ROOSEVELT WARM SPRINGS INSTITUTE FOR REHABILITATION

Emily Bradley Ashley Curren Dani Burden Kelsey Rape

WARM SPRINGS HISTORY

Warm Springs was founded after being discovered by FDR when looking for a cure for polio
Told of an improvement in polio from the warm, mineral-rich waters He then purchased the resort and turned it into what became a world-famous polio treatment center

Mission Vision

To provide the most positive experience and best possible outcome for those we serve. Caring people, changing lives....The most trusted destination for rehabilitation of the body, mind and spirit.

CDS SUMMARY
Inpatient rehabilitation goal:
24 hours/day care Interdisciplinary teams
Physicians Nurses Speech therapists Occupational therapists Physical therapists Case managers
Enable the patients to return to the most independent lifestyle possible in their homes and communities by developing an individualized treatment plan.

Patients active in own care

Highest level of functioning Physical, occupational, and speech therapy

CDS SUMMARY
Common diagnoses among patients
Cerebrovascular accident (stroke) Traumatic brain injury Spinal cord injury Amputation Post-traumatic injury

Average stay: 13 days

Costs can range from about $3 to $60 per product/intervention

Spinal cord injury recover cost:
National average: $29,643 Warm Springs: $31,505

OVERVIEW OF PAYMENT SYSTEMS

Inpatient rehabilitation is funded by Medicare, Medicaid, private insurance, self-payment, or a combination of these sources.
Medicare is the primary source of funding Private insurance companies tend to follow the same coverage guidelines as Medicare and implement similar payment systems
The only difference between private insurance companies and Medicaid is that private insurance companies may request more frequent updates regarding patient progress.

Regardless of the funding source of inpatient rehabilitation care, the patient is responsible for paying for any utilized services that are not covered.

OVERVIEW OF PAYMENT SYSTEMS

Medicare uses a Prospective Payment System (PPS) for payment according to patient condition and Oexpected utilization of resources. To determine the payment amount, Medicare categorizes each patient based on reason for rehabilitation, age, cognitive impairments, and functional ability. Patients are further categorized based on the presence or absence of comorbidities and placed into one of four payment tiers. Each payment tier represents a base payment rate If the patients estimated cost for care is suspected to succeed his/her base payment rate, the patient qualifies as a high cost outlier. The high cost outlier is an additional payment consisting of 80% of the difference between the estimated cost of the case and the outlier threshold which is a predetermined amount of money that is recalculated each fiscal year. Ultimately, the cost outlier is intended to financially protect the health care delivery system by financially compensating for costly rehabilitation care.

ECONOMICS
State run facilities must take all patients that are referred to them Inpatient rehabilitation is mainly funded by Medicare
Predetermined reimbursement for each case Many specific qualifications have to be met in order for Medicare to reimburse the facility for patient care

Combination of nursing, medical and therapeutic care for an extended length of time makes costs high Average cost of a patients stay at an inpatient rehabilitation facility is around $30,000
Facilities must balance achievement of patient ADL goals with the shortest and most cost effective stay

CASE STUDY
44 year old African American male
Admitted to hospital for difficulty with ambulation History of thoracic spinal stenosis with myelopathy Diagnosis of progressive myelopathy secondary to spinal stenosis Surgery to decompress thoracic spine Postoperative paralysis and myelopathy of lower extremities Transferred to Roosevelt Warm Springs with the goal of becoming functionally independent in a wheelchair by discharge Nursing care focused on completing activities of daily living at the highest possible level of independence
Bowel and bladder training program

Depression and apathy because of his new paralysis

CASE STUDY
Living alone with help from family and friends Case manager coordinates delivery of equipment Patient was referred to home health care upon discharge Outpatient physical and occupational therapy The patient was at Warm Springs for 21 days The total cost of care for the patient was $33,322, taking in account his stay in the facility, therapies, and medication costs Medications and therapy made up the majority of the cost $1,000 general rehabilitation cost per day Patient on Medicare- covered majority of cost

AFFORDABLE CARE ACT

The Patient Protection and Affordable Care Act of 2010 requires that the majority of all Americans, have minimum essential [healthcare] coverage by 2104. Issue: the intended definition of minimum essential coverage has not been identified
Inpatient rehabilitation facilities do not know which services will be covered by insurance providers. Without this information, insurance providers cannot develop appropriate insurance programs for healthcare consumers, i.e. there is no concrete evidence that the coverage provided by insurance companies will be adequate in comparison to the cost of care (Boninger, Gans, & Chan, 2012).

Requiring more Americans to have healthcare coverage increases the volume of patients seeking rehabilitative care
There is an overwhelming patient to doctor ratio leading to a diminished quality of care

AFFORDABLE CARE ACT

Inpatient rehabilitation facilities rely heavily on financial reimbursement from insurance companies Due to the inadequate reimbursement system put into effect by the Patient Protection and Affordable Care Act for inpatient rehabilitation facilities, there is generally a shift in focus from patient centered care to financial gain Additionally, cost outliers are implemented in order to financially protect the health care delivery system by financially compensating for costly rehabilitation care
The patient pays more for less care