Evan Grant, Medical Director, Encompass Health Rehabilitation Hospital of Miami

Invest: spoke with Evan Grant, medical director of Encompass Health Rehabilitation Hospital of Miami, about the structure of inpatient rehabilitation, the role of multidisciplinary teams, and the trends shaping the field in South Florida, including cost. “Case management starts discharge planning on day one, because getting patients home safely requires setting expectations early around length of stay, equipment, and therapy needs,” Grant said.

How are hospitals like yours delivering the level of rehabilitation needed to improve outcomes across the region?
The model we use is acute inpatient rehabilitation, also referred to as IRF, or inpatient rehabilitation facility. The structure of this setting is built around identifying which patients need a higher intensity of rehabilitation versus those who may be better suited to a less intense setting. Patients who come here need to be able to tolerate three hours of therapy per day, or 15 hours per week if that time is spread out.

That therapy usually includes physical and occupational therapy, as well as speech-language pathology for patients with swallowing, speech, or cognitive deficits. It is a higher-intensity alternative than subacute rehabilitation. Our responsibility is to evaluate patients who meet the criteria established under Medicare and CMS rules and make sure this program is a good fit, that they can tolerate the intensity, and that it will accelerate their progress beyond what they might achieve in a less intense setting.

How do your multidisciplinary teams work together to build recovery plans around each patient’s needs?
Each patient is different. We care for patients with strokes, spinal cord injuries, neurological conditions, and multiple fractures, so everyone is recovering in a different way from a different injury. It is a team effort in every sense of the word.

The rehabilitation physician sees the patient at a minimum three times per week, but in most cases, daily, along with an internist and any specialists who may need to augment the care. Occupational therapists focus more on activities of daily living such as eating, grooming, dressing, toileting, and bathing. Physical therapists focus more on leg work, trunk work, and mobility, whether that is walking, transfers from bed to wheelchair, wheelchair to toilet, or bed mobility.

Speech-language pathology has two major roles. One is swallowing, which is essential because if a patient cannot achieve nutrition and hydration, it is difficult to progress in any other area. The other is cognition, language, and speech, especially for patients dealing with confusion, cognitive decline, or aphasia.

Beyond that, nursing is essential because our patients are sick. Nurses manage skin protection, bowel and bladder care, and medication administration, and some of them pursue additional rehabilitation-specific certification. We also have nutrition specialists helping patients meet their dietary and hydration needs, particularly in neurological and older populations. Case management starts discharge planning on day one because getting patients home safely requires setting expectations early around length of stay, equipment, and therapy needs. Neuropsychology is also essential because many patients are coping with a major decline in function and need support as they adjust emotionally.

How are newer technologies helping your teams and your patients, particularly as demand continues to grow?
Technology in rehabilitation is a broad topic, and much of what we incorporate comes from large academic centers. One area where technology is clearly advancing care is prosthetics and orthotics. With amputations, we have gone from basic devices to microprocessor knees and other systems that combine hardware and software. AI will likely further augment that by helping devices measure and adjust to pressure and weight in ways that improve gait.

There is also research happening in Florida around 3D printing to make prosthetic sockets more quickly. That matters because one of the bottlenecks in rehabilitation is the time it takes for the wound to heal and for the prosthesis fabrication process to move forward. If 3D printing can shorten that timeline, it could help patients begin practicing sooner.

In spinal cord injury and, in some cases, stroke, there are also robotic systems, such as ReWalk technology, that can simulate standing. These systems are not necessarily meant to permanently replace function, but they can provide the benefits of standing, including weight-bearing, pressure through the joints, reduced atrophy, and even the psychological benefit of being upright. There are also augmented reality applications being explored for patients with stroke or brain injury, particularly for those with neglect or visual field deficits, to simulate real-life environments and create opportunities for patients to practice responding to obstacles or errors in a controlled setting.

What strategies already in use are proving effective in helping patients regain independence?
The technologies that are most executable right now are often the ones that are less hardware-intensive and more software-based. Software is usually cheaper to build and easier for hospitals to experiment with.

One example we use is the Bioness Integrated Therapy System. It is a touchscreen-based platform that creates game-like scenarios where patients can test coordination and receive feedback. The system can be set up to target visual deficits, left-side scanning, neglect, and dexterity. This kind of gamification is already being used in real time, especially in rehabilitation for brain injury and stroke, and it is one of the more practical ways to target neurological deficits without the same cost barrier that comes with more complex hardware.

As access and affordability remain major concerns, what steps is Encompass Health taking for uninsured or underinsured patients?
The first step is having a robust case management team that is familiar with community-specific resources. Services available in one part of the state may not exist in another, so local knowledge matters. We are also using a company called Getix, which helps us streamline support for patients who may be self-pay. It specializes in healthcare revenue cycle management and helps identify and enroll patients more quickly in programs they may qualify for.

That is important because once a patient is here, if their coverage runs out, we still have a responsibility to find a safe place for them. We also rely on familiarity with local shelters and community resources. We recently saw a new shelter open in our area, which created another option for patients who qualify and can manage themselves in that environment. In addition, placement specialists work with assisted living facilities and group homes and can sometimes help us bridge financial gaps when patients do not meet a facility’s income threshold.

Looking ahead three to five years, what trends do you think will shape rehabilitation medicine in Florida and Miami, and how is your hospital preparing?
Cost will remain central. The service we provide is expensive, so while we may sometimes wish patients had longer lengths of stay, we also have to be mindful that there is an upper limit to how much of this kind of service can be provided. That means we have to keep demonstrating that inpatient rehabilitation is both necessary and efficient.

We have a lobby within the company that advocates not only for Encompass Health specifically but for inpatient rehabilitation more broadly. We want policymakers to understand that this is a necessary resource, and we also need to show, through data and careful allocation of resources, that we are using that support efficiently. That will remain a major part of the future of the field.

Florida also has a unique demographic profile. The population is aging, and the state continues to draw retirees as well as immigrants and new residents from elsewhere in the United States. That creates a growing need for inpatient rehabilitation. Encompass Health is responding by expanding as a company, especially in the Southeast and in Florida, with new hospitals in areas where this service is not as available as it needs to be.

A major strength of Encompass Health is that we specialize. We do only acute rehabilitation. We draw on detailed data from 175 hospitals, which allows us to establish best practices across the company. If one hospital is underperforming compared with another, we can identify what is working elsewhere and adapt. That also helps us meet growing demands from CMS and Medicare to show that we are improving patient outcomes relative to less costly alternatives. The more deliberate we are in gathering and publishing that data, the more we can prove that this service is getting patients home sooner and better, which is the ultimate goal.