SMR Auvergne-Rhône-Alpes: Funding, Services & Regional Plan 2023-2028

Rehabilitation care is evolving in the Auvergne-Rhône-Alpes region, with a focus on adapting to the needs of an aging population and embracing innovative technologies. This evolution impacts how and where specialized medical care and rehabilitation services – known as SMR – are delivered, funded, and organised.

The Landscape of SMR Facilities

SMR activities can take place in facilities dedicated solely to rehabilitation or within larger, multi-activity healthcare organizations. An SMR facility can be authorized to provide care for one or more specific areas of expertise. The SRS 2023-2028 plan outlines key priorities, including strengthening specialized care pathways, addressing the needs of an aging population, expanding outpatient services, and supporting innovation like tele-rehabilitation, advanced technical platforms, and robotics.

Did You Know? The SRS 2023-2028 plan specifically aims to improve quality and efficiency through a focus on outpatient care and supporting innovation in rehabilitation.

How SMR is Financed

The financing model for SMR has shifted to a mixed approach. This includes a fixed component, allocated based on population characteristics and regional health needs, designed to provide a stable financial base for facilities. A second component is activity-based, providing additional funding linked to the number of patients treated during the year, supplementing the fixed allocation and rewarding increased activity.

The Auvergne-Rhône-Alpes Regional Health Agency (ARS) oversees the allocation of these resources through the Regional Consultative Committee for Resource Allocation (CCAR).

The Role of SMR Establishments

SMR facilities offer a range of services tailored to individual patient needs. These include full or partial hospitalization (day hospitals), comprehensive and coordinated multidisciplinary assessments and rehabilitation, preparation for returning home (or to a social care facility) with coordination with community services, and specialized care for specific conditions. For rare or complex cases, SMR facilities also provide expert-level activities.

Regional Organization of SMR Services

The regional organization aims to provide accessible care while also identifying specialized resources and territorial networks. Atlasante is used to map this organization.

Specialized Expertise Activities (AE)

Certain treatments require specialized skills, equipment, or organizational structures. These are designated as Activities of Expertise (AE). Recognition as an AE facility requires meeting specific criteria, including adherence to detailed guidelines, territorial coverage of the expertise, demonstrated population need, and the facility’s resources, activity volume, and involvement in research or training.

Currently recognised AE activities include neuro-orthopedic rehabilitation, post-resuscitation rehabilitation, early neurological rehabilitation, coma awakening units, early respiratory rehabilitation, early cardiac rehabilitation, cognitive and behavioral disorders in brain-injured patients, spinal cord injuries, cognitive disorders related to addiction, complex obesity, care for amputees, and mobile SMR teams.

Specialized Technical Platforms (PTS)

Specialized Technical Platforms (PTS) in SMR utilize advanced equipment and organization to enhance assessment and rehabilitation. These platforms support intensive programs, assistive technologies, and instrumented measurements. A dedicated national fund supports these PTS to stabilize investments in costly equipment. recognised PTS include balneotherapy, isokinetic analysis, quantitative gait and movement analysis, upper limb rehabilitation, intensive lower limb rehabilitation, and driving rehabilitation platforms.

Expert Insight: The emphasis on both specialized expertise activities and technical platforms suggests a strategic effort to balance accessibility of core rehabilitation services with the provision of highly specialized care for complex conditions.

National Exoskeleton Equipment Plan

Following a national plan to equip territories with exoskeletons for intensive gait rehabilitation (at least two per department), the Auvergne-Rhône-Alpes Regional Health Agency has identified eligible facilities to achieve territorial coverage. These exoskeletons are deployed in facilities authorized for neurological system care.

The Role of the Regional Health Agency

The ARS is responsible for overseeing and developing the SMR offering. This includes planning the offering through the regional health plan, authorizing facilities, coordinating with healthcare providers (MCO, SMR, social care, and community services), promoting necessary agreements, monitoring admission timelines and flow, and evaluating existing expertise activities. The ARS may also launch calls for proposals to improve territorial coverage.

Frequently Asked Questions

What types of facilities can provide SMR services?

SMR activities can be provided in facilities dedicated solely to rehabilitation or within larger healthcare organizations that offer multiple services.

How is SMR funding determined?

Funding is determined through a mixed model, including a fixed component based on population needs and an activity-based component linked to the number of patients treated.

What are some examples of specialized expertise activities (AE) offered in SMR facilities?

Examples include neuro-orthopedic rehabilitation, post-resuscitation rehabilitation, and early neurological rehabilitation.

As the healthcare landscape continues to evolve, how might these regional strategies adapt to meet the changing needs of patients requiring specialized medical care and rehabilitation?