Pages connexes

Chaque pays est confronté à la nécessité de différentier les activités de soins selon les besoins à chaque étape de la chaîne de soins tout en favorisant l’intégration des parcours de soins, centrée sur le résultat pour le patient.
Le « potentiel de réadaptation » est une des clés de l’identification des besoins par profils de patients, des programmes de soins et des ressources qu’ils requièrent , quel que soit le mode de financement choisi.
Dans un contexte de réduction des ressources, l’optimisation de la qualité et de l’efficience des soins supposent une stratégie nationale de réadaptation en vue de l’organisation et le financement d’un dispositif de réadaptation accessible et solidaire, en lien avec les politiques du handicap. Selon les organisations internationales, c’est une des conditions essentielles du respect des droits des personnes présentant ou susceptibles de présenter un handicap.
 
Une excellente synthèse pédagogique sur les paiements en post-aigu et la construction des classifications à visée tarifaire
 
 
 

Europe

Présentations / Articles

Modèles internationaux

Relation d’agence d’après Marie Houssel

La réadaptation en Europe

Belgique : le rapport du centre fédéral d’expertise (2007)

Australie : le système AN-SNAP

Grande Bretagne

Travaux de Turner-Stokes et coll.

Politics, policy and payment – Facilitators or barriers to person-centred rehabilitation? Disability and Rehabilitation 29(20-21):1575-82 · October 2007
 
 
 

Cost-efficiency of specialist hyperacute in-patient rehabilitation services for medically unstable patients with complex rehabilitation needs: a prospective cohort analysis BMJ Open 2016;6:e012112 doi:10.1136/bmjopen-2016-012112

 
 

Engaging the hearts and minds of clinicians in outcome measurement – the UK rehabilitation outcomes collaborative approach Turner Stokes et al.

Disability & Rehabilitation, 2012; 34(22-23): 1871–1879
 
 

Healthcare resource groups

 

Autres documents saillants

 
A Position Paper on Physical & Rehabilitation Medicine Programmes in Post-Acute Settings Union of European Medical Specialists Section of Physical & Rehabilitation Medicine (in conjunction with the European Society of Physical & Rehabilitation Medicine) Anthony B. Ward, BSc, FRCPEd, FRCP, Christoph Gutenbrunner, MD, PhD, Alessandro Giustini, MD, Alain Delarque, MD, Veronika Fialka-Moser, MD, PhD, Carlotte Kiekens, MD, PhD, Mihai Berteanu, MD, PhD and Nicolas Christodoulou, MD, PhD Casemix for inpatient care of elderly people: rehabilitation and post-acute care.
 
Payment by results or payment by outcome? The history of measuring medicine JOURNAL OF THE ROYAL SOCIETY OF MEDICINE Volume 99 May 2006
 

Medical rehabilitation in 2011 and beyond – Report of a joint working party of the Royal College of Physicians and the British Society of Rehabilitation Medicine November 2010 BSRM Standards for Rehabilitation Services Mapped on to the National Service Framework for Long-Term Conditions  Britih society of rehabilitation medicine (position papers, core standards and guidelines)


 

Canada

 

Just regionalisation: rehabilitating care for people with disabilities and chronic illnesses Barbara Secker*1,2, Maya J Goldenberg1,3, Barbara E Gibson1,4, Frank Wagner1,5, Bob Parke1,6, Jonathan Breslin1,7, Alison Thompson1,8, Jonathan R Lear1 and Peter A Singer1

 

Méthodologie de regroupement des patients en réadaptation – Rehabilitation Patient Group (RPG) Grouping Methodology and Weights National Rehabilitation Reporting System: Case Mix Rehabilitation Patient Group Resource Materials and Frequently Asked Questions, 2013–2014 

Méthodologie de regroupement GPR et pondérations des coûts en réadaptation
 
Système national d’information sur la réadaptation
 

L’outil de recueil: métadonnées de la Système national d’information sur la réadaptation (SNIR) (fiche d’admission, de sortie et de suivi)

National Rehabilitation Reporting System (NRS) Metadata

http://www.cihi.ca/cihi-ext-portal/internet/en/document/types+of+care/hospital+care/rehabilitation/nrs_metadata

 
Les groupes clients

« Les gestionnaires des soins de santé, cliniciens et autres professionnels de la santé au Canada doivent relever un défi de plus en plus difficile : réduire les coûts tout en maintenant ou améliorant la qualité et l’accès aux soins. Dans un tel contexte, l’information que les décideurs utilisent pour gérer les établissements de santé et les régies régionales est plus importante que jamais. Nous avons donc pris l’initiative d’élaborer et de mettre en œuvre des méthodologies de regroupement des clients. Celles-ci classent les patients dans des groupes homogènes sur les plans statistique et clinique selon les données cliniques et administratives recueillies. Il faut comprendre les différents besoins des patients et clients avant de pouvoir comparer les organismes de santé et l’utilisation des ressources en fonction des groupes clients. »

 
Michel Coulmont, Chantal Roy, Patrick Fougeyrollas
 
 
 
Examen du rôle potentiel des incitations financières dans le financement des services de santé au Canada. Décembre 2012
 
Exploration de l’enjeu des niveaux de soins alternatifs (NSA) et le rôle des politiques de financement : un fondement probant qui évolue pour le Canada
http://www.fcass-cfhi.ca/Libraries/Commissioned_Research_Reports/0666-SUTHERLAND-FR.sflb.ashx

 

La réorganisation des services posthospitaliers de convalescence et de réadaptation

 
CLINICAL AND ADMINISTRATIVE OUTCOMES DURING  PUBLICLY-FUNDED INPATIENT STROKE REHABILITATION BASED ON A CASE-MIX GROUP CLASSIFICATION MODEL Dany Gagnon, Sylvie Nadeau and Vincent Tam http://www.medicaljournals.se/jrm/content/download.php?doi=10.1080/16501970410015055
 
Mettre en lien avec l’article français suivant (avant mise en place du PMSI-SSR)
Développement d’un système de classification de type case mix pour les SSR et la réadaptation et  et évaluation de la qualité des soins. 1997
 
CONTRÔLE BUDGÉTAIRE DES ÉTABLISSEMENTS DE RÉADAPTATION BASÉ SUR UN SYSTÈME DE CLASSIFICATION : UNE EXPÉRIMENTATION CHEZ LES PERSONNES ÂGÉES RÉFÉRÉES EN DÉFICIENCE VISUELLE http://hal.archives-ouvertes.fr/docs/00/52/24/98/PDF/p16.pdf
 
Modèle de détermination du coût de revient des (usagers) patients référés dans un programme de réadaptation en déficiences physiques

A conceptual framework for the analysis of health care organizations’ performance. Sicotte C, Champagne F, Contandriopoulos AP, Barnsley J, Béland F, Leggat SG, Denis JL, Bilodeau H, Langley A, Brémond M, Baker GR. Health system performance http://www.cihi.ca/CIHI-ext-portal/internet/en/document/health+system+performance/indicators/health/indic_def_health_system_12

 
 

Suisse

 
Projet PRG 

Vaud-Genève Financement des  hospitalisations en Psychiatrie en Réadaptation en Gériatrie. Juillet 2008. Rapport final

Rapport sur les modalités de financement envisageables pour les centres de traitement et de réadaptation (CTR) vaudois, (voir dans ces documents les comparaisons internationales +++)
sur la base d’un travail de recherche de M. Nicolas Jeanprêtre. analyse du PMSI SSR français page 25 à 27
 

QUELS GROUPES DE PATIENTS POUR FINANCER LA READAPTATION ? 

La démarche des Centres de Traitements et de Réadaptation Vaudois. Eliane Deschamps, Estelle Martin, Jean-François Nicolet http://www.labelctr.ch/fichiers/article_epistula_02-05.pdf
 

Plan de mesure Réadaptation – 2011 (Association nationale pour le développement de qualité dans les hôpitaux et les cliniques)

 
Diaporama ALASS septembre 2004: Cliquer ici
 
Nomenclatures et classifications, spécificité du financement pour les patients en soins subaigus – André Assimacopoulos, HUG – Javier Blanco, Zürcher Höhenklinik Wald – Eliane Deschamps, CHUV – Pierre Metral, ATIH Lyon – Blaise Meyer, FHV http://www.isesuisse.ch/fr/conferences/conf_0805_pcs-tutorial-assimacopoulos-f-22.pdf
 
La démarche des Centres de Traitements et de Réadaptation ( Vaud – Suisse
 
Financement de la réadaptation: quelle classification pour les patients?

 

Allemagne

Réadaptation médicale: situation Situation et avenir du financement en Allemagne http://www.isesuisse.ch/fr/conferences/conf_0805_pcs-neubauer-f-23.pdf


Italie

Toward a new payment system for inpatient rehabilitation. Part I: Predicting resource consumption.
 
 

USA

Préambule: Aux USA, après les soins aigus, les malades peuvent être orientés : 1. vers la réadaptation (Inpatient Rehabilitation Facilities), 2. les soins subaigus (Skilled Nursing Facilities), 3. les services de soins au domicile (Home Health Care Agency)3et 4. les soins de longue durée (Long Term Care Hospitalization)
 
 
 
 Payments basics (MEDPAC) Home health care services payment system 10/14/2016 Document Type: Payment Basics Hospice services payment system 10/14/2016 Document Type: Payment Basics Inpatient rehabilitation facilities payment system 10/14/2016 Document Type: Payment Basics Long-term care hospitals payment system 10/14/2016 Document Type: Payment Basics Skilled nursing facility services payment system 10/14/2016 Document Type: Payment Basics Une réforme des soins post-aigus est en cours vers un système uniforme de données et de paiement.Post-Acute Quality Initiatives: The Continuity Assessment Record and Evaluation (CARE) Item SetIRF – PAI (Inpatient Rehabilitation Facilities)MDS 3.0 (Skilled Nursing Facilities, …)Aux USA outils de recueil et de tarification sont différents selon le type de soins post-aigus
 
 
 
 
 
 
 
 
 
 Schéma des parcours de soins aux USA
Final Report. Cheryl l. Damberg, Melony E. Sorbero, Peter S. Hussey, Susan Lovejoy, hangsheng liu, and ateev mehrotra
February 2009 – Assistant Secretary for Planning and Evaluation U.S. Department of Health and Human Services
 
 
Sélection d’articles
 
 
Quality and Outcome Measures for Rehabilitation Programs. Author: Carl V Granger, MD; Chief Editor: Rene Cailliet, MD  (télécharger en pdf

Imprimer l’ensemble du document: cliquer sur imprimer et sur « print the entire content »
 

« Currently, the third-party payer is exerting a force on how services are rendered and on the types of outcomes that can be expected. Thus, it is incumbent upon the clinician to balance the benefit of treatment with its cost, while taking into account perceptions of the value of the treatment from the viewpoint of the payer, patient, family, and community »  » UDSMR applies scientific research to the process of assessment of outcomes. The goal is to improve patient care and function by (1) identifying the patterns of disability and recovery and (2) providing appropriate and timely feedback to clinicians so they can promote effective and efficient care for the patient. » … « The more we study function in a systematic fashion, the more it is evident that function transcends everything. As we function, so shall we live. » Carl V Granger  Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2014

U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services (CMS) Report to Congress: Post Acute Care Payment Reform Demonstration (PAC-PRD) January 2012 http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Reports/downloads/Flood_PACPRD_RTC_CMS_Report_Jan_2012.pdf Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment – Final Report. Février 2009 http://aspe.hhs.gov/health/reports/09/mcperform/report.shtml Post-Acute Care Episodes Expanded Analytic File – Final Report – April 2011 – Prepared for: Susan Bogasky Assistant Secretary for Planning and Evaluation (ASPE) U.S. Department of Health and Human Services Hubert H. Humphrey Building, Room 443F5 200 Independence Avenue, SW Washington, DC 20201 http://aspe.hhs.gov/health/reports/2011/PACexpanded/index.shtml Top 10 Parameters for Determining a Post-acute Care Strategy http://www.thecamdengroup.com/thought-leadership/blog/top-10-parameters-for-determining-a-post-acute-care-strategy/ Post-Acute Care of the Elderly Patient Rehabilitation and Transitions of care http://www.docstoc.com/docs/62291502/Post-Acute-Care-of-the-Elderly-Patient-Rehabilitation-and Rationale and principles of early rehabilitation care after an acute injury or illness GEROLD STUCKI1,2, MARITA STIER-JARMER , EVA GRILL , & JOHN MELVIN Department of Physical Medicine and Rehabilitation, Ludwig-Maximilians-University, Munich, Germany, ICF Research Branch of the WHO FIC Collaborating Center (DIMDI), IMBK, Ludwig-Maximilians-University, Munich, Germany, and Department of Rehabilitation Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, USA http://knowledgetranslation.ca/sysrev/articles/project51/Stucki2005.pdf A conceptual framework for the OECD Health Care Quality Indicators Project. Onyebuchi A. Arah 1 , 2 , Gert P. Westert 2 , 3 , Jeremy Hurst 4 and Niek S. Klazinga 1 http://intqhc.oxfordjournals.org/content/18/suppl_1/5.full Post-Acute and Long-Term Care Reform / Estimating the Federal Budgetary Effects of the AHCA/NCAL/Alliance Proposal http://www.ahcancal.org/research_data/funding/Documents/Post%20Acute%20and%20Long%20Term%20Care%20Reform.pdf Long-Term and Post-Acute Care Financing Reform Proposalhttp://www.ahcancal.org/advocacy/Documents/FinancingReformProposal.pdf http://www.docstoc.com/docs/49810609/Summary-of-Issues-Affecting-Post-Acute-and-Long-Term La faillite sanitaire des Etats Unis – Bertrand Kiefer au sujet du rapport: U.S. Health in International Perspective: Shorter Lives, Poorer Health http://www.nap.edu/openbook.php?record_id=13497&page=1 Le rapport: http://obssr.od.nih.gov/pdf/IOM%20Report.pdf Effectiveness of case management and post-acute services in older people after hospital discharge. Wen K Lim, Sue F Lambert and Len C Gray. Med J Aust 2003; 178 (6): 262-266. Cherilyn G Murer: A Patient-Centered Vision for Post-Acute Care Reform http://murer.com/pdfs/articles/vision4post-acutecarereform-mar07.pdf

 
 
 
 Payments basics (MEDPAC) Home health care services payment system 10/14/2016 Document Type: Payment Basics Hospice services payment system 10/14/2016 Document Type: Payment Basics Inpatient rehabilitation facilities payment system 10/14/2016 Document Type: Payment Basics Long-term care hospitals payment system 10/14/2016 Document Type: Payment Basics Skilled nursing facility services payment system 10/14/2016 Document Type: Payment Basics Une réforme des soins post-aigus est en cours vers un système uniforme de données et de paiement.Post-Acute Quality Initiatives: The Continuity Assessment Record and Evaluation (CARE) Item SetIRF – PAI (Inpatient Rehabilitation Facilities)MDS 3.0 (Skilled Nursing Facilities, …)Aux USA outils de recueil et de tarification sont différents selon le type de soins post-aigus

Extrait d’un texte de Carl Granger: « Like acute medical management, functional restoration requires intensive rehabilitation that is costly but time-limited and episodic. In contrast, long-term care requires an ongoing but lower daily investment of therapy and care-giving services. Among those with the capacity for functional restoration, an episodic payment approach such as an FRG-based PPS would tend to encourage timely discharge from the SNF to the community. In contrast, a per diem rate adjusted for severity of disability may provide financial incentives to maintain residents in their most dependent state. Although a unified payment system has appeal, its development presents challenges. One approach might combine elements of an episode-based system for short-term restorative-level rehabilitation patients within a larger per diem-based scheme. »

Une mise au point sur l’histoire du paiement prospectif en réadaptation (MDS-PAC vs. FIM): Deciphering the details: an update of implementing PPS for inpatient rehabilitation facilities – Cherilyn G. Murer http://www.murer.com/files/uploads/docs/decipheringthedetails.pdf Comprendre les FIM-FRG – Function-related Group Classification and Case-mix Adjustment (Carl Granger et al.) http://emedicine.medscape.com/article/317865-overview#aw2aab6b6

Inpatient rehabilitation facility services: Report to the congress: Medicare paiment Policy; March 2010 http://www.rehabnurse.org/pdf/mpinpatient1003.pdf
Une présentation suisse de la réadaptation aux USA et du système de paiement prospectif (2003) An introduction to rehabilitation in the USA – Financement de la réadaption: Quelles classification des patients? Forum Poste Macolin, 4.12.2003 Yves Delcourte, Marketing Manager HIS products, Europe Une discussion: Dispelling the myth – It costs more for care in an IRF http://www.mediserve.com/blog/inpatient-rehab/dispelling-the-myth-it-costs-more-for-care-in-an-irf/

 
 

Paiement prospectif en soins post-aigu aux USA Les PPS à l’activité (« fee-for-service ») ont été mis progressivement en place, en 1998 pour les Skill Nurse Facilities (SNF) et 2002 pour les Inpatient Rehabilitation Facilities (IRF) l’ordre chronologique des articles retrace l’histoire de leur mise en oeuvre et des débats associés. 1994 – A case-mix classification system for medical rehabilitation, 1994, vol. 32, n° 4. – p. 366-379 Auteur(s) : Stineman, Margaret G. ; Escarce, J.J. ; Goin, J.E. ; Hamilton, B.B. ; Granger, C.V. ; Williams, S.V. Résumé : Dissatisfaction with Medicare’s current system of paying for rehabilitation care has led to proposals for a rehabilitation prospective payment system, but first a classification system for rehabilitation patients must be created. Data for 36,980 patients admitted to and discharged from 125 rehabilitation facilities between January 1, 1990, and April 19, 1991, were provided by the Uniform Data System for Medical Rehabilitation. Classification rules were formed using clinical judgment and a recursive partitioning algorithm. The Functional Independence Measure version of the Function Related Groups (FIM-FRGs) uses four predictor variables: diagnosis leading to disability, admission scores for motor and cognitive functional status subscales as measured by the Functional Independence Measure, and patient age. The system contains 53 FRGs and explains 31.3% of the variance in the natural logarithm length of stay for patients in a validation sample. The FIM-FRG classification system is conceptually simple and stable when tested on a validation sample. The classification system contains a manageable number of groups, and may represent a solution to the problem of classifying medical rehabilitation patients for payment, facility planning, and research on the outcomes, quality, and cost of rehabilitation. Voici une réflexion de Carl Granger en 1997 avant la mise en place des PPS en soins post-aigus, bien connu pour la Mesure de l’Indépendance Fonctionnelle, moins connu pour ses écrits sur les systèmes de tarification. Cela semble bien répondre à notre problématique française des programmes de réadaptation intensive et multidiciplinaire. 1997 – A modular case-mix classification system for medical rehabilitation illustrated – Innovations in Fee-For-Service Financing and Delivery  by Margaret G. Stineman, Carl V. Granger http://findarticles.com/p/articles/mi_m0795/is_n1_v19/ai_20750871/?tag=mantle_skin;content

 
 

 
 
Conclusion: « There is some overlap in the types of patients treated by inpatient rehabilitation facilities and SNFs (Kramer et al., 1997). One option in dealing with that overlap would be to determine the feasibility of modifying FRGs to include all patients receiving restorative-level rehabilitation within the full postacute continuum, regardless of setting. Such an approach to quality monitoring and payment could enhance continuity of care and discourage unnecessary shifts of patients across settings. All patients admitted to distinct-part units and rehabilitation hospitals would receive level-one rehabilitation, which, by definition, is high-intensity and restorative. In SNFs where service intensity varies and the clinical attributes and needs of populations are more heterogeneous, the overwhelming challenge would be distinguishing persons prospectively who have the potential for restorative rehabilitation from the larger group of nursing home residents who need either long-term care or a short convalescence. Like acute medical management, functional restoration requires intensive rehabilitation that is costly but time-limited and episodic. In contrast, long-term care requires an ongoing but lower daily investment of therapy and care-giving services. Among those with the capacity for functional restoration, an episodic payment approach such as an FRG-based PPS would tend to encourage timely discharge from the SNF to the community. In contrast, a per diem rate adjusted for severity of disability may provide financial incentives to maintain residents in their most dependent state. Although a unified payment system has appeal, its development presents challenges. One approach might combine elements of an episode-based system for short-term restorative-level rehabilitation patients within a larger per diem-based scheme. »
 

1997 – Testimony on Rehabilitation & Long-Term Care Hospital Payments by Barbara Wynn Acting Director, Bureau of Policy Development Health Care Financing Administration U.S. Department of Health and Human Services  http://www.hhs.gov/asl/testify/t970410b.html 1997 Medicare reimbursement system encourages increased payments to rehabilitation hospital http://www.washington.edu/news/archive/id/2957

1999 – National Health Policy Forum. Implementing the BBA: The Challenge of Moving Medicare Post-Acute Services to PPS.  (Cet article décrit le débat FIM-FRG vs. RUG qui a eu lieu au moment de la mise en place des PPS en post-aigu)
http://www.nhpf.org/library/issue-briefs/IB743_BBA_7-7-99.pdf 1999 – Medicare PPS for Rehab Functional Related Groups using the MDS-PAC http://www.tbims.org/combi/outcome2.pdf 2001 – Prospective payment for post-acute care: current issues and long-term agenda http://www.medpac.gov/publications/congressional_reports/Mar01%20Ch6.pdf 2001 – Practice issues: Prospective payment for inpatient rehabilitation is coming!  http://findarticles.com/p/articles/mi_qa3959/is_200103/ai_n8941012/ 2004 – Prospective payment for inpatient rehabilitation under Medicare: an examination of some critical issues. http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102215585.html 2004 Trends in Length of Stay, Living Setting, Functional Outcome, and Mortality Following Medical Rehabilitation (en fulltext) Kenneth J. Ottenbacher, PhD, OTR; Pam M. Smith, DNS, RN; Sandra B. Illig, MS, RN; Richard T. Linn, PhD; Glenn V. Ostir, PhD; Carl V. Granger, MD JAMA. 2004;292:1687-1695. http://jama.ama-assn.org/cgi/content/full/292/14/1687 2005 – Effects of Payment Changes on Trends in Access to Post-Acute Care http://www.rand.org/pubs/technical_reports/TR259.html – Abstract

2006 – Changes in the Use of Postacute Care during the Initial Medicare Payment Reforms Does It Matter? Wen-Chieh LinRobert L KaneDavid R MehrRichard W Madsen, and Gregory F Petroski

2006 – Changes in the Use of Postacute Care during the Initial Medicare Payment Reforms – Does It Matter? Health Serv Res. 2006 August; 41(4 Pt 1): 1338–1356.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1797075/ 2006 – Medicare Payment Issues Affecting Inpatient Rehabilitation Facilities (IRFs) Updated January 24, 2006 http://www.policyarchive.org/handle/10207/bitstreams/2254.pdf 2006 – DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for FY 2006 (De la MIF à la MIF modifiée: vers le MDS-PAC – Minimum Data Set – Post-Acute-Care) http://www.cms.gov/InpatientRehabFacPPS/downlads/cms1290p-display.pdf « The CMGs (case-mix groups) are based on the FIM-FRG methodology and reflect refinements to that methodology. »… « We modified the motor measure by removing the transfer to tub/shower item because we found that an increase in a patient’s ability to perform functional tasks with less assistance for this item was associated with an increase in cost, whereas an increase in other functional items decreased costs. We describe below the statistical methodology (Classification and Regression Trees (CART)) that we used to incorporate a patient’s functional status measures (modified motor score and cognitive score) and age into the construction of the CMGs in the August 7, 2001 final rule »

2007 – Proposals for Improved Payment Systems http://www.nrhi.org/proposals.html 2007 – The State-of-the-Science: Challenges in Designing Postacute Care Payment Policy http://www.sciencedirect.com/science/article/pii/S0003999307004455 2007 The impact of the inpatient rehabilitation facility prospective payment system on stroke program outcomes.Am J Phys Med Rehabil. 2007 May;86(5):356-63. Gillen R, Tennen H, McKee T. « Patients admitted after implementation of the IRF PPS had shorter LOS but made less progress, had lower functional levels at discharge, and had higher rates of institutional discharge. » 2008 – Rehabilitation facilities (Inpatient) payment system (Description du système de paiement pour les structures de réadaptation intensives – IRF – aux USA) http://www.medpac.gov/documents/MedPAC_Payment_Basics_08_IRF.pdf 2008 – Early Effects of the Prospective Payment System on Inpatient Rehabilitation Hospital Performance. Michael J. McCue, DBA, Jon M. Thompson, PhD http://www.archives-pmr.org/article/S0003-9993(05)01380-8/abstract 2008 Medicare’s new restrictions on rehabilitation admissions: impact on the elderly. (Cet article décrit les effets de la règle des 60%) http://journals.lww.com/ajpmr/pages/articleviewer.aspx?year=2008&issue=11000&article=00002&type=abstract http://linkinghub.elsevier.com/retrieve/pii/S0003999397904299 2008 – A Patient-Centered Vision for Post-Acute Care ReformBy: Cherilyn G. Murer, JD, CRA (cet article évoque les problèmes liés à la fragmentation des financements et à l’intégration des continuums de soins. Un système uniforme d’évaluation dans tout le secteur post-aigu est préconisé pour le CMS – Center for Medicare & Medicaid services, dans le PAC-PRD – Post-Acute Care Payment Reform Demonstration)
 

2009 – The End of Fee-for-Service Medicine? Proposals for Payment Reform in Massachusetts NEJM | July 29, 2009 | Topics: Cost of Health Care, Medicare and Medicaid http://healthpolicyandreform.nejm.org/?p=1247

 
2009 – Post-acute care bundling plans – Cherilyn G. Murer
(Cet article évoque les bundle à l’étude entre court séjour et psot-aigu et les propositions de l’AAPM&R)

http://murer.com/pdfs/articles/PostAcuteCareBundlingPlan-July09.pdf 2009 – Inpatient rehabilitation facilities under the prospective payment system: lessons learned. Zorovitz RD. Eur J Phys Rehabil Med. 2009 Jun;45(2):259-63.

 
2010 – Competition, Prospective Payment, and Outcomes in Post-Acute Care Markets – Slide Presentation from the AHRQ 2010 Annual Conference
2011 – Post Acute Care Episodes expanded analytic file. US Department of Health and Human services. Avril 2011
 
Juin 2011 – Quality and Outcome Measures for Rehabilitation Programs. Author: Carl V Granger, MD; Chief Editor: Rene Cailliet, MD http://emedicine.medscape.com/article/317865-overview
 
Voir le site du NRHI: http://www.nrhi.org/
Propositions pour améliorer les systèmes de paiement http://www.nrhi.org/proposals.html
Creating payment systems to accelerate value-driven health care: issues and options for policy reform Harold D. Miller PittsburghRegional Health Initiative September 2007 – Le rapport en pdf: Cliquer ici
(ce rapport passe en revue les défaillances des systèmes de paiement à l’activité dans, l’accessibilité, la qualité et la continuité des soins)

http://www.commonwealthfund.org/Publications/Fund-Reports/2007/Sep/Creating-Payment-Systems-to-Accelerate-Value-Driven-Health-Care–Issues-and-Options-for-Policy-Refor.aspx

Change in inpatient rehabilitation admissions for individuals with traumatic brain injury after implementation of the medicare inpatient rehabilitation facility prospective payment system. http://www.ncbi.nlm.nih.gov/pubmed/22840827#

 
 

Autres documents étrangers

Réformes du système de santé, intégration verticale, substituabilité et buffer management en soins post-aigus

USA – Pays Bas – France: effets des paiements prospectifs, intégration verticale, substituabilité des orientations, résultats cliniques…

Shorter Length of Stay Is Associated With Worse Functional Outcomes for Medicare Beneficiaries With Stroke Suzanne R. O’BrienYing XueGail Ingersoll and Adam Kelly – Physical Therapy December 2013 vol. 93;no. 12 1592-1602 2004 Trends in Length of Stay, Living Setting, Functional Outcome, and Mortality Following Medical Rehabilitation (en fulltext) Kenneth J. Ottenbacher, PhD, OTR; Pam M. Smith, DNS, RN; Sandra B. Illig, MS, RN; Richard T. Linn, PhD; Glenn V. Ostir, PhD; Carl V. Granger, MD JAMA. 2004;292:1687-1695. 2005 Effects of Payment Changes on Trends in Access to Post-Acute Care – Abstract – Site Melinda Beeuwkes Buntin, José J. Escarce, Carrie Hoverman, Susan M. Paddock, Mark Totten, Barbara O. WynnSupported by the Centers for Medicare and Medicaid2006 Changes in the Use of Postacute Care during the Initial Medicare Payment Reforms  Does It Matter?  – Autre lien Wen-Chieh Lin, Robert L Kane, David R Mehr, Richard W Madsen, and Gregory F Petroski –  HSR: Health Services Research 41:4, Part I (August 2006) « The shift in usage among settings occurred in two stages that corresponded to the timing of payment reforms for home health agencies and SNFs. Evidence strongly suggests the substitutability between PAC settings. Financial incentives, in addition to clinical needs and individual preferences, play a major role in PAC use. » Voir SUBSTITUTABILITY ACROSS INSTITUTIONAL POST-ACUTE CARE SETTINGS: 1998-2006 (US department of Health & Human Services) 2008 – Medicare’s new restrictions on rehabilitation admissions: impact on the elderly. Segal M, Pedersen AL, Freeman K, Fast A: Medicare’s new restrictions on rehabilitation admissions. Am J Phys Med Rehabil 2008;87:872-882. Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10467, USA.

 
 
 

https://www.ache.org/chapters/downloads/chapter_education/materials_template79B.pdf

 


Bundled payments ou paiements à l’épisode de soins

Introduction: qu’est que le paiement au parcours? Extrait de « 

Maximizing the value of post-acute care » – Cliquer ici (traduction de « What is payment bundling?« )

http://www.aha.org/research/reports/tw/10nov-tw-postacute.pdf

Définition: Bundled payments (wiki)
 
 

Bundling et soins post-aigus

Le paiement « au parcours » (bundled payments) et ses conséquences possibles sur les soins post-aigus

Post-acute care and vertical integration after the Patient Protection and Affordable Care Act.

 

« Obamacare »: Effets potentiels sur la MPR aux USA

Patient Protection and Affordable Care Act: An Overview &Potential Effects on PM & R

 
Position de l’American Academy of PM&R à propos du paiement par épisodes (page 4: questions clés)
 
Bundling Post-Acute Care Services into MS-DRG Payments
 
Bundling Acute and Postacute Payment: From a Culture of Compliance to a Culture of Innovation and Best Practice – Gerben DeJong 

 
Post-acute care bundling plans – Cherilyn G. Murer (Cet article évoque les bundle à l’étude entre court séjour et psot-aigu et les propositions de l’AAPM&R)
 
2011 – Post Acute Care Episodes expanded analytic file. US Department of Health and Human services. Avril 2011
 
Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Février 2009 (voir schéma des parcours de soins)

Final Report. Cheryl l. Damberg, Melony E. Sorbero, Peter S. Hussey, Susan Lovejoy, hangsheng liu, and ateev mehrotra
February 2009 – Assistant Secretary for Planning and Evaluation U.S. Department of Health and Human Services
 

Bundling Acute and Postacute Payment: From a Culture of Compliance to a Culture of Innovation and Best Practice

http://ptjournal.apta.org/content/90/5/658.full (Gerben Dejong) Bundled Payments for Care Improvement (BPCI) Initiative: General Information

 
Bundled payments & muskuloskeletal Rehab

http://blog.forcetherapeutics.com/?p=746

The 4 Models of Bundled Payments:
 

Model 1: Hospital services provided to a beneficiary during an acute inpatient stay, where physicians are partners in improving care Model 2: Hospital, physician, post-acute provider, and other Medicare-covered services provided during the inpatient stay as well as during recovery after discharge to the home or another care setting Model 3: Hospital, physician, post-acute provider, and other Medicare-covered services beginning with the initiation of post-acute care services after discharge from an acute inpatient stay Model 4: CMS would make a single, prospectively determined bundled payment to the hospital that would encompass all services furnished during the inpatient stay by the hospital, physicians and other practitioners. Physicians and other practitioners would submit “no-pay” claims to Medicare and would be paid by the hospital out of the bundled payment (2)

Bundled payments – paiments regroupés

Episode based payments. 2009
 
Moving Towards Bundled Payment. American Hospital association. Quelques questions clés à se poser
 
 
Modèles de bundled payments: accountable care organizations (ACO)
 
Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Février 2009 (voir schéma des parcours de soins)

Final Report. Cheryl l. Damberg, Melony E. Sorbero, Peter S. Hussey, Susan Lovejoy, hangsheng liu, and ateev mehrotra
February 2009 – Assistant Secretary for Planning and Evaluation U.S. Department of Health and Human Services
 
 
Accountable care organizations
« En examinant l’efficacité de toute méthode de paiement, il faut garder à l’esprit que le paiement, la structure organisationnelle et les systèmes  par lesquels les soins de santé  sont  délivrés et mesurés sont liés. (Voir le tableau 1 ci-dessous.) Pour qu’une organisation de soins responsable (ACO: accountable care organization) soit responsable de la maîtrise des coûts dans l’ensemble du continuum de soins (soins primaires, soins actifs et hospitalisations pour soins post-aigus, gestion des soins de longue durée), les incitations doivent être mises en place au chaque point de ce continuum. »
 

Geisinger Health System

Geisinger Health System Geisinger Health Systems: What Are The Gas Drilling Health Facts? For This Health System, Less Is More Le secteur hospitalier : vers quelle(s) réforme(s) ? Groupe Hippocrate: club parlementaire d’économie de la santé http://www.ces-asso.org/sites/default/files/FICHE7.pdf
La nouvelle doxa (plus ça change plus c’est pareil…): « Deux grandes thématiques peuvent structurer la prospective en matière de réformes de la tarification hospitalière : la prise en compte des indicateurs de qualité pour le financement des établissements d’une part, la poursuite des réflexions sur l’apport des systèmes de type  » episode-based  » d’autre part. » Opportunities and Challenges for Episode-Based Payment Robert E. Mechanic, M.B.A.N Engl J Med 2011; 365:777-779 September 1, 2011 http://www.nejm.org/doi/full/10.1056/NEJMp1105963 Bundled payments http://en.wikipedia.org/wiki/Bundled_payment Transitioning to Episode-Based Payment http://www.chqpr.org/downloads/TransitioningtoEpisodes.pdf SUMMARY: EPISODE-BASED PAYMENT http://www.massmed.org/AM/Template.cfm?Section=Home6&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=30250
 

USA : Patient Protection and Affordable Care Act & soins post-aigus

(the « PPACA », signed into law on March 23, 2010) Note ce paragraphe est issu d’une page sur le financement des hôpitaux

Le paiement « au parcours » (bundled payments) et ses conséquences possibles sur les soins post-aigus

 
Post-acute care and vertical integration after the Patient Protection and Affordable Care Act. Shay Patrick D., MIck Stephen S. Journal of Healthcare Management. Janvier 2013
 
ACG Chicago. Avril 2010

Research and trends (AHA) Healthcare Finance News

 

« Obamacare »: Effets potentiels sur la MPR aux USA 

 
Position de l’American Academy of PM&R à propos du paiement par épisodes (page 4: questions clés)
 
Post-acute care bundling plans – Cherilyn G. Murer (Cet article évoque les bundle payments à l’étude entre court séjour et psot-aigu et les propositions de l’AAPM&R)
 
 
Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Février 2009 (voir schéma des parcours de soins) Final Report. Cheryl l. Damberg, Melony E. Sorbero, Peter S. Hussey, Susan Lovejoy, hangsheng liu, and ateev mehrotra

February 2009 – Assistant Secretary for Planning and Evaluation U.S. Department of Health and Human Services
 

Bundling Acute and Postacute Payment: From a Culture of Compliance to a Culture of Innovation and Best Practice (Gerben Dejong)

 
The 4 Models of Bundled Payments:

Model 1: Hospital services provided to a beneficiary during an acute inpatient stay, where physicians are partners in improving care Model 2: Hospital, physician, post-acute provider, and other Medicare-covered services provided during the inpatient stay as well as during recovery after discharge to the home or another care setting Model 3: Hospital, physician, post-acute provider, and other Medicare-covered services beginning with the initiation of post-acute care services after discharge from an acute inpatient stay Model 4: CMS would make a single, prospectively determined bundled payment to the hospital that would encompass all services furnished during the inpatient stay by the hospital, physicians and other practitioners. Physicians and other practitioners would submit “no-pay” claims to Medicare and would be paid by the hospital out of the bundled payment (2)

 
 
Medicare’s new restrictions on rehabilitation admissions: impact on the elderly. Segal M, Pedersen AL, Freeman K, Fast A: Medicare’s new restrictions on rehabilitation admissions. Am J Phys Med Rehabil 2008;87:872-882. Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10467, USA.

http://www.ncbi.nlm.nih.gov/pubmed/18936554 Objective: To measure the impact of Medicare’s 75% rule on readmission and death rates in elderly patients affected by the rule. Design: Retrospective study of two cohorts, both aged ≥65, discharged from a single medical center, from acute care with diagnoses excluded by the 75% rule. Group 1 (n = 4107) represented discharges in the year before the rule’s enforcement and group 2 (n = 3893) for the rule’s inaugural year. Logistic regression was used to compare mortality and readmission rates, and Cox regression was used for time to event data. Results: Overall, patients were readmitted and died relatively sooner in group 2. Mortality and readmission rates were significantly associated with an age and group interaction, with higher rates in group 2 among older patients. The increase in readmissions was greatest for pain syndromes (from 33 to 55%). In patients older than 85 with orthopedic diagnoses, the mortality rate increased from 25 to 54%. Cardiac patients died and were readmitted sooner in group 2 and pulmonary patients also died sooner. The largest subgroups, miscellaneous and lower limb joint replacement/osteoarthritis, did not show significant differences in readmission rates and mortality. Conclusions: Restricting access to inpatient rehabilitation on the basis of diagnosis alone is associated with increased readmission and mortality, particularly in the very old. Comprehensive, evidence-based guidelines are needed to allocate rehabilitation services to those who need them most.


FIM ou MDS-PAC (Minimum Data Set)

Evaluating the planned substitution of the minimum data set-post acute care for use in the rehabilitation hospital prospective payment system. Buchanan JLAndres PLHaley SMPaddock SMZaslavsky AM. http://www.ncbi.nlm.nih.gov/pubmed/14734953 An assessment tool translation study by Joan L. Buchanan, Patricia L. Andres, Stephen M. Haley, Susan M. Paddock, Alan M. Zaslavsky

 
 
 
 
 
 
 

Comparaisons des systèmes d’orientation entre quelques systèmes étrangers

Le contenu ci-dessous est transféré sur la page pertinence des admissions et hospitalisations en SSR Le problème des systèmes d’orientation en soins post-aigu est la « substituabilité » des orientations. En témoigne, entre autres papiers, cette étude américaine:

Changes in the Use of Postacute Care during the Initial Medicare Payment Reforms  Does It Matter? Wen-Chieh Lin, Robert L Kane, David R Mehr, Richard W Madsen, and Gregory F Petroski –  HSR: Health Services Research 41:4, Part I (August 2006) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1797075/

« The shift in usage among settings occurred in two stages that corresponded to the timing of payment reforms for home health agencies and SNFs. Evidence strongly suggests the substitutability between PAC settings. Financial incentives, in addition to clinical needs and individual preferences, play a major role in PAC use. » Nous présentons rapidement ici la diversité des systèmes d’orientation d’après un rapport du centre fédéral d’expertise belge de 2007. L’importance d’un outil de recueil commun et fondé sur des indicateurs robustes apparaît capitale au regard des risques induits par les réformes du financement (paiements prospectifs par cas et bundled payments). Des effets inattendus peuvent doivent être analysés et prévenus en terme

  • d’intégration verticale et horizontale
  • de re-spécification (division horizontale des activités post-aiguës, hospitalières et ambulatoires) et de substituabilité du choix d’orientation entre les types d’activités, en lien avec les modes de gouvernance (décentralisation et niveaux des décisions)
  • de gestion des durées de parcours hospitaliers par les techniques de « buffer management » (séjours prolongés et impasses hospitalières ou « bed blockers »)

Tiré de: Kiekens C, Van Rie K, Leys M, Cleemput I, Smet M, Kesteloot K, et al. Organisation et financement de la réadaptation locomotrice et neurologique en Belgique. Health Services Research (HSR). Bruxelles: Centre fédéral d’expertise des soins de santé (KCE); 2007. KCE reports 57B Chapitre 8 cliquer ici

 
Représentations graphiques de quelques modèles d’organisation de la réadaptation étrangers

Tiré de: Kiekens C, Van Rie K, Leys M, Cleemput I, Smet M, Kesteloot K, et al. Organisation et financement de la réadaptation locomotrice et neurologique en Belgique. Health Services Research (HSR). Bruxelles: Centre fédéral d’expertise des soins de santé (KCE); 2007. KCE reports 57B  – Chapitre 8 cliquer ici


Webographie: pertinence des admissions / systèmes d’orientation en SSR

« ENQUÊTE NATIONALE POUR L’ÉVALUATION DES INADÉQUATIONS HOSPITALIÈRES. LOT 1 : MESURE DES INADÉQUATIONS ; LOT 2 : COÛT DES INADÉQUATIONS HOSPITALIÈRES ». DGOS, SANESCO. Cette étude menée en 2010 fait ressortir que 10,3 % des lits sont occupés de façon inadéquate (ce taux est de 5 % dans les services de chirurgie et de 17,5 % dans ceux de médecine). L’étude ouvre des pistes d’amélioration, notamment en demandant aux ARS de sensibiliser les médecins traitants sur les impacts financiers.
 
 
 

Patients Hospitalized for Medical Conditions in Winnipeg, Canada: Appropriateness and Level of Care

 

Travaux de la HAS sur la pertinence des demandes de transfert et d’admission en SSR
 
Note de cadrage 

Réalisation d’une grille d’analyse de la pertinence
des demandes de transfert et d’admission en SSR
 

Comparaisons internationales
 
USA substituabilité et réforme des soins post-aigus: Voir la sélection d’articles consacrée aux USA et à la réforme
 
 
STANDARDS FOR ASSESSING MEDICAL APPROPRIATENESS CRITERIA FOR ADMITTING PATIENTS TO REHABILITATION HOSPITALS OR UNITS « As a starting point, we offer the following for consideration: 

  • · The preadmission screening system should collect information necessary to identify reimbursement requirements and demographic information for planned and actual admissions. 
  • · Clinical indicators that will assist preadmission reviewers evaluate patients against established criteria of medical appropriateness, with appropriateness information available to physicians on a “just in time” basis. 
  • · The preadmission system should have the ability to follow patients through the preadmission process and report on any unmet requirements, particularly tied to compliance. 
  • · The preadmission system should provide volume and dollar values of denials by insurers to report on the effectiveness of preadmission screening. »

How appropriate is the use of rehabilitation facilities? Assessment by an evaluation tool based on the AEP protocol

 
 

Long-Term and Post-Acute Care Financing Reform Proposal

http://www.acep.org/Clinical—Practice-Management/Utilization-Review-FAQ/ Davido A, Nicoulet I, Levy A, Lang T. Appropriateness of admission in an emergency department: reliability of assessment and causes of failure. Qual Assur Health Care 1991;3(4): 227-34.

Le potentiel de réadaptation

Le potentiel de réadaptation d’une personne ne peut être considérée isolement de ce qui aurait été le résultat sans réadaptation. La question à laquelle le spécialiste de MPR tente de répondre est la suivante:
« Est-ce que le patient bénéficiera du programme de réadaptation dans un sens qui aurait été différent si la récupération avait été laissée au hasard? »
L’histoire naturelle des déficiences, des altérations des aptitudes fonctionnelles et des restrictions de participation qui en découlent jouent un rôle majeur dans l’éventuel résultat de la réadaptation. Certaines conditions peuvent guérir spontanément et l’intervention précoce peut donner la fausse impression que la thérapie a été efficace. D’un autre coté, l’intervention précoce de réadaptation peut être associée à un résultat amélioré même si la récupération complète ne se produit pas.