T HE R OLE OF PM&R IN M ANAGED C ARE

1. U N D E R S T A N D I N G PM&R THE ROLEOF PM&R IN MANAGED CARE

2. Understanding the Role of PM&R: Controlling Healthcare Costs, Improving Quality

3. 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

4. What is PM&R? • Restore or maximize function • Integrates elements of: • orthopedics/musculoskeletal care • neurology • rheumatology • “Quality of Life” specialty

5. What Conditions DoPM&R Physicians Treat? • Acute and chronic conditions • Musculoskeletal conditions • Severe disabilities

6. Conditions • Low back pain • Sports-related injury • Birth defect • Trauma recovery • Spinal cord injury

7. Conditions • Brain injury • Stroke • Amputation • Cancer • Multiple sclerosis

8. Conditions • Neck pain • Arthritis • Tendonitis • Work-related injury • Repetitive stress injury

9. 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

10. 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

11. 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

12. The PM&R Approach • Whole care • Case management • Prevention • Nonsurgical treatment • Team orientation • Goal-directed care

13. Ideal Rehabilitation Process • Begins immediately in acute care • Continues through various levels of care • Restores function and quality of life

14. Cost-Effective PM&R • Minimizes resource consumption • Utilizes continuum of care • Achieves durable outcomes • Maximizes function and independence

15. Cost-Effective PM&R (cont’d) • Case management • Nonsurgical approach to treatment • Interdisciplinary team leader • Measurable goals

16. Outcomes - Injured Workers • NWNL study - Rehab saves $35 for every $1 spent • UC-Davis wellness program saves 55.8% in direct workers’ comp costs

17. 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

18. 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

19. LBP: PM&R approach • Comprehensive clinical exam • Assessment of patient lifestyle, occupational risks • Potential for future complications • Goal setting

20. LBP: PM&R treatment plan • Pain and sleep medication • Physical therapy program • Patient counseling and education • Measure progress

21. LBP: Results • Pain relief • Return to work in 33 days • Patient practicing self-management, prevention techniques

22. 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

23. Stroke - Statistics • Leading cause of disability among the elderly • 3 million Americans have stroke- related disability • Estimated annual cost to society $30 billion • Recovery typically involves multiple care settings

24. 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

25. Stroke Rehab: PM&R approach • Interdisciplinary team care • Patient assessment • Focus on continuity of care • Patient and family involvement

26. 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

27. Stroke Rehab: PM&R goals • Restore patient to maximum mobilization • Help patient regain functional independence, confidence • Prevent more falls

28. 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

29. Stroke Rehab: Results • Patient’s confidence restored • Two years later, continues to live independently with no more falls

30. What Can PM&R Physicians Offer Your MCO? • Case management skills • Consultative/administrative services • Team orientation • Nonsurgical treatment

31. 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

32. 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

33. 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

34. 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

35. “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.”