Preventative care has become increasingly important as healthcare organizations seek to lower costs and improve outcomes.
It's no secret the gap in medical care is a huge problem in the United States, and the pricing structure is less than fair. As the government pushes for greater transparency, breaking down the silos of the healthcare organization has become a bigger Goliath than most states expected. Insurance companies negotiate billing prices, insured patients’ health plans determine what they will pay, and those who are uninsured end up paying the entire cost.
Take, for example, the average out-of-pocket for a knee replacement in the U.S.: approximately $40,000. For those with insurance, the cost might be lower, but perhaps only a few thousand dollars, depending on the coverage. Then there are post-operative costs, and suddenly, that $40,000 begins to climb until everyone is cringing and trying to figure out how to survive—literally.
During cardiac rehabilitation, which averages three to six months in length, patients will typically work with cardiologists, dieticians, exercise rehabilitation specialists, occupational therapists, physical therapists, psychologists and psychiatrists. Add up the visits, time off from work and copays that aren’t projected or anticipated by the hospital, and suddenly, the cost for surgery has ballooned.
Improving Treatment
For many, the decision to have surgery is a last resort. Clinicians are finding more and more patients coming in with debilitating pain that has progressed to the point where medication no longer provides relief. Some wait years before addressing their poor health, so hospitals are treating patients who are depressed, unhealthy, overweight, weak and exhausted.
Pressure from the White House is forcing healthcare organizations and insurers to take additional measures to decrease their high-risk demographics, and as a result, preventative healthcare, or prehabilitation, has become increasingly significant. Prehabilitation is not just for those undergoing surgery, cancer treatment or another disease-related intervention; its benefits are also important for those likely to be high users of healthcare resources, such as the elderly, the disabled and low-income groups. In addition, the benefits are not just financial; prehabilitation has been shown to decrease treatment-related morbidity, increase treatment options, and improve physical and psychological health outcomes, regardless of diagnosis.
Prehabilitation gives healthcare providers a pretreatment baseline, which helps in understanding their patients' needs, as well as their limitations. By evaluating and assessing patients prior to a procedure, providers are more efficient with their time and more successful anticipating the effects or complications related to treatment. This type of data has the potential to further decrease costs incurred by everyone across the healthcare spectrum. When providers are able to treat patients in healthier physical and psychological states, treatment becomes much more successful.
Benefits and Savings
Prehabilitation can include (but is not limited to): therapeutic and general exercise, balance/gait therapy, alcohol reduction/cessation, education, smoking cessation, counseling and psychiatric evaluation, diet and nutrition counseling, treatment for fatigue, sleep problems, chronic pain and much more. The goals and benefits of prehabilitation include:
- Improved physical and psychological outcomes
- Increased treatment options
- Minimization of unnecessary testing and treatment
- Reduced recovery time, length of hospital stay and risk of future readmission
- Reduced absences from work by significantly decreasing recovery time.
The potential for savings can be seen in:
- Improved psychological health, proven to decrease length of hospital stay
- Improved strength and fitness, which prevents or reduces the severity of treatment-related impairments that may cause disability
- Decreased absenteeism from work, both pre- and post-op Decreased instances of disability insurance and workers compensation costs for employers.
The next step in the field of physical medicine and rehabilitation is gaining the support of healthcare organizations, providers and insurers to implement a standard of prehabilitative care and evaluation. As the country moves toward a healthcare model that theoretically puts patient care first, organizations will undoubtedly try to find lucrative ways to do just that—by starting to address the recovery component before surgery and treatment, not after. iBi
IPMR provides prehabilitation therapy for all areas of treatment. For more information, visit ipmr.org or call (800) 957-4767.
