(Note: This is part two of a two-part series on issues affecting worker’s compensation, brain injury rehabilitation, and appropriate patient care).
The focus in health care today is often on the high cost of care and ensuring access to care through legislative reform. Change in recent years has focused largely on preventative care and care for common medical conditions. However, health care after catastrophic injury, such as brain injury, is vastly more complicated.
Few individuals receive the full measure of treatment after brain injury that we now know will bring them to their ultimate recovery and functional status possible – due to uninformed financial restrictions to accessing care. We have learned that early treatment is better than late treatment, in part, because we can prevent the development of unnecessary complications. Expert treatment avoids inappropriate medications and surgeries while promoting and optimizing the neurological recovery of function.
“Patient-centered care” must be combined with the notion that “the dollars follow the patient” to enable this maximized recovery and return to the most meaningful and productive, as well as, the least expensive and least restrictive life after brain injury. Catastrophic brain injury presents unique challenges in comparison to other health conditions. A brain injury can affect multiple organ systems quite randomly, and it is often said that no two patients are the same. The tremendous variability requires medical treatment that is both comprehensive and expensive. Furthermore, the cost of treatment has not and will not be reduced to a pill or a surgery. So, treatment of brain injury requires a regiment of physicians, allied health professionals, case managers, attorneys, and family members, in addition to combination therapies that may also include surgeries and medications. Simply put, there is no medical condition today that is as complicated as brain injury.
Further, care pathways and endpoints of treatment are evident in most medical conditions. Appendicitis, as an example, is a medical condition that can almost always be treated the same way – but this is less the case for brain injury. Each patient recovers differently depending upon a host of variables that include the injury itself, the person’s educational, vocational and social history, the person’s pre-injury medical status, the person’s genetic factors, other system involvement, the timing of emergency treatment, the etiology of the injury, the expertise of the treatment given, the duration of treatment provided. Factors that affect access to treatment are also variables and may include access to insurance, socioeconomic status, patient and family education, and awareness of advocacy by treaters of appropriate treatment options.
What are the cost savings of a full-time comprehensive postacute rehabilitation program?
When treatment duration is determined by patient progress alone, rather than interference by financial restrictions, the data shows us that many patients seem to reach maximized recovery after injury when exposed to intensive and expert medical rehabilitation. These patients’ outcomes are stable or improving at extended follow-up 5 to 7 years post-injury. Additionally, the financial benefit to an insurance company or society is tremendous – at an average of $1.5 million per person lifetime. Incredibly, some patients’ recoveries have resulted in more than $7 million in lifetime savings. When the expense of these treatments is contrasted to the financial savings alone, the return on investment is truly immense.
Is access to health insurance vital for TBI recovery?
Health insurance is not yet routinely providing all the treatment one would reasonably prescribe in the first year after injury. This is not to say recovery doesn’t extend beyond this point in time; rather it says that this is the most rapid and easily modifiable recovery period. The solution is found in collaborating with the teams of professionals who work to determine how benefits are applied and medical researchers who are on the hunt for the most productive and efficient treatment. It is doubtful that recovery from brain injury will ever be reduced to a pill or a surgery. Recovery will remain dependent upon intensive, expensive and well-executed therapies combined with thoughtful use of appropriate medications and surgeries.