Tuesday, October 11, 2016

AHCA’s Ciolek Is Voice for Skilled Nursing Profession During Capitol Hill Briefing

(Dan Ciolek-in the center)
Daniel Ciolek and Dana Halvorson

Last Thursday, October 6, AHCA’s Associate Vice President of Therapy Advocacy, Daniel Ciolek, spoke at an American Heart Association/American Stroke Association breakfast briefing on the associations’ first ever evidence-based guidelines that are “intended to optimize the rehabilitation and recovery of stroke survivors.” According to the briefing notice, “Nearly 800,000 Americans have a stroke each year, and the rehabilitative care and support a patient receives can have a significant impact on his or her ultimate recovery.” Mr. Ciolek was one of five invited expert panelists speaking on the guidelines, and was the leading voice on the skilled nursing center perspective.

The panel discussed topics on how the 227 recommendations in the stroke rehab guidelines could be applied to fill in the gaps in stroke rehab research, align with the new IMPACT Act quality measures, improve interdisciplinary care coordination across the continuum, and improve overall patient care. It was notable that the guideline authors and other panelists pointed out that one of the recommendations indicating a preference for IRF over SNF created some controversy, and acknowledged that many SNFs have the facilities and capabilities to furnish intensive stroke rehab with good outcomes.

During the panel, Mr. Ciolek focused on the fact that new payment models must meet the acute and chronic care needs of the stroke survivor. He provided examples where outpatient therapy cap policy and third-party prior authorization processes are counterintuitive to facilitating care coordination and transitioning care to meet the rehabilitation needs of stroke survivors. Ciolek noted that stroke survivors across the country need rehab, and many SNFs near their homes have stepped up their game to fill in the void. He agreed with other panelists that hospitals, physicians, patients and their families should ask a potential SNF about their facilities, staffing, expertise, and experience with rehabilitating stroke survivors. With regards to patient-centered care, Mr Ciolek cited research that the lack of common language as a patient moves from setting to setting is a key barrier to successful outcomes - and that the standardization of functional assessment information and outcomes measures across settings required by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act that became law in October 2014 should improve coordination at care transitions - but only if the information is shared. Finally, with regards to the stroke rehab guidelines document, Mr. Ciolek stated that overall they are a helpful step as they can be used by SNFs as an aspirational document to improve their assessment and treatment approaches, and to fill in gaps in stroke rehab care not covered yet by IMPACT measures.

Moderating the panel discussion was Dr. Daofen Chen (Program Director of Sensorimotor Systems & Neurorehabilitation Research at NINDS/NIH Neuroscience Center. Other panelists included Dr. Alexander Dromerick (Chairman and Professor of the Department of Rehabilitation Medicine at Georgetown University Medical Center and Vice President for Research at MedStar National Rehabilitation Hospital), Dr. Joel Stein (Simon Baruch Professor of Physician Medicine and Rehabilitation at Weill Cornell Medical College and Professor and Chair of the Department of Rehabilitation Medicine at Columbia University College of Physicians and Surgeons), Dr. Mary Beth Walsh (Board Member of the American Medical Rehabilitation Providers Association and Executive Medical Director of Chief Executive Officer of the Burke Rehabilitation Hospital), and Dr. Carolee Winstein (Professor of Biokinesiology and Physical Therapy and Director of Motor Behavior and Neurorehabilitation Laboratory at the University of Southern California). Frank ‘Chip’ Celestano, MD, a stroke survivor also provided a patient perspective of the short- and long-term challenges of recovering from stroke and obtaining therapies necessary to improve his function.

For more information on this briefing, please feel free to contact Dan Ciolek at dciolek@ahca.org, or AHCA’s Senior Director of NFP & Constituent Services, Dana Halvorson, at dhalvorson@ahca.org.

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