetes contributes to numbness in feet
 Patient has residual weakness from stroke
 Patient’s fear of falling limits activity
Stroke Rehab:
PM&R goals
Restore patient to
maximum mobilization
Help patient regain functional
independence, confidence
Prevent more falls
Stroke Rehab:
PM&R treatment plan
Safety improvements to living environment
Short intensive outpatient program with
emphasis on stair climbing
Daily home exercises to improve circulation
Stroke Rehab: Results
Patient’s confidence restored
Two years later, continues to live
independently with no more falls
What Can PM&R Physicians
Offer Your MCO?
Case management skills
Consultative/administrative services
Team orientation
Nonsurgical treatment
PM&R Contributions
in Managed Care
Case Management
Kaiser Permanente in Northern CA
Coordinate care
Valued for their versatility
Help other specialists focus on own
comparative strengths
PM&R Contributions
in Managed Care
Administrative Consults
Large managed care firm
Assess appropriateness of treatment
Guide patient through system
Maximum medical improvement
(MMI) objective
PM&R Contributions
in Managed Care
Cost-effective Partners
Workers’ compensation insurers
Best outcomes at lowest cost
Return patients to work
Focus on education, prevention
PM&R Physicians
Adding Quality
to Life
Match resources to
patient needs
Maximize patient function, self-sufficiency
Balance quality and cost of care
Team players—work well with PCPs
“Quality of life has long been the
goal of PM&R. We strive to achieve
that goal by looking at the multiple
problems of patients, minimizing
those problems and optimizing
function.”