American archives of rehabilitation therapy最新文献

In the 1990s, operational strategies to assure survival will be crucial for all healthcare providers. All will face an accelerating rate of change, and the paramount change will be an intensified competitive marketplace. How does this impact rehabilitation? Like acute care hospitals, rehabilitation facilities will diversify into alternative delivery systems. This paper examines the course one provider--Casa Colina, Inc.--has taken, the pitfalls and problems along the way, and the implications for other rehabilitation providers. Strategies used to strengthen various areas of rehabilitation are considered, including ambulatory care, skilled nursing, traumatic brain injury, medical and vocational rehabilitation, residential programs, joint ventures, rehabilitation hospitals and outpatient services. A strong consensus exists today among healthcare experts concerning where we are headed and operational strategies for survival in 1990. How does this consensus impact rehabilitation? Before dealing with rehabilitation, let us review essential agreements. For HOSPITALS, the experts agree that: multi-hospital systems will continue to grow and will be best positioned to implement and take advantage of the strategies of choice in the new competitive market; money spent nationally on healthcare services will continue to grow; new types of providers will erode acute care inpatient hospitals' share of healthcare expenditures; emphasis in healthcare will shift to ambulatory services and delivery systems; and hospitals may be at a disadvantage in attracting capital financing and many will have to create new corporate structures and business ventures to compete in the capital market.(ABSTRACT TRUNCATED AT 250 WORDS)

Health care services in the late 1980's are undergoing drastic changes. Similarly the laws, insurance regulations, etc. are changing so rapidly that the health care system appears to be having a difficult time keeping up with the ever changing needs of the consumers (that is, the patients). Diagnosis Related Groups (DRGs) have resulted in decreased hospital stays for patients with subacute and chronic conditions, and therefore patients are being care for in outpatient rehabilitation agencies, and/or outpatient clinics associated with hospitals. In short, a patient cannot stay in the hospital unless he or she is acutely ill or in need of surgery. Outpatient care is gradually becoming more important since patients who would have still been in the hospital several years ago, are now released to go home, with an order to receive outpatient therapy at the local rehabilitation agency. Currently there is no model available for starting an outpatient rehabilitation agency, and as a result health care professionals interested in starting such a facility have no guidelines or methodology for establishing a private rehabilitation practice.

This article was written as a result of an inservice project presented in RMS at the VAMC, Biloxi, MS, by the staff Educational Therapist, Donna Tasker. Her research material was utilized as the basis. The information is geared towards the field of rehabilitation therapy and the history of the various disciplines. Although it does not discuss each discipline in detail, it does cover the most important facets. Special appreciation is given to Ms. Tasker for her collection of the research materials used for this paper and also for her dedication to the field of rehabilitation.

Rehabilitation facilities are inescapably involved in the ongoing national debate over the financing and delivery of health care services. The relatively small portion of the debate involving our facilities does not involve questioning the need for rehabilitative medicine in serious trauma or illness, rather, the discussion revolves around how the services can best be delivered and the cost containment of the inherent costs. The recent interest evidenced by the government in DRG and related prospective payment plans is credited by some with effectively slowing the increase in health care costs. We believe that a careful look beyond just the numbers could demonstrate that cost "savings" are simply cost shifting to private payers. We believe that if DRG plans are strictly applied to rehabilitation facilities the results could be detrimental to both the facilities and their patients. Potential new markets are being explored such as the role our facilities can play in the area of treatment of catastrophic injury resulting from third party negligence. Liability litigation involving bodily injury is an area of enormous concern for the nation and its liability insurers, as is evidenced by the increased media attention given to the "liability insurance crisis" recently. The obvious long term cost containment effects of treatment in rehabilitation facilities is attracting the attention of the liability insurers as a potential vehicle by which liability exposures can be mitigated. The emergence of profit driven health care corporations and the enormous competition accompanying it is one of the most significant developments to be considered.(ABSTRACT TRUNCATED AT 250 WORDS)