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Life Care Planning Projections for People with Spinal Cord Injury: A Measure of Therapeutic Intervention Effectiveness Sarah A Morrison, PT Vice President.

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Presentation on theme: "Life Care Planning Projections for People with Spinal Cord Injury: A Measure of Therapeutic Intervention Effectiveness Sarah A Morrison, PT Vice President."— Presentation transcript:

1 Life Care Planning Projections for People with Spinal Cord Injury: A Measure of Therapeutic Intervention Effectiveness Sarah A Morrison, PT Vice President Clinical Services Shepherd Center

2 Objectives Define the life care planning process Describe how therapy interventions can be utilized for projecting lifetime costs for persons with spinal cord injury Describe other lifetime economic challenges for persons with spinal cord injury

3 IOM Commission Recommendations Cost benefit should be offset by savings elsewhere Minimum benefits should reflect those provided by small employers in private market Should not cover treatments unless they demonstrate superior outcomes to current treatments Only medically necessary services should be covered

4 The Given! Value-Based Healthcare Outcomes achieved = Value Costs of achieving outcomes

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6 How will this Effect Rehabilitation Reimbursement? Probably through a bundled payment system –Most likely will include entire episode of care. How will cost be allocated? –Providers need to be prepared to take risk, but will they? –Most likely focus on high cost episodes of care

7 Bundled Payments Advantages: –Focus on outcomes and increased efficiency –??regulatory hassles?? –Force providers to become more integrated –Consumer involvement more important Disadvantages: –Financial incentive for providers to cut corners –Who to control? Acute care? –Elimination of small freestanding providers? –How will unique providers be taken into account?

8 Life Care Planning A dynamic document based upon published standards of practice comprehensive assessments, data analysis and research Provides an organized concise map for current and future needs with associated costs for individuals Performed by LCP in collaboration with interdisciplinary treatment team, practice guidelines, etc

9 14 Common Topics Projected evaluations Projected therapeutic modalities Diagnostic testing/education assessment Wheelchair mobility needs Aids for independent function Orthotics/prosthetics Home furnishings/accessories Drug/supply needs Home/attendant/facility care Future routoine medical care Transportation Health/strength maintenance Architectural renovations

10 Example of LCP Use for Outcome Locomotor Training (LT) –5 days per week, 1.5 hours per day –Tx in body-weight supported environment, over ground and in community –PT + 3 PT aides Participants –4.5 yo boy; C8 AIS C;16 mos post;76 sessions –61 yo woman; C3 AIS D; 16 mos post; 198 sessions Morrison, SA et al. JNPT. 2012;36:

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12 Clinical Results 61 yo –Increased LEM by14 points –BBS increased from 6 to 47/56 –6MWT increased from unable to 700 ft –10 MWT decreased from 0.05 m/s to 0.71 m/s –Stairs improved from unable to 12 steps independently –ADL’s improved from mostly dependent to mostly independent 4.5 yo –LEM unchanged –GMFA 45.8% to 60.2% –Increased mobility self care and mobility PEDI scores –improved from unable to perform to 0.29 m/s (selected) and 0.48 m/s fastest walking speed –Dependent to independent ambulation within home –Able to perform stairs

13 61 yo Pre and Post Life Time Costs Low End $ PRE LTPOST LTDifference Equipment Needs$5,322$180$5,142 WC Needs$28,970$0$28,970 WC Accessories$4,140$0$4,140 WC Maintenance$9,775$850$8,925 Home Mods$50,000$0$50,000 Transportation$56,180$0$56,180 TOTAL$150,247$2,010$148,237

14 4.5 yo Pre and Post Life Time Costs Low End $ PRE LTPOST LTDifference Equipment Needs$22,240$21,485$(4,122) WC Needs$95,285$42,730$52,555 WC Accessories$$35,190$13,440$21,750 WC Maintenance$35,070$18,625$16,450 Home Mods$50,000$0$50,000 Transportation$306,600$980$305,620 TOTAL$535,050$97,260$437,790

15 Other Additional Costs 61 yo PRE LT4.5 yo PRE LT Annual Medical Expenses387,3451,370,094 Personal Care377,3701,039,916 Total764,6152,410,010

16 Looking at the Value Equation Direct Cost for Providing LT –$78.40 higher cost (personnel)/treatment session Total increase in cost for 61 yo = $15, Total increase in cost for 4.5 yo = $6, Is it worth the $?

17 Caution This was not a randomized controlled study LCP projections were only 1 point in time. However, outcomes were maintained at 6 months and 1 year. Aging process was taken into consideration with equipment needs

18 Annual Charges and Cost C1-4 ABCC5-8 ABCT1-S5 ABCAIS D Annual Chg (1 st year) 953,336688,886464,633311,141 Annual Chg (post year 1) 165,554101,56061,55037,792 Annual Direct Cost (1 st year) 423,152293,529191,431122,753 Annual Direct Cost (post yr 1) 150,50889,25449,14733,535 Cao Y, Chen Y, DeVivo MJ. Top Spinal Cord Inj Rehabil 2011;16(4):10-16

19 Primary Causes for Rehospitalizations %Mean LOSChargesCost Urinary29.5%7.3 days$24,007$12,617 Skin16.5%19.8 days$75,872$38,866 Respiratory12.6%7.5 days$29,975$15,096 DeVivo MJ, Farris V. Top Spinal Cord Inj Rehabil 2011;16(4):53-61

20 Rehospitalizations Total days within 1 st yr: 24.7 Top Causes: –Diseases of genitourinary (45%) –Disease of the skin (17.7%) –Diseases of the respiratory system (15.3%) –Diseases of circulatory system (11.2%)

21 Cost of Care With and Without Pressure Ulcer Stroupe KT, et al. Top Spinal Cord Inj Rehabil 2011;16(4):62-73

22 What About Other Interventions?


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