CON law elimination sets off inpatient rehab rush in Florida

As well being techniques like BayCare contemplate inquiries from rehab suppliers trying to associate, they have to determine whether or not it makes extra sense to hitch up or go it alone. There are professionals and cons of each.

Hospitals are more and more on the hook for the overall price of sufferers’ care below Medicare bundled-payment applications or Medicare Benefit plans. In that setting, executives mentioned they like to have possession over all features of their remedy, together with—if vital—inpatient rehab.

“To be able to do that in a continuum of which you have complete control is a potentially even more reliable way to ensure, first and foremost, optimized care for every single patient,” mentioned Tom VanOsdol, CEO of Ascension Florida and Gulf Coast. “And secondarily, optimized performance under any episode-based payment methodology.”

Ascension Florida and Gulf Coast can also be taking calls from rehab suppliers about joint ventures. The system would not presently provide inpatient rehab, and VanOsdol mentioned they’re actively contemplating the easiest way so as to add it. It’s going to possible make extra sense to insource, particularly as a result of the well being system participates in iterations of Medicare’s Bundled Funds for Care Enchancment program and its Complete Look after Joint Substitute mannequin, he mentioned.

For his or her half, rehab suppliers argue that outsourcing to them and succeeding below value-based contracts aren’t mutually unique.

Bundled funds are simple to handle below established partnerships with rehab suppliers, mentioned Mullin, of Choose Medical. Hospitals can simply observe sufferers’ progress. If there’s not a relationship, it may be troublesome to switch sufferers to rehab in a well timed method, probably leading to pricey delays, he mentioned.

Orlando Well being, a 10-hospital system that is rising quickly, with $1 billion in energetic building initiatives, is one more system trying to develop its inpatient rehab choices. It already has a 53-bed unit at one in all its Orlando hospitals, however is assessing the place to develop and by how a lot, mentioned Matt Taylor, Orlando Well being’s vp of asset technique.

It might make sense for Orlando Well being to associate with a supplier that is solely targeted on inpatient rehab, Taylor mentioned. The system has already entered joint ventures on residence care, pressing care and hospice companies.

“You might want to think about, ‘Can we do this better, faster, cheaper and for higher quality by partnering with someone that only does this?’ ” Taylor mentioned.

However elevated participation in value-based fee may additionally imply suppliers have incentives to maintain sufferers out of costly inpatient rehab amenities if it is not completely vital. They may as an alternative refer sufferers to residence care or outpatient bodily remedy.

If that performs out, Florida will quickly have an overcapacity of inpatient rehab beds, given all the development underway, mentioned Doug Baer, CEO of Brooks Rehabilitation, a not-for-profit rehab supplier based mostly in Jacksonville. That mentioned, Florida’s quickly rising inhabitants is including demand, he mentioned.

“The more prevalent those models are, I think some of the utilization of higher-cost facilities—which are inpatient facilities—are not as much,” Baer mentioned.

Nathan Carroll, assistant professor of well being companies administration on the College of Alabama at Birmingham, was among the many healthcare specialists who predicted that state of affairs. However the outcomes of his 2019 examine recommend that participation in Medicare’s BPCI program would not make hospitals any much less more likely to refer sufferers to their very own inpatient rehab.

“What it suggests to me is that maybe the financial incentive under the bundled-payment program isn’t stronger than the financial return for treating patients at the inpatient rehab that you own,” Carroll mentioned.

Carroll’s examine additionally discovered that Medicare paid extra for hospitalizations—inpatient and post-acute mixed—in instances the place hospitals owned inpatient rehab in contrast with after they owned skilled-nursing amenities and residential well being companies.

If these outcomes maintain true in Florida, the federal authorities can anticipate to spend extra on care when the brand new inpatient rehab amenities come on-line, Carroll mentioned.

“Post-acute is a big concern with respect to controlling the overall Medicare budget,” he mentioned.

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