Traveling therapists give care in remote areas

Hospital contracts with community providers

When patients in rural Oregon can't come to the hospital for outpatient occupational or speech therapy services, St. Charles Medical Center brings the services to them. The rehab department at the Bend, OR, hospital has contracts to provide therapy services for three other community hospitals in central Oregon. Hospital therapists made 2,300 patient visits outside Bend last year. All three communities already have access to physical therapy, either through the hospital or a community clinic.

"Through an organization of health care providers, Central Oregon Hospital Network, we try to support other facilities by providing rehab services for people in their communities," says Alan Burke, LCSW, team leader for outpatient rehab and social work.

St. Charles' rehab services employees two occupational therapists and a speech/language pathologist who travel to the communities and provide therapy in a variety of settings, including homes, nursing homes, hospices, and acute care hospitals. The communities are 20 to 45 miles from Bend. Some patients served by St. Charles are homebound and can't come to Bend for services. Others can participate in outpatient services, but St. Charles tries to provide them in the community so they don't have to spend two hours a day traveling. "A lot of times, travel can fatigue patients. This way, they can benefit more directly from actual therapy," Burke says.

Some patients were discharged from St. Charles Hospital; others have been inpatients at local hospitals. Two occupational therapists provide 60 hours a week of coverage. The speech pathologist works with patients for 30 hours a week. Because of increased need, the hospital will add a second speech-language pathologist this year who will provide 16 hours of coverage a week. The traveling therapists often work 10 hours a day because of the travel. "It allows us to get more done in a day than if they were putting in an eight-hour day. We find this is more cost-effective," Burke says.

St. Charles' therapy services department bills the contracting hospitals an hourly rate, based on 15-minute increments, and includes mileage and travel time in the bill.