Bringing Patient Solutions to Light: Dr. Robert Krug’s Advocacy For Rehabilitation Medicine

President of Rehabilitation Medicine and Disability Consultants, Dr. Robert Krug, advises clients on complex disability claims and chronic medical conditions, providing care navigation and other advisory services that optimize patient outcomes. He is a past Chair of the American Medical Rehabilitation Providers Association and a prominent advocate for appropriate patient access to the specialized care offered by inpatient rehabilitation hospitals. In addition to his extensive clinical and administrative experience, Dr. Krug’s expertise in medical technology companies and startups that address senior wellness has positioned him as a leader in his field. He is committed to the use of evidence-based clinical guidelines. incorporating innovative technology and data analytics to achieve high-quality interdisciplinary care and, in turn, high-value clinical outcomes. 

Where did your passion for medicine come from?

From a very young age, I knew that I was born to be a physician. The privilege of caring for others, of being a healer—what could be better than that? It was during my fourth year of medical school and subsequent clinical internship year that I was first exposed to the medical field of Physical Medicine and Rehabilitation. To see the individual challenges each patient confronted—amputee, partial paralysis, brain injury sequelae, etc—and how they found the strength within themselves to overcome these with the help of the rehabilitation team working together for one singular purpose was inspiring. 

At the time, Harvard had just started its ACGME-accredited residency program in Physical Medicine and Rehabilitation (PM&R). I applied and became part of the first PM&R Residency Class for Spaulding Rehabilitation Hospital and Mass General Hospital in Boston. Here, I learned what it truly meant to be a physiatrist and how individuals with impairments related to injury, illness, or chronic disease can rebuild their lives. Choosing rehabilitation medicine as my chosen field has been the best decision I’ve ever made.

What is a problem you have identified in your field?

Physical Medicine and Rehabilitation is not a well-publicized or understood specialty field compared to other, more long-standing specialties. In the past couple of decades, there has been an increasing awareness of the value that our specialty brings to treating a diverse group of neurologic and musculoskeletal conditions—both acute, like a stroke or traumatic brain injury, and more chronic, such as multiple sclerosis. 

How do you think your background has impacted the success of Rehabilitation Medicine and Disability Consultants?

My experiences as a clinician, healthcare executive, and clinical service line leader have spanned the care continuum. They have provided me with a unique perspective on the many incentives, inefficiencies, and shortcomings of the U.S. Healthcare System, a system that very much remains in flux during this transformative period that goes back almost two decades when the concepts of accountable and value-based care started to go mainstream.

As a fervent believer in value-based care, my work with payors, providers, physician-hospital organizations, clinically integrated networks, and others has provided me with a deep understanding of the best ways to assist patients in navigating the healthcare system. The goal is to achieve the best possible outcome by anticipating the challenges and obstacles along their recovery/care journey. An illness or serious injury is often impacted by many life stressors, some of which result from the way the healthcare system functions and others that are specific to each individual’s circumstances. There is a common saying, “Life is as much about the journey as it is the destination.” This really rings true when dealing with one’s health. By providing the patient with more seamless, less stressful, high-quality care, the likelihood of achieving the best possible outcome is increased. Top-performing health systems or hospitals understand this, developing processes and care approaches that embrace the patient experience as part of their high-value care outcome quality dashboard.

Such knowledge, combined with my understanding of what rehabilitation services offer when optimally implemented, has enabled Rehabilitation Medicine and Disability Consultants to assist hospitals in improving their patient flow and triage. This ensures patients are getting the right care at the right place at the right time. When implemented properly, the net results include better patient experience, better quality outcomes, a significant reduction in excess days, and an overall improved financial performance. Everyone—the patient, the provider, the hospital, and the payor—wins. 

What is a unique tenet of your work that sets you apart?

In any work we undertake, we focus on being good listeners and communicators to ensure that the stakeholders fully understand the issue we are working through. When we are providing patient advisory services, it’s ensuring they have an understanding of the clinical issues, management options (including sites of service), reimbursement and coverage issues, and support available upon discharge. The goal is always to develop an individualized plan of care that is realistic and achievable. 

When working with an organization, we take the time to understand the goal within the context of the organization’s strategic plan, culture, alignment with its medical staff, and current operational performance. It is this more holistic approach that yields action steps or tactics that result in the successful attainment of each goal.

What is one of your greatest achievements, and how did the experience make you feel?

Looking back on my career, one of my greatest achievements has been my role in developing a unique integrated care model for those afflicted with multiple sclerosis. MS is a disease that often declares itself when one is in their twenties or thirties. For those more severely afflicted, it can impact them physically, cognitively, and emotionally. The medical issues and the financial challenges that often result can be particularly stressful. Being able to provide a truly integrated, interdisciplinary approach to their care that is easily accessible and coordinated under one roof resonated with the MS community.

Housing this innovative model within a medical rehabilitation hospital provided access to all the wrap-around services that truly distinguished this program from most other MS Centers. When Rich Gifillian, a former leader of the CMS Innovation Center, toured the Mandell MS Center in 2015, he opined that it represented the quintessential example of what a clinical home should look like for a specific patient population. He asked me that day if I thought the concept was scalable, and that led to my team opening two Mandell centers in Waterbury, Connecticut, and Springfield, Massachusetts. Thousands of individuals with MS have benefitted from the comprehensive, individualized care offered at these centers.

Top Takeaways

• Patients facing challenges find strength with the right resources and rehabilitation team.

• An integrated care model for common maladies addresses unmet healthcare needs in new and important ways.

• The value of Physical Medicine and Rehabilitation, both to patients and healthcare organizations alike, is considerable, and continued awareness will positively impact patient outcomes and connect them with the proper resources.