Quality & Practice

Innovative Models of Care Delivery

Gregory Worsowicz, MD, ​MBA

Physiatrists in Practi​ce: Unique Delivery Models of Patient Care for the Future

AAPM&R’s Public and Professional Awareness Committee is seeking AAPM&R members who are involved in unique or innovative health care delivery models who would be willing to share their experience. The information gathered from these interviews will document the value and diversity of the specialty of PM&R. It will help AAPM&R position the specialty within the future of the changing health care environment and emphasize how it meets the Triple Aim. Once information is gathered, it can be used to reach policymakers, consumers, and other stakeholders to describe the value of the specialty. As the committee catalogs the different ways AAPM&R members are practicing, it will be shared with Academy members as a resource for those considering a transition to a new practice model.

In the months ahead, the committee will share some of the member stories it collects in The Physiatrist. This month, the focus is on a unique practice model practiced by Gregory Worsowicz, MD, MBA.

Q: Can you explain your practice setting? 
A: I am currently employed by the University of Missouri in Columbia, MO, and I work in an academic practice that serves patients at multiple sites. Most of our consultative and outpatient services are provided at our academic medical center. Our inpatient rehabilitation care is provided at a limited liability company owned by the University of Missouri and HealthSouth. We also provide services at a long-term acute care hospital and subacute rehabilitation center owned by entities other than the university. Providing physiatric practice and developing a comprehensive postacute care program in each of these settings produces some unique challenges.

Q: Does the location of where you practice impact care strategies? 
A: Based on our geographic location (Midwest college town) and the need to travel to multiple sites with fluctuation in patient volumes and revenue from patient care at these different centers, physician coverage must be balanced. Since we are also somewhat geographically isolated and many of our patients are followed for years by the same physician, clinicians can develop large panels of patients limiting new patient access. A nurse practitioner (NP) was hired to specifically assist these physicians. This model has increased access to PM&R services as our NP is involved in more of the follow-up care. A patient can see our NP for follow up, and our physicians are seeing more new patients. This increased access and decreased wait times for appointments and also has increased patient and referring physician satisfaction. There has been economic benefit to this model as our physicians’ time has become more efficient.

Q: Can you describe one of your care models? Can it be reproduced? 
A: One model is our work to develop an acute and postacute care network. Guidelines have been developed that trigger PM&R consultative services to assist with care of patients during their acute stay as well as to provide care throughout their postacute period. Becoming involved earlier in patient care has allowed PM&R to be involved across the entire care process (acute and postacute). These processes are allowing our department to lead the system’s postacute rehabilitation programs, and medical directorships are starting to be funded to assist with this care management and to compensate time.

Q: Can this model be easily reproduced by other physiatrists? 
A: Yes, our current strategy was to pick service lines that most frequently require our services. Then, we developed strong relationships with these service lines (neurosciences/trauma) at the university’s hospital to trigger early involvement. We have also developed leadership roles at the different postacute settings. The balance between compensated versus uncompensated time needs to be monitored.

Q: How has this model impacted patient care, satisfaction, outcomes, cost, and time savings? 
A: It has allowed our physicians to provide direct care in all acute and postacute settings. Patients, other care providers, and social workers have reported improved satisfaction with care transitions as patients feel they are not “abandoned” by the system as a service known to them (PM&R) will follow them at their new care setting. We are also tracking all bounce backs to acute care from each care site and through better communication, working to prevent unnecessary care transfers. Since the current and expected increase in penalties for 30-day readmissions, systems and other providers are becoming more interested in funding these postacute programs.

Q: How do you see your model fitting into the patient-centered medical home? 
A: The patient-centered medical home is all about care management and access to services when needed. Our primary care providers are now utilizing physiatrists to direct the rehabilitative care and assist with specialized medical care of patients with diagnoses, including spinal cord injury and traumatic brain injury. Physiatrists should participate in the decision process about when patients are transferred to different levels of postacute rehabilitative care. Many of our processes are starting to utilize the physiatric model of combining medical, functional, social, financial, access (geographic), and patient choice as a template for these transitions. As models of care continue to develop, we must keep PM&R a critical component of patient care.

If you are involved in a unique practice model, please share your story with AAPM&R. E-mail pracmod@aapmr.org and an Academy staff member will contact you.