Introduction
For "Clinics of post acute care" Top Physio Engineering® represents a useful tool for resizing of organization process aimed at reducing waste and enhancing the quality of service provided by the post-acute care facilities.
The term "post-acute" defines a series of treatments which are provided to the patient during the acute phase of a disease and before the stabilization phase. Clinics of post acute care are public or private facilities accredited with the National Health Service (NHS), which provide this series of treatments.
HISTORY
Clinics of post-acute care has shown in recent years a steady growth both in terms of beds and resources involved. This development was mainly determined by the transformation of the network of hospitals induced by the introduction of DRG system - Diagnosis Related Group.
The introduction of the DRG impeded the reimbursement of medical expenses “a per diem" while determined a specific contribution for a single pathology and for every medical service. All this in order to cut the healthcare costs and improve the quality of services.
The introduction of the DRG has given rise to the following attitude: drastic reduction of the period of hospital stay. This has, in its turn, resulted in a high turnover of beds and provided availability of beds for people in acute phase of a disease in need of medical treatment.
For its part, the National Health Service has decided to protect the patient, usually discharged early after the acute phase, introducing the assistance in the post acute phase, however without applying of the DRG concept to this kind of service. The consequences were the following:
Clinical situation: the patient considered discharged from a medical and surgical point of view - but is not completely cured.
Logistic situation: the patient is transferred from a hospital to a clinic of post acute care so that it can be cured completely;
Economic situation: partial introduction of the DRG. In this case the National Health Service pays for each medical service provided and not “a per diem” and save on surgical services but at the same time the National Health Service pay to a new subject – the clinic (which should have a lower cost for its services than the hospital) – for the post acute treatment "a per diem”! The cost of the post acute phase treatment surmounts that of the acute phase!
The synthesis of the situations described above is as follows: provision of complete healthcare assistance for patients but a very substantial inflow of people to the clinics of post acute care.
Failure in applying of the DRG approach for the clinics of post acute care and consequent dissipation of money for the post acute treatment rather than for the surgical procedure. That means displacement of the economic problem rather than its resolution. In this way the National Health Service uncontrollably impoverishes its resources first in hospitals and then in the clinics of post acute care. A striking example of this can be that the National Health Service pays the hip prosthesis in the acute phase approximately 7.500,00 euro and about 12,000 euro in the rehabilitation phase, approximately 200 € per day for 60 days!
For years the post-acute care facilities have been real "containers" that indistinctly admitted every kind of patient in order to make available beds in hospitals, however, producing very high costs for the National Health Service without a proven medical validity. During the transformation period the clinics of post-acute care have become the only economic beneficiaries of the new approach of the National Health Service.
The situation has become exasperated with the arrival to the clinics of post acute care of patientswithout a proven necessity of medical treatment.
In addition to the uncontrolled remuneration and high profits, the management of post-acute care facilities has focused its attention on the administration of "long-term" patients considered to be "clinically easier cases" than those actually needy, with the result that patients with complex pathologies in need of a hospital bed during the post-acute rehabilitation phase have as yet difficulty to find a structure that could accommodate them because the structures are full of patients who have no objective need of hospitalization but which are preferable by the management in charge.
In the frame of this schizophrenic approach, in the last period the regions responsible for the budgets of these accredited facilities have started putting the brake in order to:
- 1. insert in the container only patients with evident medical necessity (not for pure relocation);
- 2. put expenditure ceiling to a daily coverage limit (for example for a patient with an orthopedic trauma the period of post-acute treatment decreased from 60 to 25 days).
Clearly this is not enough to economically revive these structures and it is necessary to study in detail the DRG approach that can be sustainable for both patients and region budgets.
In the interest of sustainable development it is not acceptable that a "fake entrepreneur" of a clinic of post-acute care which operates in a falsified market in which does not exist the concept of "retrieval of the patient" and in which business risks are insured by the National Health Service may have the vision of an entrepreneur who operates in the conditions of a free market.
In this period of efficiency of the entire country and fewer resources available it is necessary to resize the whole business of the glorious past and ensure that someone will seriously take care of patients in need.
REALITY
Normally an orthopedic patient of any age who undergoes an intervention of hip or knee prosthesis in a private clinic not accredited with the National Health Service, after 5-8 days period of stay in a hospital keep on practicing an outpatient rehabilitation program at home. Only few complex but statistically insignificant orthopedic pathologies require the presence of the patient in a hospital during the post acute rehabilitation period .
The situation changes when it comes to neurologic diseases. These patients show clear need for the post acute treatment and sometimes there are no structures able to accommodate such kind of patients and satisfy their needs.
The world structures of post acute care are mainly neurologic as far as the patient afflicted by a stroke or a spinal cord injury requires in a specific way the post acute treatment in stabilization stage of a disease and during rehabilitation period because constrained to serious limitations in their life and need a gradual adaptation over time.
In Italy the post acute care facilities are mostly orthopedic.
Top Physio Engineering® is able to design and realize a structure specialized in post acute treatment of only two types of patients that neurological and with complex trauma – so called complex orthopedic cases. Our objective is to realize a structure aimed to satisfy the needs of patients with this type of pathologies, totally private or accredited with the National Health Service but economically sustainable and INDEPENDENT from the public health budget.
Top Physio Engineering ® is able to design and realize a structure oriented to satisfy the needs of real patients, that are fortunately few, but who do not receive the proper treatment due to the present situation.
We offer space to those who really need it.
