Guest Columns

Regaining an appreciation of prevention

Tara Roberts
Tara Roberts

Have you ever really considered what the phrase "an ounce of prevention is worth a pound of cure" means?  

This wise saying is defined as basically, if you have put in a little effort to prevent a problem, you will not have to put in a lot of effort to solve the problem.

This seems simple, and is certainly applicable to healthcare and its delivery. So why don't we model payment reform in this way?  

Healthcare is mandated to reduce spending (seems to be the blinding priority), eliminate unnecessary re-hospitalization (where much of the excessive spend happens), provide quality care with measurable outcomes (who doesn't want that?) and KEEP the beneficiary well for longer periods of time (equals less spending, healthier lives and quality validated). 

The problem is that the Centers for Medicare & Medicaid Services and others are so blinded by the “reduce spending” element that we have lost our ability to appreciate prevention. Payment reform is a must. But cuts alone are not sustainable. When you reduce spend for one PAC provider, the spend goes up for another PAC provider. 

What if we actually looked at incentivized prevention? This means we WANT there to be spending up front. The difference is that this spending is deliberate, not reactive. This spending is targeted, not broad. This spending is responsible, not burdensome.  

For example, there is a lot of focus and scrutiny on rehab provision of services. MedPAC, CMS and others feel long-term care overuses therapy benefits and basically says providers exploit the payment model. 

However, if we applied the “ounce of prevention” philosophy to a Medicare beneficiary, there is a different perspective. What if we incentivized providers to “pro-actively” provide full-expert skilled therapy evaluations annually, or bi-annually, or even quarterly under the philosophy that prevention and  early intervention WILL reduce spending annually? This would allow us to meet legislated mandates for eliminating unnecessary re-hospitalizations, achieve quality and measurable outcomes and keep the beneficiary well for longer periods of time. 

We generally provide skilled therapy services under a reactive payment system. This means a significant event has occurred (the beneficiary has fallen, is ill, etc.) and therapy services are warranted. This significant event may have even resulted in a re-hospitalization, which drives reimbursement under Medicare Part A benefits. Either way, you can bet the skilled therapy plan of care under Part B or Part A services in our reactive model will result in a lengthier bout of therapy services. It's likely going to result in more intensive and expensive nursing and medical treatment.  

In comparison, a proactive therapy services model would potentially say Medicare money.

Wellness can create healthcare savings. Residents with less depression, fewer wounds, fewer medications, fewer negative behaviors, fewer infections all would say money. That brings up another saying: "You got to spend a dollar to make a dollar." Healthcare could save the system a ton of dollars by intentionally, meaningfully, incentivizing providers to spend a dollar on skilled therapy services.

There will be folks reading this who still believe LTC and therapy providers only want to make money. To them, I quote Charles F. Glassman, who said, "”Believing in negative thoughts is the single greatest obstruction to success." Those who truly do not have the heart for LTC and legitimacy in healthcare will go away. The rest of us will be delivering "an ounce of prevention!" 

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Guest columns are written by long-term care industry experts, ranging from academics and thought leaders to administrators and CEOs.

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