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Sarah A Morrison, PT Vice President Clinical Services Shepherd Center

Life Care Planning Projections for People with Spinal Cord Injury: A Measure of Therapeutic Intervention Effectiveness. Sarah A Morrison, PT Vice President Clinical Services Shepherd Center. Objectives. Define the life care planning process

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Sarah A Morrison, PT Vice President Clinical Services Shepherd Center

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  1. Life Care Planning Projections for People with Spinal Cord Injury: A Measure of Therapeutic Intervention Effectiveness Sarah A Morrison, PT Vice President Clinical Services Shepherd Center

  2. Objectives • Define the life care planning process • Describe how therapy interventions can be utilized for projecting lifetime costs for persons with spinal cord injury • Describe other lifetime economic challenges for persons with spinal cord injury

  3. IOM Commission Recommendations • Cost benefit should be offset by savings elsewhere • Minimum benefits should reflect those provided by small employers in private market • Should not cover treatments unless they demonstrate superior outcomes to current treatments • Only medically necessary services should be covered

  4. The Given! Value-Based Healthcare Outcomes achieved = Value Costs of achieving outcomes

  5. How will this Effect Rehabilitation Reimbursement? • Probably through a bundled payment system • Most likely will include entire episode of care. How will cost be allocated? • Providers need to be prepared to take risk, but will they? • Most likely focus on high cost episodes of care

  6. Bundled Payments • Advantages: • Focus on outcomes and increased efficiency • ??regulatory hassles?? • Force providers to become more integrated • Consumer involvement more important • Disadvantages: • Financial incentive for providers to cut corners • Who to control? Acute care? • Elimination of small freestanding providers? • How will unique providers be taken into account?

  7. Life Care Planning • A dynamic document based upon published standards of practice comprehensive assessments, data analysis and research • Provides an organized concise map for current and future needs with associated costs for individuals • Performed by LCP in collaboration with interdisciplinary treatment team, practice guidelines, etc

  8. 14 Common Topics • Projected evaluations • Projected therapeutic modalities • Diagnostic testing/education assessment • Wheelchair mobility needs • Aids for independent function • Orthotics/prosthetics • Home furnishings/accessories • Drug/supply needs • Home/attendant/facility care • Future routoine medical care • Transportation • Health/strength maintenance • Architectural renovations

  9. Example of LCP Use for Outcome • Locomotor Training (LT) • 5 days per week, 1.5 hours per day • Tx in body-weight supported environment, over ground and in community • PT + 3 PT aides • Participants • 4.5 yo boy; C8 AIS C;16 mos post;76 sessions • 61 yo woman; C3 AIS D; 16 mos post; 198 sessions Morrison, SA et al. JNPT. 2012;36:144-153

  10. Clinical Results • 61 yo • Increased LEM by14 points • BBS increased from 6 to 47/56 • 6MWT increased from unable to 700 ft • 10 MWT decreased from 0.05 m/s to 0.71 m/s • Stairs improved from unable to 12 steps independently • ADL’s improved from mostly dependent to mostly independent • 4.5 yo • LEM unchanged • GMFA 45.8% to 60.2% • Increased mobility self care and mobility PEDI scores • improved from unable to perform to 0.29 m/s (selected) and 0.48 m/s fastest walking speed • Dependent to independent ambulation within home • Able to perform stairs

  11. 61 yo Pre and Post Life Time CostsLow End $

  12. 4.5 yo Pre and Post Life Time CostsLow End $

  13. Other Additional Costs

  14. Looking at the Value Equation Is it worth the $? • Direct Cost for Providing LT • $78.40 higher cost (personnel)/treatment session • Total increase in cost for 61 yo = $15,721.20 • Total increase in cost for 4.5 yo = $6,034.40

  15. Caution • This was not a randomized controlled study • LCP projections were only 1 point in time. However, outcomes were maintained at 6 months and 1 year. • Aging process was taken into consideration with equipment needs

  16. Annual Charges and Cost Cao Y, Chen Y, DeVivo MJ. Top Spinal Cord Inj Rehabil 2011;16(4):10-16

  17. Primary Causes for Rehospitalizations DeVivo MJ, Farris V. Top Spinal Cord Inj Rehabil 2011;16(4):53-61

  18. Rehospitalizations • Total days within 1st yr: 24.7 • Top Causes: • Diseases of genitourinary (45%) • Disease of the skin (17.7%) • Diseases of the respiratory system (15.3%) • Diseases of circulatory system (11.2%)

  19. Cost of Care With and Without Pressure Ulcer Stroupe KT, et al. Top Spinal Cord Inj Rehabil 2011;16(4):62-73

  20. What About Other Interventions?

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