Shift happens: using outcomes to survive and thrive under PPS

In the post prospective payment system (PPS) era, acute rehabilitation providers are presented with multiple challenges and opportunities. All inpatient rehabilitation facilities (IRFs) face the requisite demands for improved efficiency (e.g., reduced length of stay for persons with stroke) and the re-institution of monitoring for compliance with the 75% rule. However IRFs also now have a dramatic opportunity to shift the paradigm of "how we do business" by adopting cutting edge technology and continuous quality improvement methodology and by rethinking and revising how we evaluate a stroke program. Today, more than ever before in our industry, providers have an opportunity to evolve to a consumer-driven program evaluation model with the resultant modification of rehabilitation outcomes, indicators, and metrics. The article argues for a climactic and dramatic change in how acute rehabilitation providers market for patients, deliver care, and report on their outcomes. In the current context of PPS and the 75% rule, we are quite literally considering the survival of the industry as we know it. Improved rehabilitation processes and revised rehabilitation report cards (customized for the various stakeholders) hold the key to market share and organizational success. If patient access, quality outcomes, patient safety, and functional gains are to be achieved, the industry needs to change the way it does business and as a consequence the way it evaluates its programs.