Visioning PM&R Bold

Visioning PM&R Bold

For our Patients, For our Specialty, For YOUR Future

Since July 2016, AAPM&R has been championing an initiative—Visioning PM&R Bold—to help define the future of PM&R.

We know the health care landscape is changing quickly and challenging the way medicine has always been practiced. As the primary medical society for the specialty of physical medicine and rehabilitation, AAPM&R wants physiatrists to be bold in the future health care landscape—as new models are being tested that pay for performance and quality care. 

The Visioning PM&R BOLD initiative has boldly sought awareness, feedback, data, and widespread engagement through a variety of innovative formats and forums. After 7 months of robust efforts and the engagement of 1,000s of physiatrists, a Visioning PM&R BOLD Summit was convened to gather a diverse group of nearly 50 PM&R thought leaders to consider the findings. Below is an overview of our efforts.

 

 

 

Research and Participation

Research

In order to capture maximum input from practicing physiatrists, AAPM&R leveraged digital communications, new technology, and in-person discussions. Research was conducted by Academy staff and volunteers as well as by a professional facilitator. The following is an outline of the types of research tactics used to support this endeavor.
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Analysis

The quantitative and qualitative results of the 2016 Visioning PM&R BOLD survey were analyzed as well as the documented qualitative input from interviews, focus groups, Community Gatherings, Member Council gatherings, etc. The data was tracked, reviewed, and “tagged” to validate the recurring themes we gathered from respondents. “Tags” were then used to create a naming convention to denote when we heard similar input throughout the qualitative research.

Demographics

More than 1,000 physiatrists representing varied clinical, practice, and geographic areas provided their input. Research was focused to ensure we heard from physiatrists in:

  • Musculoskeletal Medicine
  • Pain Medicine/Neuromuscular Medicine
  • Central Nervous System Rehabilitation
  • Pediatric Rehabilitation/Developmental Disabilities
  • General and Medical Rehabilitation
  • Residency
  • Academic and Research Settings
  • Affiliated Private Practice
  • Non-affiliated Private Practice
  • Private Practice Multi Specialty Group
  • Private Practice PM&R Group
  • Private Practice Solo
  • Outpatient
  • Inpatient Rehabilitation Facilities
  • Skilled Nursing Facilities
  • Long-Term Acute Care
  • Home Health
  • Acute Care
  • Community Hospitals
  • Cancer Rehabilitation Medicine
  • Rural Physiatrists
  • Women in Physiatry
  • Early Career Physiatrists

 

 

Your Input

Here are some thought-provoking excerpts from some of the physiatrists we spoke to:

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"We’re trying to get in earlier...We know alternative payment plans/models will be looking for streamlining and we have to figure out where we come in, and our cost savings."

Source: MSK Virtual Town Hall 
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“There should be a physiatrist in every ICU. Every brain injury patient should be seen by a physiatrist. We excel in this area and we are underutilized.” 

Source: Interview – New Orleans Site Visit
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“There is an opportunity for primary care partnerships, with a tiered triage where primary refers to physical therapy first, then escalate to PM&R, and then to surgery.” 

Source: Interview – Philadelphia Site Visit 
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Post-Acute Care is an opportunity for us to be leaders… While we’re doing some, there are so many more opportunities to be leaders on the adult and pediatric side. Our livelihood has been in the IRF setting, but we can do the same thing in other settings.” 

Source: Interview – Seattle Site Visit 
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“The concept of a medical home originated from working with pediatric patients with disabilities, so physiatrists in general… have the opportunity to lead this effort and show others how to structure medical homes.”

Source: Pediatrics Virtual Town Hall
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“There are opportunities in the geriatric world – fall prevention, general wellness, etc. The term ‘prehabilitation’ is often a descriptor.”  

Source: Seattle Focus Group
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“We need to play a role assuring that in every phase of the PAC continuum, patients achieve anticipated outcomes in a cost-effective manner. We do that in the IRF environment, but we need to broaden this scope and hold companies accountable for functional outcomes.” 

Source: General & Medical Rehabilitation Virtual Town Hall
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“I’m in a big health system and faculty will go and spend a day or 2 per week with primary care. We also work with hospital administrators and contribute to their directive to improve access because we’re in the best position to determine what level of care a patient needs.” 

Source: Pain Virtual Town Hall
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“There is an acute MSK role potentially in ortho partnerships, where PM&R is the non-surgical case manager for a surgical group.”

Source: Outpatient Annual Assembly Focus Group
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“Be more closely involved with acute care consults to shorten length of stay.” 

Source: Community Gathering Feedback Card

 

 

Emerging Themes

Theme 1:

Across all research avenues, there is an opportunity to be positioned at the entry point and/or early in patient care as they enter the health care system. Early in care is a broad statement, but specific examples provided by physiatrists include:

  • Early in patient care, across different practice settings
  • Before they enter the system
  • Pre-habilitation/Wellness (sports prevention, surgical preparation, geriatric fall prevention, obesity prevention)

Theme 2:

The second cross-cutting theme focused on the opportunities to further expand and continue to be transformational across the continuum of health care and in doing so, apply physiatric principles that deliver value.  Expanding across the continuum includes:

  • Driving integration across the post-acute care spectrum
  • New or expanded models for delivery of MSK/ambulatory care
  • Applicable to settings and clinical areas where PM&R has not traditionally been before. Examples include cancer rehabilitation and palliative care

Visioning PM&R BOLD Summit

At the end of February 2017, 50 physiatrists gathered to discuss your input, the emerging themes, and potential visions for the future of physical medicine and rehabilitation as a result of this BOLD data. They collaborated on models and discussed the barriers that need to be addressed to secure a thriving future for the specialty. Thank you to our Summit participants!

Dr. Bill Adair
Dr. James Atchison
Dr. David Bagnall
Dr. Deb Bergfeld
Dr. Joline Brandenburg
Dr. John Chae
Dr. Larry Chou
Dr. David Crandell
Dr. Kelley Crozier
Dr. Peter Esselman
Dr. John Finnoff
Dr. Steve Flanagan
Dr. Steve Geiringer
Dr. Michelle Gittler
Dr. Martin Grabois
Dr. Michael Hatzakis
Dr. Kurtis Hoppe
Dr. Prakash Jayabalan
Dr. Darryl Kaelin
Dr. DJ Kennedy
Dr. Carolyn Kinney
Dr. Scott Laker
Dr. Michael Lupinacci
Dr. James McDeavitt
Dr. Brian McMichael
Dr. John Melvin
Dr. Andre Panagos
Dr. Lisa Pascual
Dr. Joel Press
Dr. Kerrie Reed
Dr. Leon Reinstein
Dr. Michael Saffir
Dr. Deepthi Saxena
Dr. Sunny Sharma
Dr. Eric Shaw
Dr. Charlotte Smith
Dr. Adam Stein
Dr. Azlan Tariq
Dr. Deb Venesy
Dr. Kevin Vincent
Dr. Thomas Watanabe
Dr. Stuart Weinstein
Dr. Amy Wilson
Dr. Eric Wisotzky
Dr. Greg Worsowicz
Dr. Michael Yochelson
Dr. Ross Zafonte
Dr. Jenn Zumsteg 

What's Next?

It’s time for your Academy take your BOLD ideas and develop a strategic plan to support you and the specialty in 2017 and beyond!  

Watch your member communications, including the weekly Connection e-newsletter and monthly The Physiatrist print newsletter for updates. We’ll also resume our Bold Updates e-newsletter when needed to pass along more news and next steps.