Time and Money
Now that I'm home from CSM, I've had an opportunity to process all of the information. Most of the presentations were excellent. Those that weren't purely theoretical had a common theme. We have to maximize what we do because we're spending less and less time with patients. We have less time to spend because there isn't money to pay for our services.
More than ever, the underlying theme was get as much as you can as quickly as you can. Prioritize what you do. We no longer have the luxury of waiting on return of function to work on recovery. Now it's see what you have. Assess the length of stay and do the best you can. Among the unintended consequences is the difficulty in getting more heavily involved patients mobilized earlier and into acute rehab.
The problem isn't therapists. Payer sources aren't funding longer lengths of stays. They aren't giving us the number of treatments we need to accomplish our goals. In their zeal to cut costs, payers have forgotten that home is less expensive than long-term care. If we had more time acutely, or even subacutely, more patients could return home. That means no more paying for long-term care. I can't imagine another week of inpatient rehab is more expensive than months and months of nursing home care.
Money also affects staffing. Cutting staff levels means spending less money. Now fewer therapists must see more patients. Those that are heavily involved, in the ICU, or difficult to mobilize are the ones most frequently skipped. Sadly those are also the ones who need therapy the most. They don't demonstrate immediate gains, which creates the impression the therapy isn't helping.
We're getting better and better at what we do. Brains can only repair themselves so fast. Often they need more than seven to 10 days to reorganize. No matter how hard I, or anyone else tries, we can't speed the process along. The same is true of musculoskeletal injuries and disease processes. Yet somewhere along the line, someone decided that's all the time that's needed.
What if someone created an intervention to completely reverse the effects of a stroke? What if it took two weeks for the intervention to be effective? How would payers respond? I'd like to think they would make adjustments in their reimbursement structure but I doubt it. It would be too expensive. What if that intervention was physical therapy? PT can restore lost function after stroke. With adequate therapy, many stroke survivors can return to some level of their previous lives. Most don't get adequate therapy because it's too expensive.