What, exactly, is a physiatrist?
Kerrie Reed, MD
AIM Rehabilitation Solution
Kerrie Reed, MD, physiatrist and medical director of the AIM Rehabilitation Solution, on the under-the-radar role that helps patients with diverse needs maximize function and manage pain
Rehabilitative medicine aims to enhance and restore function and quality of life to those with physical impairments. Sometimes simply called rehab, it encompasses physical, speech, and occupational therapy; however, it also goes beyond those disciplines.
Rehab practitioners treat patients with conditions that span a diverse range of medicine, from sports medicine and neurosurgery to oncology and even infectious disease. To maximize efficiency and effectiveness of rehab for a patient with complex needs, a team leader is needed — a medical expert to coordinate non-surgical treatments across multiple medical specialties.
Enter the physiatrist. But what, exactly, is a physiatrist?
In our latest InterVū Q&A below, Kerrie Reed, MD, a physiatrist and medical director of the AIM Rehabilitation Solution, explains her specialty, the important role it plays at the center of patient care, and how she applies its collaborative approach to her role at AIM.
Many people aren’t familiar with physiatry. Can you define what a physiatrist is?
A physiatrist is a physician—an MD or DO—who specializes in physical medicine and rehabilitation.
We attend four years of medical school and several years of residency training – like every physician. The distinction is that our post-residency training is in the specialty of physical medicine and rehabilitation, or PM&R. And our focus is on helping patients maximize function by managing acute and chronic pain and other impairments with nonsurgical treatments for the neuro-musculoskeletal system.
To do this, we draw on a broad knowledge of medicine, biomechanics, musculoskeletal function, anatomy, and comprehensive knowledge of musculoskeletal and neurological disorders.
What we do cuts across so many conditions. We bring the medical component to our collaborative work with physical, occupational, and speech therapists. Together, we’re very much a team.
For example, we diagnose what’s impacting a patient’s function – or rather dysfunction – and might prescribe physical, occupational, or speech therapies to restore as much function as possible, decrease or eliminate pain, and foster physical and cognitive independence.
We tell people that a physiatrist doesn’t save lives — we save quality of life.
Does a physiatrist and the PM&R team address only patients with musculoskeletal issues?
We have our hands in many medical cookie jars.
At our core, we’re about function, so we look at how muscles, bones, nerves, joints, tendons/ligaments, and the brain work together to create function. The issue we treat may be musculoskeletal in nature, but the issue or cause may be a sports- or work-related injury. It might be a chronic disorder or serious disease, such as cancer, cardiac disorders, stroke, spinal injuries, or multiple sclerosis.
Consider a woman being treated for breast cancer. The oncologist treats the cancer, and a good result is curing the patient’s cancer. That’s phenomenal!
But throughout treatment, the patient also experiences emotional, mental, and physical issues that disrupt her ability to function. That’s where physiatry comes in.
Likewise, PM&R can make an impact on the COVID-19 pandemic. Patients needing hospitalization due to the virus often suffer extreme weakness and fatigue and may require formal rehabilitation to recover. The rehabilitation collaboration driven by the physiatrist can start early in the ICU to prevent or mitigate complications, like nerve damage.
Ultimately, for a physiatrist, no matter the disease or the condition, a good result is maximizing the patient’s ability to function and live his or her life as comfortably and fully as possible – before, during, and after treatment.
How would you describe your role at AIM?
Collaboration is woven into the fabric of my specialty – whether that means coordinating strategies with other medical specialties or working with my AIM colleagues across the business. It’s all right up my alley as a practicing physiatrist.
For example, I’m primarily responsible for developing the clinical strategy for our Rehabilitation Solution and ensuring its clinical integrity. I’m also involved in supporting our team in provider engagement and growth initiatives and ensuring the determinations we issue are clinically appropriate.
Additionally, I participate in optimizing our day-to-day operations. For example, during the coronavirus pandemic, we’ve modified our program to include telehealth rehabilitation services.
You mentioned that a physiatrist works closely with physicians from other specialties. How does that translate to your work at AIM?
At AIM, we have medical directors from many disciplines, like oncology, orthopedics/musculoskeletal, and radiology. We’re all resources for each other.
Let’s look at our guidelines in development for back pain—part of our Rehabilitation Solution. I’ve been consulting on these with our Musculoskeletal Solution leaders and our Radiology Solution leader, since both rehabilitation, orthopedics, and radiology play large roles in optimal treatment for most patients with back pain.
In this case – as in every case – the physicians’ interests align, which is always about what’s best for the patient. Together we collaborate to identify the most efficient way to get there. It really has to be a team for best possible success.
Can a well-managed rehabilitation program positively affect a health plan and its members?
Definitely. We help ensure that the treatment ordered for health plan members addresses the actual and full problem with appropriate care.
Through our review process, we align care with established best practices, which leads to a more efficient and effective course of action. Our goal is to not only treat the presenting problem but to help prevent and reduce the need for further interventions.
For example, when treating patients with injuries, we seek to prevent re-injury. This approach naturally decreases costs. And that’s important.
The demand for rehabilitation services is growing — largely due to America’s aging population but also because of our emphasis on fitness, which can lead to injury at any age. And rehabilitative medicine can be costly. In the U.S., it’s a $30 billion market, according to the American Academy of Orthopedic Surgeons.
Though it may be a low-cost intervention on a unit basis, the sheer volume of service drives up total costs. There’s no getting around the fact that rehab services are inherently a high-volume business — almost every medical condition is, to some degree, amenable to rehab therapies.
And given rehab’s proven effectiveness and ability to avoid more costly interventions, widespread use of rehab is generally a good thing for members and health plans alike.
But inappropriate use of rehab — i.e., extending services beyond those that are medically necessary — inflates the volume and thus the total costs. So the conundrum lies in utilizing rehab services at a level that maximizes the benefits of these services while keeping overall spending in check.
We believe the answer lies in applying firm, evidence-based medical necessity criteria. That allows a health plan to actually promote the judicious use of medically appropriate, cost-reducing rehab while preventing overuse and abuse of costly, medically inappropriate therapies.
Our solution provides for such evidence-based care with the goals of optimizing a patient’s function and reducing risk of prolonged injury, chronic pain, re-injury and, consequently, costs. We feel that reducing costs and ensuring member well-being by emphasizing appropriate care is a win-win for the member and the health plan.
What lies ahead for the AIM Rehabilitation Solution?
The AIM Rehabilitation Solution will continue to take us in a more holistic and realistic direction that puts the member at the center—because it makes the most sense.
Appropriate care often goes beyond one singular treatment and whether or not that treatment is appropriate or meets medical necessity at a specific point in time.
So the AIM Rehabilitation Solution will expand to review a complex condition and pull together all our resources and expertise across medical specialties to create a comprehensive pathway that addresses any treatment in the care of a particular condition. Moving forward, I expect the benefits of this approach to gain momentum.
What drew you to physiatry, and what led you to AIM?
I feel it’s important to treat the whole patient. It’s an approach that empowers the patient. Suddenly this person is no longer a “cancer patient” or a “back injury.” This is a whole person with a medical condition but also a vital life that’s affected by disease, chronic pain, and treatment.
What drew me specifically to AIM was the depth of talent. Our clinical leadership team speaks fluent rehab—which is essential in order to put the patient at the center of health care.
As I said, the management of medical care is already moving in this direction; the AIM Rehabilitation Solution is keeping ahead of the movement.
Driving the use of medical evidence for rehabilitative therapies
The AIM Rehabilitation Solution ensures that health plan members receive the right care, at the right place, for the right duration. Learn how it couples clinical appropriateness review with member engagement to address the most common challenges associated with rehabilitative medicine.