A Director of Rehab’s Take on the Future of Hospital-Based Therapy

Thanks to a seemingly endless stream of healthcare reform initiatives, providers—especially large-scale providers like hospitals—are under greater pressure to reduce treatment costs while simultaneously improving patient outcomes. To do that, many hospital leaders are looking inward and re-evaluating the way they leverage the resources at their disposal—including traditionally overlooked care options like rehab therapy. In this interview-style post, Matt Kraemer—the director of acute and outpatient therapy services at Banner University Medical Center Phoenix—discusses how this environment of change is impacting his organization.

1. Tell us a little bit about yourself—your background, how you landed in your current position, and what you do on a day-to-day basis.

I studied exercise science at Arizona State University and then continued on to A.T. Still University, where I earned my doctorate in physical therapy. I also received my certification in sports and conditioning through the NSCA and my athletic training certification through the NATA. I have performed additional training to become ASTYM certified as well as dry needling certified. Before I accepted the position at Banner, I practiced outpatient orthopedic physical therapy in a private practice setting for 11 years and was the director of the clinic for the last 9 of those. I transitioned to my current role in the hopes of growing my professional skillset and getting the opportunity to play a more direct role in the transformation of health care in general and the role therapy services play in that continuum, specifically.

As a rehab director, it’s my job to assess the method in which we deliver therapy services, the manner in which therapists drive the direction of care, and the effect therapy has on patient outcomes. This means spending much of my time meeting with other groups and leaders—both inside and outside of the Banner system—to help reinvent and progress the collaborative care process. I also still treat patients occasionally so I can keep my clinical skills sharp and ensure my staff’s needs are recognized.

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2. What are some of the challenges unique to hospital-based rehab therapy providers?

There are always pros and cons to being based in a hospital system. One of the pros is the stability of a large organization. Furthermore, being a part of a single entity working to deliver holistic patient care means you, as a therapy professional, have a voice in important discussions about care collaboration, referral processes, outcomes reporting, and changes in alignment.

Unfortunately, there are negatives associated with this as well. For example, hospitals tend to carry a reputation of being corporate, unfeeling entities that aren’t fully invested in the details that lead to great care. There’s a perception that we care only about quantity, not quality. In fact, before I joined Banner, I actually subscribed to this mindset—and that’s because I didn’t have any insight into, or knowledge of, the reality of a large corporate healthcare organization. Additionally, with size, you sacrifice agility—which can make it difficult to not only react to change, but also lead the change you envision. The hospital billing model is another challenge. While it typically allows for higher levels of reimbursement, the ACA has diverted some of the financial responsibility away from the payer and to the patient, thus creating a financial barrier to care.

3. Thanks to various healthcare reform initiatives—including the Hospital Readmissions Reduction Program and the trend toward bundled payments—hospital leaders are under greater pressure to increase care quality while reducing costs. You are closer to those pressures than most folks in the outpatient rehab therapy space. So, from your perspective, what opportunities do you see for the growth of hospital-based rehab therapy in the coming years?

Reduced length of stay and lower rate of readmission are primary patient success metrics for large hospital organizations, which means they represent a huge area of focus for those organizations looking to reduce costs and increase reimbursements. Hospitals are trying to foster fully integrated patient care—from the moment a patient is admitted to the Emergency Department all the way to that patient’s discharge following outpatient treatment. To do that—and to support the triple aim—hospitals must work toward consistency in their outcome tools, interventions, and care transitions. This, in turn, helps ensure that each patient receives the right care, at the right time, from the right clinician. This means having highly trained clinicians—including therapists—driving the patient care journey in all arenas (e.g., the ED, acute, inpatient, SNF, and outpatient).

4. Do you think hospital leadership recognizes those opportunities? If so, have they acted on them?

I can only speak to my specific situation, and in that case, the answer is a resounding “yes.” Banner is very focused on driving change rather than reacting to it. As an organization, Banner is very concerned with the tightening restraints of healthcare coverage and the resulting needs of the patients. I am certain we’re not the only healthcare system noticing these changes and looking for a better solution to care delivery.

5. You’ve mentioned that even within a hospital system, there’s a need for therapy providers to educate other physicians and specialists about what they do and how they fit into the overall patient care picture—to market themselves, essentially. Why is that, and have you had success with that in your specific role?

Unfortunately, change does not always happen as quickly as we’d hope. There are a variety of different clinicians out there all trying their best to offer the best care to their patients. It takes a lot of time and effort to perfect, drive, and evolve your skill—and before you know it, you are off on an island, totally unaware of others’ efforts. We call these silos. I have found that the most successful solution to this is communication. I identify the right people I should be speaking to—the ones who should be working side-by-side with therapy providers to make decisions that accelerate outcomes—and we talk, face-to-face. We educate each other on what we have to offer, and begin to ask the question, “What if…?”

6. It seems like health care in general is moving toward a more collaborative model. Have you experienced an increased emphasis on collaboration within your organization? If so, how has that impacted the rehab therapy department?

Yes—and that shift has brought therapy services to the forefront of each conversation. Therapy touches nearly everything. Speech therapists drive medication selection and diets, occupational therapists influence the next setting for a patient, and physical therapists guide equipment selection and interventions—including which interventions (e.g., imaging) are indicated.

7. What do you think is the biggest barrier to rehab therapists being leveraged to their full potential within hospital settings?

Physician orders are still the driving force behind therapy utilization. Physicians need to be educated on the role therapists are capable of playing, the opportunity that therapy represents, and the positive influence this type of care has on patient outcomes.

8. What tools do therapists need to achieve their fullest potential as hospital-based care providers?

Great communication, agility, willingness to explore previously limited options, and leadership.

How do you foresee the role of rehab therapy evolving in the next several years? Have you observed any changes within your own organization? Share your thoughts in the comment section below.