Trends Transforming Transitional Rehabilitation Therapy

Post-acute rehabilitation centers and home healthcare companies are using technology to meet the increasing demands for care after a hospital stay.

Transitional rehabilitation therapy is changing in America today. This growing industry brings together various disciplines such as physical, occupational or speech and language therapies on a short-term basis to help patients regain their independence after a hospital stay due to an injury or surgery. According to Deloitte’s healthcare providers practice, one in five patients are admitted to post-acute care after being discharged from the hospital (about 8 million patients annually).

In the U.S., demand for transitional rehabilitation therapy is increasing and is likely to do so for the foreseeable future, due to an aging baby boomer population. The U.S. Census Bureau reports that residents age 65 and over increased from 35.0 million in 2000 to 49.2 million in 2016. Further, according to Medical Marketing & Media, boomers are less healthy and more costly than previous generations. In fact, by 2030, the American Hospital Association estimates that 37 million boomers, or more than 6 of every 10, will be managing multiple chronic conditions.

To help this aging population regain function after receiving acute care at a hospital, rehabilitation therapy can be accomplished at either a short-term, post-acute inpatient facility or through home health care, depending on the recommendation of a patient’s medical team.

Growth of Post-Acute Care

Regardless of location, Medicare spending on post-acute care has nearly doubled. According to an analysis last year by the Agency for Healthcare Research and Quality, spending increased from $29 billion to $59 billion between 2001 and 2013. In addition, patients are spending less time in the hospital and more in rehab care. According to The New England Journal of Medicine Catalyst, hospital stays decreased, dropping from 6.3 to 5.7 days, while the average length of stay at post-acute care facilities increased from 4.8 days to 6.0 days between 2004 and 2011.

Patient stays at post-acute facilities can also be less expensive than hospital stays. For example, the California Association of Health Facilities reports that, compared to an average cost of $2,200 per day for a hospital stay, a nursing facility subacute unit generally runs $300 to $600 per day or less, depending on the patient’s needs.

In this changing industry, patients can now choose where to receive their transitional inpatient rehabilitative care—at short-term care sections of a nursing home or hospital campus, or at an independent facility designed just for their short-term rehab care needs. Both nursing home chains and small independent facilities have been investing in renovations and upgrades in order to meet the demand for more short-term rehab stays. Growth in this sector has primarily been in new freestanding facilities often associated with a large health system as well as the expansion or renovation of existing facilities on acute care campuses.

Making Today’s Post-Acute Rehab Centers More Inviting

While rehabilitative therapy is still at the epicenter of each post-acute facility, the design and atmosphere of centers are now focused on creating an inviting patient experience. For example, Healthcare Design magazine reports today’s post-acute centers improve the patient’s healing process by bringing together private rooms, common spaces with a community feel, and abundant natural light. The goal is to create an environment that makes the patient and family feel good about their selection of the rehab center.

Modern post-acute centers are both high tech and high touch, developing spaces that can accommodate the necessary rehabilitation equipment and technology, while creating an environment that promotes a calming atmosphere. In fact, Senior Housing News reports state-of-the-art post-acute care facilities are now taking cues from the hotel industry to create a rehab experience that feels more like a vacation. For example, the Atrium Post-Acute Care of Woodbury in New Jersey features a pub, movie theater and bistro, in addition to the rehab gym.

The bottomline focus at all post-acute centers is still helping patients regain their independence and return home. To do that, centers focus on spaces that recreate home environments or are dedicated to simulating areas of daily life. Some have scenarios that include airplane seat transfer, driving, woodshop activities or streetscapes with stoplights and sidewalk ramps. The goal is to strengthen patients’ skills so they can navigate real-world environments with confidence.

Cutting-Edge Rehab Technology

Technology is beginning to take center stage at post-acute care centers. From bionics and robotics to gaming, technology is transforming patient recovery. Take the EksoGT suit, which can assist patients suffering from varying degrees of paralysis. Developed by Ekso Bionics, the aluminum and titanium exoskeleton helps facilitate patient progress with revolutionary step modes and enforces normal biomechanical alignments and gait patterns. Web PT reports patients typically start walking during their first session with the EksoGT suit.

Robotics is another natural fit for the new age of rehabilitation therapy since robots can easily facilitate the repetitive movements that are key to a patient’s recovery. According to the Indiana University Physical Therapy department, robots can help patients perform about ten times the number of repetitions in a one-hour session. Lokomat is one example of a robotic treadmill that can help patients gain mobility through repetitive movements.

Robotic therapy may also be particularly effective for stroke patients. Medpage Today reported robot-assisted therapy (RT) can enhance stroke patient recovery by helping to restore upper extremity function. One benefit of rehabilitation RT is that it can be customized to an individual patient’s needs and abilities while providing direct quantitative feedback that can enhance a patient’s motivation.

Other types of technology are also making an impact. For example, gaming technology has moved from the couch to the rehab center. Therapists have been using Nintendo Wii technology to help engage patients for several years. Now, virtual reality can be used in stroke patient rehab. One example, Saebo VR, is the world’s only virtual rehabilitation system that exclusively focuses on activities of daily living (ADLs) as it simulates real-life activities and allows stroke patients to work on self-care skills in a setting that is usually impossible to create in a hospital environment.

Advancements in rehab technologies such as these help engage patients during their stay at a post-acute rehab center and can lead to better outcomes.

The Growth of Home Health Care

After receiving care during a hospital stay, sometimes recovery at “home sweet home” is just what the doctor ordered. Like post-acute rehab centers, the home health industry is growing. In fact, the Bureau of Labor Statistics predicts the home health industry will be the fastest-growing employer until 2026. Centers for Disease Control and Prevention (CDC) statistics show there were 12,400 home health care agencies in 2014, serving 4.9 million patients in 2013.

While the home environment does not offer access to some of the latest rehab equipment such as the EksoGT suit, technology is still improving patient care. For example, Bayada Home Health Care, one of the nation’s top ten largest home health companies, is using an artificial intelligence component comparable to Apple’s Siri or Amazon’s Alexa. DINA, a digital nursing assistant, is used to analyze patient data from several different sources in order to drive timely health interventions before health worsens.

Telehealth is another tool that home health agencies are using to keep tabs on their patients, even when they are not there. As reported by mHealth Intelligence, an organization for the mobile health industry, FirstHealth of the Carolinas provided patients with an mHealth-enabled tablet that allowed them to track their own vital signs and send that data to FirstHealth. The digital health platform also enabled patients to access personalized health and wellness information and collaborate with FirstHealth on an ongoing care plan to help keep patients healthy in a home environment. First Health reportedly saved almost $2 million by using telehealth to care for high-risk patients who didn’t qualify for Medicare-funded home health services.

The Shift to Alternative Payment Models

To reduce costs while maintaining patient care, Medicare and Medicaid have been moving toward alternative payment models such as bundled payments.

As of January 2018, Centers for Medicare & Medicaid Services (CMS) announced the launch of a new voluntary bundled payment model called Bundled Payments for Care Improvement Advanced (BPCI Advanced). Under traditional fee-for-service payment, Medicare pays providers for each individual service they perform. Under this bundled payment model, participants can earn additional payment if all expenditures for a beneficiary’s episode of care are under a spending target that factors in quality. In its research of early participants in bundled payments, Deloitte found that early adopters have seen some cost savings, the greatest of which resulted from reduced use of post-acute care following joint replacement, with CMS demonstrating identified savings of $864 per episode.

The continuing changes in the regulatory environment bear a close watch throughout 2018 for both short-term post-acute and home health care.

The Future of Transitional Rehab Care

What does the future hold for transitional rehab care? While growth has been on an upswing for both inpatient post-acute and home health care, the regulatory aspect for these two sectors has been in flux this past year.

In the post-acute rehab sector, Dynatronics predicts there are a number of positive trends on the horizon in 2018. Among them are better data on quality and patient satisfaction indicators, more coordination with local hospitals and other partners and an increased staff focus on the bottom line.

In the home health arena, Home Healthcare News predicts further developments in Medicare home health payment reforms in 2018 as well as increased development of smart homes that feature Internet-connected devices to promote aging in place. Mergers and acquisitions will also continue to affect the industry, such as Humana’s recent 40 percent stake in Kindred at Home. Through its partnership acquisition of the nation’s largest home health provider, Humana believes it can extend more care into the home by increasing care coordination and support services.

The changing regulatory and competitor environment will continue to prove challenging for both short-term post-acute rehab centers and home health care in 2018. However, with the increased population of baby boomers and the potential development of rehab technology that delivers positive patient outcomes, the future for continued growth in transitional rehabilitation care is bright.

The views expressed by the author are not necessarily those of Fifth Third Bank and are solely the opinions of the author. This article is for informational purposes only. It does not constitute the rendering of legal, accounting, or other professional services by Fifth Third Bank or any of their subsidiaries or affiliates, and are provided without any warranty whatsoever.