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Volume 5 / Issue 4 / April 2013

PM&R - The journal of injury, function, and rehabilitation

Registration Now Open for 2013 AnnualAssembly

Online registration is now open for the 2013 Annual Assem-bly, which is being held October 3-6, 2013, in NationalHarbor, MD. Visit www.aapmr.org to register today.

Plus, register early to reserve your spot for this year’spreconference courses:

● Introduction to Diagnostic and Interventional UltrasoundApplications in Physiatry: October 1-2, 2013

● Coding and Billing Workshop: October 1-2, 2013

The Annual Assembly is the only event each year thatrings together the largest number of PM&R physicians inhe US. This year’s meeting site will enhance that experiencey combining housing, education, and networking eventsnder one roof.

The Gaylord National Hotel is the host hotel for 2013nnual Assembly attendees. The hotel features a spectacular9-story glass atrium that offers sweeping views of the Po-omac River. Attached to the hotel is the convention center,hich will house all of the educational sessions and work-

hops, plenary sessions, poster presentations, Exhibit Hall,nd much more. Attendees don’t even have to go outside toravel from their room to their courses and back.

National Harbor, MD, is a new, waterfront developmenthat spans 350 acres and includes shopping and dining spotsithin easy walking distance from the Gaylord National’s

ront door. There are frequent outdoor events, such as musicnd art events, and of course the waterfront location alsoffers boating.

Interested in seeing Washington, DC, while at the Assem-ly? It is only eight miles away. No rental car is neededecause bus, shuttle, and boat transportation are all availableetween National Harbor, MD, and the nation’s capital. The

ocation also makes travel to this year’s Annual Assemblyasy. Gaylord National is just a 15-minute drive from Reaganational Airport and a 45-minute drive from both Dulles andaltimore Washington International Airports.

Academy Leadership ProgramApplication Deadline Is April 30

The application deadline is quickly approaching for theAcademy Leadership Program—an opportunity to identifyand train future leaders who have limited volunteer experi-ence and immerse them in the culture of volunteerism at the

Academy. AAPM&R members selected to participate in the

program will be taken through a two-year curriculum thatintroduces them to association leadership, strategic planning,media skills, Academy governance, products and services,and volunteer leadership.

For full details and to apply, visit the AAPM&R Web site atwww.aapmr.org, and type “Academy Leadership Program” inthe search box.

Meaningful Use and EHR IncentivePrograms

An Update From AAPM&R

Has your practice started to receive electronic health record(EHR) meaningful use incentive payments? What does thismean for you and your practice?

In late 2012, after some detailed revisions and updates,the final outline of the Centers for Medicare & MedicaidServices (CMS) final rule “Medicare and Medicaid Programs;Electronic Health Record Incentive Program-Stage 2” waspublished in the Federal Register. Both Medicare and Medic-aid have been authorized to provide incentives to eligibleprofessionals, eligible hospitals, and critical access hospitals(CAHs) that demonstrate meaningful use of EHRs.

The definition of meaningful use is using certified EHRtechnology to improve quality, safety, and efficiency; reducehealth disparities; improve care coordination; improve pop-ulation and public health; engage patients and their familiesin their health care needs; and ensure patient privacy andsecurity is maintained.

In 2009, the American Recovery and Reinvestment Actoutlined three basic components of meaningful use:

● Using EHRs in a meaningful manner (eg, through the useof e-prescribing)

● Using EHRs for the electronic exchange of health careinformation to ensure quality and improve safety

● Using EHRs for the reporting of clinical quality measuresor other such measures

In late December 2012, CMS reported that it had paid aecord amount in incentive distributions to eligible profes-ionals, eligible hospitals, and CAHs, including:

● $1 billion in Medicare and Medicaid incentive paymentswere distributed to hospitals.

● $175 million in Medicare incentive payments were distrib-uted to physicians and other eligible professionals.

● $80 million in Medicaid incentive payments were distrib-

uted to physicians and other eligible professionals.

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352 AAPM&R ACADEMY NEWS

Meaningful use is divided into three stages. Fulfillment ofthe requirements of each stage is necessary to access theincentives.

Stage 1, which began in 2011, set the baseline for elec-tronic data capture and information sharing. Demonstratingmeaningful use in stage 1 was achieved by establishing evi-dence of capturing data through a series of “core objectives”and a series of objectives from a secondary list called a “menuof objectives.”

Stage 2, which will begin in fiscal year 2014 for eligiblehospitals and CAHs or calendar year 2014 for eligible profes-sionals, is more involved and has more detailed requirementsfor fulfillment by demonstrating advanced clinical processesand the capability of the certified EHR to allow health infor-mation data exchange. Eligible professionals must meet 17core objectives and three menu objectives that they selectfrom a total list of six, or a total of 20 core objectives. Eligiblehospitals and CAHs must meet 16 core objectives and threemenu objectives that they select from a total list of six, or atotal of 19 core objectives. CMS has also introduced someobligatory objectives for eligible professionals and eligiblehospitals that will have a positive impact on patient care andsafety:

● Eligible professionals must use secure electronic messag-ing to communicate with patients on relevant health infor-mation.

● Eligible hospitals and CAHs must automatically track med-ications from order to administration using assistive tech-nologies in conjunction with an electronic medicationadministration record.

Patient access is also a main focus for stage 2 and isemonstrated by the step that has been taken to remove thexisting stage 1 objectives of providing electronic copies ofealth information or discharge instructions and replacinghem with provisions for timely access to health informationith objectives that allow patients to access their health

nformation online as outlined below:

● Eligible professionals must provide patients the ability toview online, download, and transmit their health informa-tion within four business days of the information beingavailable to the eligible professional.

● Eligible hospitals and CAHs must provide patients theability to view online, download, and transmit their healthinformation within 36 hours after discharge from thehospital.

A great emphasis has also been put on the capability ofhe certified EHR to be able to participate in the exchangef health care information. This has been done to improvehe process of care coordination among providers. Eligiblerofessionals, eligible hospitals, and CAHs will have toemonstrate achievement of a core objective that requires

roviders who transition or refer a patient to another

etting of care or provider of care to provide a summary ofare record for more than 50% of those transitions of carend referrals.

Stage 3, which is slated to start in 2016, is quicklypproaching as well. In this stage, meaningful users willave to demonstrate improved outcomes. Stage 3 preruleomments were sent from AAPM&R to CMS in late Janu-ry 2013.

For additional information about meaningful use, visitww.cms.gov to learn more about the specific requirementseeded to meet each stage and to be able to claim the

ncentives outlined by CMS. Visit the AAPM&R Web sitewww.aapmr.org) and type “performance measures re-ources” in the search box to learn what AAPM&R is doing inegard to EHRs and to read past postings on meaningful usend EHRs.

Physiatrists in Practice: Unique DeliveryModels of Patient Care for the Future

AAPM&R’s Public and Professional Awareness Committee isseeking AAPM&R members who are involved in unique orinnovative health care delivery models who would be willingto share their experience. The information gathered fromthese interviews will document the value and diversity of thespecialty of PM&R. It will help AAPM&R position the spe-cialty within the future of the changing health care environ-ment and emphasize how it meets the Triple Aim. Onceinformation is gathered, it can be used to reach policymakers,consumers, and other stakeholders to describe the value ofthe specialty. As the committee catalogs the different waysAAPM&R members are practicing, it will be shared withAcademy members as a resource for those considering atransition to a new practice model.

This article focuses on a unique practice model practicedby Gregory Worsowicz, MD, MBA.

Q: Can you explain your practice setting?A: I am currently employed by the University of Missouri

in Columbia, MO, and I work in an academic practice thatserves patients at multiple sites. Most of our consultative andoutpatient services are provided at our academic medicalcenter. Our inpatient rehabilitation care is provided at alimited liability company owned by the University of Mis-souri and HealthSouth. We also provide services at a long-term acute care hospital and subacute rehabilitation centerowned by entities other than the university. Providing physi-atric practice and developing a comprehensive postacute careprogram in each of these settings produces some uniquechallenges.

Q: Does the location of where you practice impact carestrategies?

A: Based on our geographic location (Midwest collegetown) and the need to travel to multiple sites with fluctu-

ation in patient volumes and revenue from patient care at

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353PM&R Vol. 5, Iss. 4, 2013

these different centers, physician coverage must be bal-anced. Since we are also somewhat geographically isolatedand many of our patients are followed for years by thesame physician, clinicians can develop large panels ofpatients limiting new patient access. A nurse practitioner(NP) was hired to specifically assist these physicians. Thismodel has increased access to PM&R services as our NP isinvolved in more of the follow-up care. A patient can seeour NP for follow up, and our physicians are seeing morenew patients. This increased access and decreased waittimes for appointments and also has increased patient andreferring physician satisfaction. There has been economicbenefit to this model as our physicians’ time has becomemore efficient.

Q: Can you describe one of your care models? Can it bereproduced?

A: One model is our work to develop an acute andpostacute care network. Guidelines have been developed thattrigger PM&R consultative services to assist with care ofpatients during their acute stay as well as to provide carethroughout their postacute period. Becoming involved ear-lier in patient care has allowed PM&R to be involved acrossthe entire care process (acute and postacute). These processesare allowing our department to lead the system’s postacuterehabilitation programs, and medical directorships are start-ing to be funded to assist with this care management and tocompensate time.

Q: Can this model be easily reproduced by otherphysiatrists?

A: Yes, our current strategy was to pick service linesthat most frequently require our services. Then, we devel-oped strong relationships with these service lines (neuro-sciences/trauma) at the university’s hospital to triggerearly involvement. We have also developed leadershiproles at the different postacute settings. The balance be-tween compensated versus uncompensated time needs tobe monitored.

Q: How has this model impacted patient care, satisfac-tion, outcomes, cost, and time savings?

A: It has allowed our physicians to provide direct care inall acute and postacute settings. Patients, other care provid-ers, and social workers have reported improved satisfactionwith care transitions as patients feel they are not “abandoned”by the system as a service known to them (PM&R) will followthem at their new care setting.

We are also tracking all bounce backs to acute care fromeach care site and through better communication, working toprevent unnecessary care transfers. Since the current andexpected increase in penalties for 30-day readmissions, sys-tems and other providers are becoming more interested in

funding these postacute programs. w

Q: How do you see your model fitting into the patient-centered medical home?

A: The patient-centered medical home is all about caremanagement and access to services when needed. Our pri-mary care providers are now utilizing physiatrists to directthe rehabilitative care and assist with specialized medical careof patients with diagnoses, including spinal cord injury andtraumatic brain injury. Physiatrists should participate in thedecision process about when patients are transferred to dif-ferent levels of postacute rehabilitative care. Many of ourprocesses are starting to utilize the physiatric model of com-bining medical, functional, social, financial, access (geo-graphic), and patient choice as a template for these transi-tions. As models of care continue to develop, we must keepPM&R a critical component of patient care.

If you are involved in a unique practice model, pleaseshare your story with AAPM&R. E-mail pracmod@aapmr.org and an Academy staff member will contact you.

Impact Factor Announcement ComingSoon

Your articles in this publication now have more impact thanever. Articles published in this journal are now being countedtoward PM&R’s impact factor.

In 2012, AAPM&R announced that this publication hasbeen accepted for coverage in the Thomson Reuters abstract-ing and indexing services and is expected to receive its firstimpact factor in June 2013. Abstracting and indexing forPM&R began with Volume 2:2010 in Science Citation IndexExpanded (also known as SciSearch®), Social Sciences Cita-tion Index,® Current Contents®/Clinical Medicine, and Jour-

al Citation Reports/Science Edition.The impact factor measures how many times PM&R arti-

les published in 2010 and 2011 are cited in 2012 relative tohe total number of PM&R citable items published over theame two-year window.

This journal will be ranked in two categories: rehabilita-ion and sports science. This is an incredible accomplishmentor this journal because having an impact factor raises theisibility and stature of PM&R among scientific journals, andt adds to the influence and prestige of this publication.

An impact factor will also help the journal attract moreigh-quality submissions both from US and internationalesearchers.

Additionally, 2013 is a landmark year for AAPM&R. AsAPM&R celebrates its 75th anniversary and this publicationelebrates its fifth year of publication, the impact factornnouncement adds to the excitement and celebration of theear.

Help make this journal the definitive resource for rehabil-tation and sports science. Submit your research to PM&R at

ww.ees.elsevier.com/pmrjournal.