The Future of Medical Rehabilitation

Bruce M. Gans, MD

Predicting the Future

Past Performance Leading Indicators Threshold and Pattern Analysis Consensus Processes Patterns in related domains Speculation

Patterns of Change

Stability Evolutionary Disruptive

Factors that Lead to Societal Change

TechnologySocial-Political Forces

Economics

Emerging Technical Innovations

Diagnostic and Prognostic Tools

Musculoskeletal Ultrasound

fMRI

qEEG

Genetic Markers of Rehabilitation

Neural Interfacing

DBS

TCMS

TCDS

Brain-Machine Interfacing

Human Augmentation

Cardiac Augmentation(LVAD)

L/E High Performance Prosthetics

DARPA Hand

Enhanced Exoskeleton

Powered Orthotics

Innovative Therapies and Programs

Hyperbaric Oxygen Therapy

Vestibular Rehabilitation

Better Living Through Electricity

Pain Management

Strengthening

Function

Sensation

Respiration

Tele-Rehabilitation

Video calling Tele-presence Sensory Data Transmission Haptic Data Transmission Motor Data Transmission

Replacements for Staff

Robot Professionals

Robotic Arm Therapy

Robot-Assisted Gait Training

Transfer Robot

Fall Prevention Alarms

Drug Vending Machines

3D Drug Printing

Virtual Reality

Virtual Reality

Augmented Reality

Social-Political Factors

Human Resources

Declining physiatrist interest/availability for inpatient care

Aging caregiver workforce Trend towards more autonomous

practitioners (DPT)

Demand Growth

Turning Problems into Opportunities

Bariatric Rehabilitation

Diabetes

Wounded Warriors

Health Care Political Issues

Health Care Reform (ACA) Partisan Politics Disability Rights Veteran and Active Military Concerns IMPACT ABLE PIMA SGR - MPPS

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

Healthcare Reform Legislation (continued)

Continuing Care Hospital Pilot Accountable Care Organizations Medical Home Expanded Insurance Coverage Definition of Rehabilitation Benefits for

Health Insurance Plans

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

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

Accreditation Standards and Enforcement

CARF The Joint Commission Others

Globalization of Healthcare

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

Economic Factors

The Macro Economy

Governmental spending for health care

Employment related health insurance Global economic pressure Deficit Spending and the Federal

Debt Inflation

The Micro Economy

Deferring the expensive Delaying the discretionary Shopping for cheaper options Shifting insurance coverage landscape Price Transparency Narrow Network High Deductible

Insurance

Reimbursement pressures

Medicare rates Medicaid rates Commercial rates Self-pay/bad debt

Behavioral Economics

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

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

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

We Make our Own Future

Time for Discussion