Basic Tenet of Accountable Care

The term “Accountable Care Organization” (ACO) was first used by Elliott Fisher,Director of the Center for Health Policy Research at the Geisel School of Medicine at Dartmouth in Hanover, NH. In essence, ACO is based on the concept of “provider-led organizations with a strong base of primary care that are collectively accountable for quality and total per capita costs across the full continuum of care for a population of patients.” ¹ One interesting aspect is the discussion involving “full continuum of care,” and how that affects hospital relations with physician groups, insurance providers and other hospital networks. This has led to a particular concept based around ensuring the patient receives the appropriate evaluation and treatment at the appropriate time in their recovery process, commonly referred to as a “Life Coach” or “Patient Concierge.” In essence, once a patient is admitted to a healthcare network, a representative is assigned to be with the patient from initial testing completion through follow up and therapy if required.

Position of Rehabilitation Hospitals

The goal for rehabilitative care is to ensure that patients are able to be discharged to their homes instead of an acute care or nursing facility. To this end, rehabilitation hospitals are already on the cutting edge of what healthcare reform is all about because their approach to patient care is very much team-based care. “In rehab, you are putting the whole person back together. It can’t be just the physician; there is the need for the therapist, the case manager, the whole team. It is part of the recovery process,” ² says Charles Pu, MD, Chief Medical Officer for Spaulding Hospital in Boston, MA. With the increasingly aging population and a focus on full continuum of care, rehabilitative care will become a progressively more important component to the healthcare delivery process. Relationships between acute care facilities and rehab hospitals can result in improved outcomes and reduced expenses through collaboration and cooperation. “An interdisciplinary team approach is the foundation of the system. The team consists of physical, respiratory, occupational and speech therapists, as well as a neuropsychologist, physician, nurse, dietitian, infection control nurse and clinical case manager, which allows patients to see a wide variety of spinal cord specialists.” ³

Recent Trends in Rehabilitation Services

Rehabilitation hospitals occupy a unique position within the spectrum of aging/patient care with connections both into acute care hospitals and into senior living/skilled nursing facilities. In a recent white paper released by RehabCare, “there are opportunities to proactively prepare for changes and anticipate positive clinical and business outcomes. Rehabilitation programs present an immediate opportunity to achieve increased operational excellence in providing quality outcomes in a cost effective setting.” ⁴ The paper goes on to suggest 10 steps to improve rehabilitation services:

1. Build your program around quality people
2. Invest in the professionalism of the Therapy Department
3. Develop specialized programs that meet the needs of the facility and community
4. Excellent therapy management
5. Know the rules and follow them
6. Know your customers and the market
7. Strategically approach census development
8. Make it easy for your customers
9. Manage the rehab stay
10. Keep your customers happy

In the ever-increasing consumer empowerment of healthcare selection, I would propose that the order should start with #8, followed by #10. To achieve those metrics, the facility must excel at all of the other steps. Having a strategic design partner to assist with thought leadership and national best practices and ensure that the facility design matches the forward thinking of the operational process is the next logical step.

1. http://en.wikipedia.org/wiki/Accountable_care_organization
2. http://www.healthleadersmedia.com/print/MAG-264915/Rehab-Hospitals-Retooling
3. http://www.healthleadersmedia.com/print/MAG-264915/Rehab-Hospitals-Retooling
4. http://www.rehabcare.com/uploadedFiles/RehabCare_-_rehabcarecom/Hospital_Partners/Content/144155%20RC%20White%20Paper

This blog was written by a former architectural designer with Array, Shane Williams.