Although efforts to create more coordinated care systems may be making a small impact, as late as 2010 expenditures on health care in the United States were skewed toward the "super utilizer" patients—the 1% of patients who consume 21% of money spent on health care.
According to a recent story from the Kaiser Health Network, the lopsided expenditure rates are related to the prevalence of emergency room use by patients, often with multiple problems, who are unable to steer through a complex and often fragmented health care delivery system. Conditions that could be effectively treated in outpatient settings are often addressed in hospitals, and follow-up compliance can be hit-or-miss, the story indicates.
The problem has been well-documented, most recently in a report from the federal Agency for Healthcare Research and Quality, and is addressed to some extent by provisions in the Affordable Care Act (ACA) that penalize hospitals that readmit certain Medicare recipients in fewer than 30 days. Attempts to create more coordinated systems that use case managers to help individual patients understand their care are making an impact, according to Kaiser, but the scope of these efforts are limited.
Physical therapists (PTs)—particularly those who work in emergency departments--often have the opportunity to collaborate on the coordination of care for patients with conditions that affect neuromusculoskeletal, cardiovascular/pulmonary and integumentary systems, as well as provide follow-up care. Information about this expanding area of practice is available at APTA's Physical Therapist Practice in the Emergency Department webpage, which includes a toolkit designed to help PTs incorporate PT practice in an emergency department.
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