Due to the nature of the material presented in the text, we anticipate that health care will change faster than we can revise the book, so this website is intended to supplement, update, and generally serve as a reference and resource for instructors, students, and all readers of the book.

First, a little about the book:

This text is intended to be used by instructors in a variety of different courses in educational programs that prepare rehabilitation professionals. I originally developed this as a text for a seminar, Health Care Delivery Issues, in the Master in Physical Therapy program at California State University, Fresno. Although the book is written from the perspective of the physical therapy profession, similar changes and issues have affected all segments of the health care market.

New graduates entering practice in this environment face challenges that may change the mechanisms of service delivery and essential roles they must assume to provide health care services in this changing environment. This text can be used as a means to help students understand the changing system and help them develop strategies that will serve them most effectively in this changing environment.

Some of these changes include:

1. The influence of prospective payment systems, which continue to change mechanisms for health care reimbursement and provide strong incentives for reduced services.
2. Widespread development of health maintenance organizations and preferred provider organizations have forced providers to organize professional networks and provider associations to stay in business.
3. Reduced access to increasing numbers of our population who are underinsured and uninsured.
4. Corporatization of health care with large corporate entities controlling major segments of the health care market.
5. Shifts from inpatient hospital care to subacute, home health, and outpatient settings.
6. Cutbacks in allowable reimbursement for services.
7. Institutional reductions in professional staff positions leaving fewer professional personnel to manage increasingly larger caseloads.

The challenge then becomes:

How does one create an educational experience that will support clinicians to both make sound clinical decisions and develop responsive and innovative service delivery mechanisms that respond to the constraints of this changing environment?

This book was created to help students understand the structure, policies, constraints, trends, and likely future of the health care delivery system. To prepare for future practice, they must have the skills to effectively manage their time, caseloads, and multiple support personnel. They must be able meet ongoing demands for effective documentation, utilization review, quality assurance and outcomes management. Most importantly, they must be able to envision additional ways to offer and deliver physical therapy services by developing new programs to meet our growing needs for prevention and health promotion.

Chapter 1 begins with a discussion of the evolving role of the physical therapist. Chapters 2 and 3 provide an introduction to mechanisms of health care financing, reimbursement, and cost containment. Chapters 4, 5, 6, and 7 focus on physical therapy access issues and trends in three common physical therapy practice settings including acute, subacute, and home health care. Chapters 8 through 14 provide an indepth look at professional practice issues, including time management, caseload management and delegation, patient care documentation, measuring outcomes, utilization review, quality assurance, and increasing opportunities for physical therapy in the area of prevention and health promotion.

Although the "rules" may change frequently, health care providers who can understand the system and see creative avenues to provide patient care services will thrive in the new and changing health care environment.

About the website

On this site you will find links to summaries of the chapters in the book, exercises to test your skills and knowledge, links to instructional strategies, and links to the latest developments in the changing health care environment.

The resources and links available through this site are intended to support instructors and students seeking educational experiences that foster and promote these skills and abilities. I welcome your feedback on how we can effectively meet these challenges.

Kathleen A. Curtis, PhD, PT