Wednesday, May 28, 2014

An Open Letter to "Payers" Regarding Stroke recovery: You're Doing it Wrong

Dear Insurance Providers, 


I'm sure you want to help stroke survivors. A survivor that is home in the pursuit of happiness is healthier and cheaper. 

But there's a problem... The systems that insurance companies and Medicare ("payers") have developed is a hodgepodge based on a patchwork of incorrect assumptions and old science.

The following are some recommendations to better align insurance regulations with the aspirations of survivors.

1. Make immediate screening for TPA mandatory, even in the most rural hospitals.

2. Where a survivor goes for therapy matters. Unfortunately, the decision determining where the lion's share of recovery will take place is made within the first few days post-stroke way too soon. Given the emerging healing in the brain acutely there is simply no way for any clinician to predict where that survivor is going to be, functionally, in a week, let alone a month – or several months out. 

There are some who believe that future movement can be predicted within the first week post stroke. However, those predictions are accurate only because they force a self-fulfilling prophecy. Based on the algorithmic prognosis, survivors are put in less than optimal rehabilitation settings. Thus, they do not reach the highest level of recovery  providing justification for the original in-hospital prediction.

Instead of forcing therapists to make this decision in the first few days, wait until day 14. By then the resolution of the penumbra will have revealed true future potential-- at least in ischemic strokes. Hemorrhagic strokes take even longer to predict.

3.  Clinicians are forced to discharge survivors once they have plateaued. However, given the massive potential brain plasticity, it is now known that plateau is a slowing, not an ending, of recovery. Given the potential for recovery into the chronic phase of stroke, complete disengagement from therapy is a mistake. I would strongly suggest maintenance visits with therapist, introduction to well-trained stroke specific exercises at local gyms and workout facilities, as well as distance (i.e. phone calls) with therapist.

Sincerely,
Peter G. Levine

5 comments:

Mike said...

Unfortunately, the whole thing with the influx of invea=stors, pharmas, doctors, rehab centers have become a multi billion dollar business.When there's lots of money involved the 'care' in healthcare dissipates

Shelley Scuse said...

Instead oh home therapy I wish I could have extended my therapy sessions outside. The home therapy was not as good.
I wish stroke patients had some leeway in the rehab area to get the most beneficial rehab for them.

Glen Litsinger said...

to help with my dexterity issues with buttons, my wife took a number of my pairs of shorts to a local cleaners, where a seamstress replaced the button over the fly with a VELCRO CLOSER, mUCH BETTER AND FASTER WHEN i'M IN A HURRY.

Glen Litsinger said...

To address my dexterity issuesinvolving buttons, my wife had a local seqamstress replace the fly buttons on a bunch of my shorts with Velcro@ closers. Much easier amd faster to put on or remove now.

Glen Litsinger said...

To address my dexterity issuesinvolving buttons, my wife had a local seqamstress replace the fly buttons on a bunch of my shorts with Velcro@ closers. Much easier amd faster to put on or remove no

Blog Archive