Bridging the gap between clinical practice and other sectors, this new resource challenges rehabilitation providers to think beyond treatment to disability management. It provides the theories and knowledge needed to effectively manage patients' disabilities within a managed care framework, with the goal of better collaboration with claims adjusters, case managers, risk managers, human resource personnel, safety and health officers, attorneys, peer reviewers, and others in the health care system. Highly visual and packed with useful information, it provides an excellent introduction to the wide variety of interested parties with whom a therapist will interact in the course of managing a client's health.
- The author has more than 23 years of experience consulting with insurance companies, employers, and the legal sector, and offers proven strategies for collaboration between providers and others involved with the health care system.
- Filled with numerous illustrations, graphics, and tables, many of which are useful for training and education of staff or clients.
- The appendix contains a large and diverse collection of helpful information that is not readily available from other sources. It also provides an essential list of resources for further reading about this constantly changing field.
- Chapters cover theoretical issues (management models, definitions of disability) as well as disability management in long-term care, worker's compensation, outcomes management, legal implications, and more.
- Case studies throughout the book present realistic examples of situations to improve the reader's technical and critical thinking skills.
- Focused on managing disabilities (i.e., functional problems) rather than on treating impairments (i.e., diseases), encouraging rehabilitation providers to think "out of the box" and to position themselves better within and beyond managed care.
I. UNDERSTANDING DISABILITY
1. Disablement Models
2. Disability: Costs and Demographics
II. UNDERSTANDING DISABILITY MANAGEMENT FUNDAMENTALS
3. Disability Management: Principles and Practices
4. Disability Management in Long-Term Care
5. Disability Management in Workers' Compensation
6. Disability Management: An Insurer's Perspective
7. Confounding Obstacles to Disability Management
III. DISABILITY ASSESSMENT
8. Disability Determinations
9. Functional Capacity Evaluation
10. Utilization Review and Management
11. Descriptive Study of Physical Therapy Case Management
IV. HEALTH INFORMATION MANAGEMENT
12. Information Technology in Disability Management
13. The Search for Quality
14. Outcomes Management
15. How to Locate Sources of Disability-Related Data
V. ETHICAL-LEGAL-REGULATORY-COMPLIANCE ISSUES
16. Risk Management
17. Ethical Considerations in Disability Management
18. Fraud and Abuse Prevention: Legislative and Regulatory Issues of Importance for Rehabilitation
19. Federal Reimbursement-Focused Statutes for Rehabilitation Providers
VI. TRENDS AND ISSUES IN HEALTH CARE FINANCE AND DELIVERY
20. Transition to Change in a Complex Healthcare Sector
21. Delivery Paradigm Shifts
22. Chronicity: Rehabilitation's New Horizon?
23. Evolution of Managed Care
24. Complementary and Alternative Medicine
25. Beyond Managed Care: A Vision of the Future
VII. FROM CLINICIANS TO CONSULTANTS
26. Profiles in Disability Management
27. Consulting Opportunities for Rehabilitation Providers
APPENDIX: Resource Compendium