THE ROLE OF THE REHABILITATION PHYSICIAN IN THE POSTACUTE CONTINUUM

Compared to just 10 years ago, the US health care terrain looks much d ifferent today. In 1985, hospitals were the hub of a bustling delivery system that focused on acute care services and undervalued primary or preventive care. Health insurance benefits created incentives for con sumers to use hospitals where their care was fully reimbursed, and dis couraged office visits for which there were hefty copayments. Today, a dmissions into acute care hospitals are screened by none other than th ose same primary care physicians. These gatekeepers often have more au thority over patient services and referrals than do the specialists an d the hospitals. Financial incentives have made a 180 degrees shift, n ow motivating consumers to use outpatient care and office visits to sa tisfy the majority of their health care needs. Moreover, there are cur rently health care providers actively delivering a wide range of treat ments and services that were not available or ''covered'' a decade ago . The migration of treatment out of hospitals into the vast frontier o f postacute care has revolutionized our thinking about how patients re ceive treatment, in what locations, and by whom. This article describe s the trends in financing and in clinical innovation that have contrib uted to the expansion of postacute alternatives. The factors that most clearly contribute to new opportunities facing rehabilitation physici ans in postacute care are discussed, as are the added competencies req uired of those who choose to take a leadership role in the postacute d elivery system. A case study of one model ''managed care system'' wher e the rehabilitation specialists are driving the care is presented. Th e future for rehabilitation specialists who are positioned to particip ate in setting the standards for high-quality postacute and chronic ca re in a future marketplace dominated by managed care is discussed. (C) 1995 by the American Congress of Rehabilitation Medicine