rehabilitation, value based care and horticultural …...rehabilitation, value based care and...

Rehabilitation, Value Based Care and Horticultural Therapy

John R. Corcoran, PT, DPT, MS

Site Director of Rehabilitation

Clinical Assistant Professor

October 2018

Rusk Rehabilitation

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John Muir – “Keep close to nature’s heart ... and break clear away, once in awhile, and climb a mountain or spend a week in the woods. Wash your spirit clean.”

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Vermont Wildflowers

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The History of Rehabilitation –

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History of Rehabilitation

• In the ancient world, people with disabilities were summarily excluded from

everyday life (Conti 2014)

• The notion that disabilities were punishments from the gods and deities

was widely accepted

• Disabilities were assumed to be the direct result of one’s moral failings,

sins, or acts against the gods

• People with disabilities were thus prescribed complete removal from

society

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History of Rehabilitation

• Ancient Egypt

– Edwin Smith Surgical Papyrus

• 2000 BCE

• Ancient Greece – father of modern medicine

– Hippocrates 460 – 370 BCE

– Olympic Games

• Rome – famed physician Galen

– 130 – 200 CE Soldiers

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History of Rehabilitation

• People were treated by their families or religious establishments until the

later part of the 20th century

• Penicillin – Alexander Fleming 1928, first treatment 1942

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History of Rehabilitation

• Howard A. Rusk, MD

– Father of Rehabilitation Medicine

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Rusk: The Foundation of Rehabilitation Medicine (1948)

Howard A. Rusk, MD – wounded and disabled servicemen were left to “simply lie around getting custodial care, with nothing to do, bored to distraction, helpless, hopeless, waiting for some kind of infection or disease to carry them off.”

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Howard A. Rusk, MD – “Gradually the concept of rehabilitation came to me as I found out how much really could be done for these men. In the beginning, I knew only that everything possible should be done to return them to physical and mental health. This meant finding ways for them to function despite their disabilities.” 15 Rusk Rehabilitation

Howard A. Rusk

• World War II

• Academic Class Work

• Early Mobilization

– Improve outcomes, decrease readmissions

• Interdisciplinary Teams

• Psychosocial Functioning

• Physical and Vocational Rehabilitation

• Horticulture

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Howard A. Rusk

Horticulture at Rusk – The Garden of Enid – The Glass Garden 1959

“Hundreds of patients through the years have not only found joy and solace in the

program but many have gone on to follow careers in horticulture ….. Distressed

families have found peace in this atmosphere.”

“The idea has been copied throughout the entire country and has spread like wild

flower seeds scattered by kindly winds.”

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Glass Garden -

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Rusk Without Walls – Dr. Lee

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20 Rusk Rehabilitation Photo credit: www.iasc.mcn.org

History of Horticultural Therapy

• Ancient Egypt

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Why is HT offered in the hospital environment?

• Patient satisfaction

• Decrease pain

• Decrease anxiety

• Decrease stress

• Improved sleep

• Best practice

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What are the drawbacks of horticultural therapy?

• Need for space, light, soil, water can be a challenge in an urban environment

– Roof top gardens, green roofs, creative use of space

• Not reimbursed (in the US) by insurance

– Value Based Care, Triple Aim

• Dependent on grant funding

– Research

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Why do you support HT for clients and patients?

• Personal experience

– Family

– Patient letters and photos

• Best rehabilitation is when the patients don’t realize it is rehabilitation

• Payment related to patient satisfaction

• It works!

• Need more research and QI studies

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• Kimmel Pavilion

• Hassenfeld Children’s Hospital

• Tisch Hospital

New Hospitals

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Advanced Comprehensive Stroke Center

Certified VAD Center

Heart, Lung, Face Transplant Center

Patient Care

Specialty Programs

• Brain Injury

• Stroke

• Pediatrics

• Limb Loss

• CIIRP

o Comprehensive Integrated Inpatient Rehabilitation Program

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Accolades

Rusk Rehabilitation has been ranked

among the top ten in the country since

U.S. News started its rankings in 1989 and

#1 in New York State

This year, NYU Langone Health Systems

ranks among the top ten hospitals

nationally, its highest ranking to date

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• The Traumatic Brain Injury Model System grant is a collaborative endeavor involving

Rusk Rehabilitation and Bellevue Hospital, several trauma and medical centers

throughout New York City, and a nationally renowned rehabilitation outcomes research

center at the University of Michigan.

• Cultural disparities and culturally-accessible knowledge in rehabilitation

healthcare among patients with TBI.

Rusk Rehabilitation: One of 16 National TBI Model Systems

Value Based Care Michael Porter

𝑉𝑎𝑙𝑢𝑒 =𝑄𝑢𝑎𝑙𝑖𝑡𝑦

𝐶𝑜𝑠𝑡

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Value Based Medicine

Value = Quality/Cost

Bundled Payment Initiative

CMS Pilots

Triple Aim

Improving pt experience

Improving outcomes

Reducing cost

(Institute for Healthcare Improvement)

Rusk Rehabilitation Initiatives

Presentation Title Goes Here 32

Value Based Care - Bundled Payment Initiatives

the risks for embracing new payment

models as they evolve is worth the

opportunity to identify what works and

influence future policy

Presentation Title Goes Here 33

Value Based Care - Bundled Payment Initiatives

Presentation Title Goes Here 34

Value Based Care - ICU Early Mobilization

Early Rehabilitation in the Medical and

Surgical Intensive Care Units for Patients

With and Without Mechanical Ventilation:

An Inter-professional Performance

Improvement Project John R. Corcoran, PT, DPT, MS, Jodi M. Herbsman, PT, DPT, MS, Tamara Bushnik, PhD,

Steve Van Lew, MS, OTR/L, Angela Stolfi, PT, DPT, Kate Parkin, PT, DPT, MA, Alison

McKenzie, MA, RN, NE-BC, CCRN, Geoffrey W. Hall, MBA, MSW, FACHE, LCSW,

Waveney Joseph, MBA, Jonathan Whiteson, MD, FAAPMR, Steven R. Flanagan, MD

PM&R. Feb 2017

Presentation Title Goes Here 35

Early Mobilization Study Results:

• Rehabilitation therapy services increased by 60 minutes

• ICU LOS decreased by 20% from 4.6 to 3.7 days (P=.05)

• Floor bed LOS decreased 40% from 6.0 to 3.4 days

• 40.5% vs 18.2% discharged home without services

• Annualized net cost savings of $1.5 million

Presentation Title Goes Here 36

Value Based Care - ICU Early Mobilization

LOS

• Reduced ICU length of stay by 0.93 days – 20%

LOS

• Reduced Med-Surg bed length of stay by 1.9 days – 30%

$ • Reduced average direct cost per day by 12%

Presentation Title Goes Here 37

Value Based Care - ICU Early Mobilization

Annual Net Cost

Savings of

$1.5M $2.2M saved with an annual increase in salaries of $740K

Performance Improvement

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Green Satisfaction Team

Performance Improvement

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Project goal: The aim of this study

is to explore whether adding nature-based

elements in the hospital room may improve

the patient experience. Patient perceptions

of their room, pain control, quality of sleep,

quality of room, and quality of care will be

assessed.

Matthew Wichrowski, MSW, HTR

Presentation Title Goes Here 40

The Rehabilitation Therapy Team Value:

• Improving the patient experience

• Horticultural Therapy

• Improving patient outcomes

• Horticultural Therapy

• Decreasing hospital length of stay

• Reducing hospital costs

• Decreasing the need for post acute services

• Preventing readmissions

Lifelong Rehabilitation

• Did your program provide the foundation…

Bottom Line!

From fitness to health, location-aware medical wearables are about to

transform our lives . Embedded –computing.com ; Sept 2015.

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Reaching the Nation

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Spreading the Word: Using Podcasting to Advance Scientific Knowledge Across the Spectrum of PM&R Geoff Hall, Doug Elwood, Joanna Feliz

Rusk Insights on Rehabilitation Medicine

Who is Involved?

Over 85 leaders from the field with

weekly episodes

What is the Reach?

Over 25,000 downloads

in 15 months

Downloads in

all 50 states in

the US plus 14

countries

What is it?

Leaders in the field discussing key topics

in rehabilitation

Matt Wichrowski, MSW, HTR

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Events, Contests, Patient/Family and Staff Education

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John Muir – “The clearest way into the universe is through a forest wilderness.”

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References: • Early rehabilitation in the medical and surgical intensive care units for patients with and

without mechanical ventilation: an inter-professional performance improvement project:

Corcoran, Herbsman, Bushnik, Parkin, McKenzie, Van Lew, Stolfi, Hall, Joseph,

Flanagan (PM&R Volume 9, Issue 2, February 2017, pg. 113-119).

• Medical Aspects of Disability – 5th edition. Editors: Flanagan, Zaretsky, Moroz.

Introduction Chapter 1 Parkin, Corcoran, Stolfi (pg. 1 – 18). Copyright, Springer

Publishing 2016.

• Conti, A. A. (2014). Western medical rehabilitation through time: A historical and

epistemological review. The Scientific World Journal, 2014, 1–5.

• View through a window may influence recovery from surgery: Ulrich (Science, Vol. 224,

April 1984, pg. 420-421).

• The Strategy that will fix health care: Porter, Lee (Harvard Business Review, Vol. 91,

Oct. 2013 pg. 50- 70).

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References:

• The Triple Aim: Care, health, and cost. Berwick DM, Nolan TW, Whittington J. Health

Affairs. 2008 May/June;27(3):759-769.

• The Glass Garden – a Therapeutic Oasis in New York City. Chambers, Fried and

Wichrowski. Copyright, Arena Books Associates, LLC. 2014.

• Rusk, H. A. (1977). A world to care for–the autobiography of Howard A. Rusk, MD. New

York, NY: Random House/Reader’s Digest Association.

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Questions?

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THANK YOU