The Path Ahead …

D C ur health care system is at a “fork in the road.” That is just one of the many clichés and ound bites that pundits on both sides use to sum up our national health care predicament. et many of these overused sayings do help point to the challenges ahead and to the issues hat Americans must face. As usual, political dynamics and posturing are adding noise, onflict, and divisiveness to what otherwise is an imperative message: there must be, and ill be, changes to the current health care system in the United States. On this point, the onsensus is overwhelming. The health care delivery journey traveled in the past will nquestionably change direction in the future, and the pace of that change will accelerate. he road ahead has been paved by such groundbreaking initiatives as The Institute of edicine’s “To Err is Human” project [1], which has placed an important focus on patient afety, and the Dartmouth Atlas projects [2], which have highlighted regional variation in uality, outcomes, and resource consumption that have exposed the shortcomings and aws in our current health care delivery systems and models of care. To repeat yet another cliché, today’s economic realities are likely the “straw that breaks he camel’s back,” igniting urgent actions to address the flaws in our system. As a collective ation of patient-consumers, providers, policy makers, purchasers, and taxpayers, we must ddress the ills in our current health care system. We must redirect our collective energies nd focus on having productive debates that will help define the future path or paths we will ravel instead of fruitlessly attempting to maintain the status quo. Previous debates centered n the “need” to change. It is now time to move on to more productive discussions about the ore challenging question of “how” to transform the health care delivery system. As a medical specialty, physical medicine and rehabilitation (PM&R) has been closely ligned with the tenets of health care system reform. Physiatry was born out of a health care ystem that fell short in meeting the needs of certain patients. Physiatrists work with some f the most vulnerable patient populations who fall through the gaps in the current tructures and processes of health care delivery within the United States. Still, one can dentify tremendous failures in the current models that limit access and high-quality care to atients who would greatly benefit from PM&R services in both inpatient and outpatient ettings. Physiatrists operate in a patchwork system that drains the energies of patients and roviders and the resources of the nation, and often falls short on its promises to those with isabling conditions and chronic illness. As an organization that represents the PM&R specialty, the American Academy of hysical Medicine and Rehabilitation (the Academy; AAPM&R) has voiced the concerns of ts members in the first phase of the health care reform debate and deliberations. The ounding values of the specialty and the Academy’s mission and vision have served as a ompass to guide strong advocacy efforts on behalf of patients to improve function as well s health status. The debates of 2009 and early 2010 primarily focused on insurance reform, eflecting the overarching needs of (our) patients for health care coverage, consistent with he values of our specialty: nondiscrimination on the basis of disability and health status, limination of pre-existing conditions exclusions, guaranteed issue and renewability of ealth insurance, and prohibitions on lifetime and annual caps. We are now entering phase 2 of health care reform, that is, the true health care delivery ystem reform phase. PM&R must have a strong voice in shaping the future. I believe that we ave answers and solutions. It is noteworthy that the more than 1000-page combined Patient Protection and Affordble Care Act (Public Law 111-148) and the Health Care and Education Reconciliation Act Public Law 111-152) do not enumerate specific delivery model solutions. The Acts S a