T HE R OLE OF PM&R IN M ANAGED C ARE U N D E R S T A N D I N G PM&R

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 stroke- related 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.”