By Kristen M. Pratt
In these erratic political times comes the also mercurial talk of implementing prospective payment systems (PPS) and restoring Medicare funding. Unfortunately, the news is somewhat grim. Both Stuart S. Kurlander, JD, MHA, (see Regulatory Report), and Frances J. Fowler, FAAHC, (see Building Alliances), discuss the nitty-gritty of the Health Care Financing Administration's proposal on employing a per discharge PPS for inpatient rehab hospitals and units. George G. Olsen, JD, covers the once "good bet" on the 106th Congress passing Medicare "giveback" legislation, which would restore some funding to rehabilitation that was cut in the Balanced Budget Act of 1997; it could now be a losing proposition due to the three-ring circus that masqueraded as our presidential election (see Legislative Watch). Adding to this dour scenario is the fact that the United States is not just recovering from a political crisis—we are truly in a health care crisis. Costs keep skyrocketing, the ability to provide adequate care is increasingly difficult, and the uninsured are forced to use the emergency department as a primary physician visit. Currently, 16% of Americans (42 million) are without health insurance and 14% receive a form of public health care assistance.1 President elect George W. Bush proposes covering an additional 3 million uninsured through tax credits, which would help people buy their own, private health insurance, at a cost of $135 billion over 10 years.2 Will Bush's plan begin to solve this health care dilemma? Will it even have a chance of implementation if party lines stay so deeply embedded? We will have to wait and see, or consider alternatives. I recently came across an article on a new program in the School of Pharmacy and Pharmaceutical Sciences at the University of New York, Buffalo, that is designed to train new pharmacists in pharmaceutical therapy management. The goal of the program is to produce pharmacists who can assist seniors in better managing their prescriptions, which are often prescribed by several different health care providers; it is hoped that the program will reduce the number of medications and ensure patient compliance, with the ultimate goal of maintaining independence as long as possible. Not only do the patients benefit physically, but pharmaceutical therapy management can also significantly reduce costs.3 I believe that preventative care is the future of medicine and one of the keys to solving our health care crisis. Physical medicine and rehabilitation (PM&R) practitioners are poised to be pivotal players on the preventative care team. Rehab has already established itself as one of the first medical specialties to take a closer look at complementary and alternative medicine. Smart move—according to a study published by JAMA, in 1997, 4 out of 10 Americans used alternative therapies and spent $27 billion out-of-pocket to do it.4 In this issue are two different approaches to incorporating non-traditional aspects into rehabilitation. Ronald Glick, MD, successfully uses acupuncture in his chronic pain management practice (see Needling the Pain) and the Mind/Body Medical Institute of Bon Secours, which does not deem its paradigm "alternative medicine" because it is evidence-based, uses an holistic approach—integrating the physical, social, emotional, and spiritual aspects of people into their treatment, particularly through emphasizing self-care (see Facility Profile). The fluid and innovative field of PM&R seems a perfect fit for prevention. Where will the reimbursement dollars come from? How will it help rehab's bottom line? I don't know, but if any field can turn prevention into opportunity, I would put my money on rehab. —Kristen Pratt Machado is no longer Editor of Rehab Management. Please address any correspondence to Sarah Schmelling, Senior Editor, at cwolski@medpubs.com. References
