The Future of Medical
Rehabilitation
Bruce M. Gans, MD
Predicting the Future
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Past Performance
Leading Indicators
Threshold and Pattern Analysis
Consensus Processes
Patterns in related domains
Speculation
Patterns of Change
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Stability
Evolutionary
Disruptive
Factors that Lead to
Societal Change
Technology
Social-Political Forces
Economics
Emerging Technical
Innovations
Diagnostic and Prognostic Tools
Musculoskeletal Ultrasound
fMRI
qEEG
Genetic Markers of
Rehabilitation
Neural Interfacing
DBS
TCMS
TCDS
Brain-Machine Interfacing
Human Augmentation
Cardiac Augmentation
(LVAD)
L/E High Performance
Prosthetics
DARPA Hand
Enhanced Exoskeleton
Powered Orthotics
Innovative Therapies
and Programs
Hyperbaric Oxygen Therapy
Vestibular Rehabilitation
Better Living Through
Electricity
Pain Management
Strengthening
Function
Sensation
Respiration
Tele-Rehabilitation
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Video calling
Tele-presence
Sensory Data Transmission
Haptic Data Transmission
Motor Data Transmission
Replacements for Staff
Robot Professionals
Robotic Arm Therapy
Robot-Assisted Gait Training
Transfer Robot
Fall Prevention Alarms
Drug Vending Machines
3D Drug Printing
Virtual Reality
Virtual Reality
Augmented Reality
Social-Political Factors
Human Resources
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Declining physiatrist interest/availability for
inpatient care
Aging caregiver workforce
Trend towards more autonomous
practitioners (DPT)
Demand Growth
Turning Problems into
Opportunities
Bariatric Rehabilitation
Diabetes
Wounded Warriors
Health Care Political Issues
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Health Care Reform (ACA)
Partisan Politics
Disability Rights
Veteran and Active Military Concerns
IMPACT
ABLE
PIMA
SGR - MPPS
Healthcare Reform Legislation
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Quality Measurement and Reporting
Electronic Health Records
Interoperability
Value Based Purchasing
Bundling of payments to acute care
providers
Innovation Programs
Market Basket Cuts
Healthcare Reform Legislation
(continued)
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Continuing Care Hospital Pilot
Accountable Care Organizations
Medical Home
Expanded Insurance Coverage
Definition of Rehabilitation Benefits for
Health Insurance Plans
Regulatory Trends
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Stricter enforcement of medical necessity
Rehabilitation Therapy Intensity and
Staffing Patterns
Recovery Audit Contractors
Office of the Inspector General
False Claims Act use by the Department
of Justice
ALJ Backlog
Litigation Trends
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Interaction among safety, quality of care
and risk management
Failure to enact “tort reform”
Economic incentives to file and sue
Jimmo vs. Sibelius Settlement
Accreditation Standards and
Enforcement
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CARF
The Joint Commission
Others
Globalization of Healthcare
Globalization of Health Care
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Transmissible Illnesses
Economic growth increases demand
for health care
Import/export of health care
Nationalistic desires to become
autonomous delivering health care
Examples: China; Middle East
Economic Factors
The Macro Economy
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Governmental spending for health
care
Employment related health insurance
Global economic pressure
Deficit Spending and the Federal
Debt
Inflation
The Micro Economy
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Deferring the expensive
Delaying the discretionary
Shopping for cheaper options
Shifting insurance coverage landscape
Price Transparency
Narrow Network High Deductible
Insurance
Reimbursement pressures
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Medicare rates
Medicaid rates
Commercial rates
Self-pay/bad debt
Behavioral Economics
Creating our Future
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Adopting the best of new
technologies
Focusing on Programs
Continuous quality improvement
Marketing our Services
Forming alliances and relationships
with referral sources, other segments
of the health care continuum
Embracing Innovation
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Capital Investments
• Facilities (single occupancy rooms)
• Equipment
• Information technology
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Program Adoption and Development
Managing with measures and data
Focusing on efficiency and
effectiveness
Final Observations
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Moving into a time of “interventional
rehabilitation”
Demand will start skyrocketing in about 10 years
Care givers will be in very short supply
Expectations for interventions will be higher
Dollars will be more scarce
Confusion about the distinction among the PAC
settings will be even greater
We Make our Own Future
Time for Discussion