Quality & Practice

Innovative Models of Care Delivery

Benton Giap, MD

Physiatrists in Practice: Unique Models of Patient Care for the Future

AAPM&R’s Public and Professional Awareness Committee is seeking members who are involved in a unique or innovative practice model and would be willing to be interviewed to share their experience. The information gathered from these interviews will document the value and diversity of the specialty of PM&R and will help your Academy position the specialty within the future of the changing health care environment in regard to reimbursement, quality, and practice management. 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 our members are practicing, it will share that information with Academy members as a resource for members 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 developed by Benton Giap, MD.

Q: Can you explain the model you initiated? 
A: While working at Kaiser Permanente, I saw an opportunity and made a case to start a physiatry consult service at the Center for Neurosurgery/Neurosciences to assess the medical and rehabilitation needs of patients immediately following surgeries and other interventions. Since many surgeons/interventionalists are not as readily available as physiatrists, I believed that physiatrists could play an important role in providing the leadership in this setting in coordination of care, managing appropriate use of resources and therapy services, and determining the level of care by facilitating the flow through the continuum. For some of these patients, it means getting them to an acute rehabilitation hospital in a more efficient manner.

Q: How and why did you get involved with this model and how successful has it been? 
A: This model was implemented in an integrated delivery health care system. It was designed to integrate assessment and care coordination of patients to create a better flow of patients across the continuum and between acute neurosurgical, medical, and rehabilitation settings. I believe that physiatry has an important role in early involvement in the rehabilitation and recovery of a patient. Because of our training and comfort of the various levels of care, rehabilitation physicians can easily identify the care that is needed postsurgery.

I participated in rounds in the neurointensive care unit and also started rounds on the neuroscience unit three times per week. Patients, as well as families, are happier because there is someone to guide them with appropriate information and directives, such as giving the OK as to when to get out of bed, when a patient can start driving again, and when they can walk up and down stairs. The leadership and guidance we provide to the therapy staff is also important since this is a medically challenging population. In addition, we also play a role in working with patient care coordinators in anticipating the level of care needed. In this uncertain period following an acute neurological event, it is important that patients know where and what they are supposed to do and what the following phase of rehabilitation will be. We have been able to reduce hospital stays in the neurosurgical and acute medical care setting by an average of 1.25 days using this model—the rate of savings at the time for an acute medical/surgical bed was approximately $7,000 to $9,000 per day.

Q: Can this model be easily reproduced by other physiatrists and used for a specific diagnosis? 
A: With health care reform implementation and the requirement for accountable care organizations to efficiently manage quality, costs, and resources, the role of the physiatry consulting model is important, not just for the neurologic-specific diagnoses, but also for other patient populations in our acute medical centers. This model is alive and is sustainable; I recruited two additional physiatrists for this consulting service. Q: How has this model impacted patient care, satisfaction, outcomes, and cost and time savings? A: We have had a great, positive response to this model. The collaborative model across specialties is rewarding. This model really highlights the value of a physiatry consult service (beyond determining whether someone meets the acute inpatient rehab criteria). We could play an important role in improving outcomes of using this model by reducing (potential) medical complications of immobility and transitioning patients to the appropriate level of care. There has also been a reduction in avoidable days spent in the hospital, which leads to major cost savings. From the patients’ experience perspective, we are able to interface with our patients and their families and improve the perception. There has been improved coordination and communication, improved utilization, better risk management, elimination of significant practice variations, and cost containment.

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