Issues, Issues, Issues…. “the Hurrier I Go, the Behinder I Get” (the White Rabbit in Alice in Wonderland)

Your AMRPA is a busy organization. The challenges and opportunities seem to keep coming. Representing the field of inpatient rehabilitation hospitals and units is clearly a journey, rather than a destination. Let me take a few lines to help you be aware of some of the major issues being addressed. All of these efforts are fundamentally geared towards preserving and protecting access to rehabilitation by Medicare and private insurance beneficiaries, and promoting a favorable reimbursement and regulatory environment for providers.

Quality Reporting for Inpatient Rehabilitation Hospitals and Units (IRH/U). The new health reform legislation (the Patient Protection and Affordable Care Act, PPACA) has made it mandatory for IRH/U reporting of quality to occur in the near future. What those measures are, and how meaningful, relevant, and burdensome they are, all need to be addressed. AMRPA’s Quality Committee is actively addressing these issues.

Preparing for Bundling and Continuing Care Hospital Pilot Programs. PPACA also has mandated trials of acute care/post acute care bundling, as well as our proposal to test the Continuing Care Hospital model of service delivery reform. The AMRPA CCH and Bundling Committee is addressing these issues, with the intent to help Federal policy makers “get it right” as implementation of this initiative moves forward.

Group Therapy in the Inpatient Rehabilitation Hospital/Unit. We expect that CMS will likely address the issue of the staffing ratios for inpatient therapy in the IRH/U and have asked our Regulatory Committee, along with our Outpatient and Therapies Committee, to address this issue to be sure that overly simplistic assumptions don’t force further distortions to the inpatient rehabilitation care delivery enterprise.

Health Information Technology Use in the IRH/U setting. While the acute care hospitals received substantial financial support to adopt electronic medical record keeping systems, IRH/U (along with other post acute providers) were deliberately excluded from being eligible for these funds. AMRPA believes that federal support, in one form or another, is vital to assist the IRH/U community to adopt this technology. The Data Committee is working to identify the technical aspects of how we would like to receive support, and the regulatory and legislative tactics that may be required to do so.

Business as Usual. Every day, issues seem to emerge that need addressing. Whether they are regulatory proposals that would slash outpatient reimbursement by Medicare, technical adjustments to the inpatient rehabilitation facility prospective payment system that reduce payment, or data needs of a member organization to help them with a dispute with their local Medicare Administrative Contractor, they all take time and staff attention.

In recognition of the growing demands for attention to these many issues, AMRPA is going to be expanding (judiciously) its full time staff capacity to create additional capacity and depth to handle all of these concerns. Staying trim and lithe will always be high on our plans for managing the Association, but the Board has determined that cautious expansion for our staff is now essential.

In the coming months, as we welcome our new staff person, he or she will be introduced to you in these pages, on the phone, or in person at our various meetings.

Bruce M. Gans, MD