Making a program financially viable
Making a program financially viable
Piggyback with other treatments
Cancer patients who come to a campus center or hospital for treatment expect the services to be covered by insurance, and if it isn’t they frequently won’t participate. Therefore, when Complete Care, The Complementary Medicine Program of Fox Chase Cancer Center in Philadelphia was implemented in 1998, management had difficulty attracting patients to the services that were not reimbursed by insurance. To make the program viable, John R. Martinez, MPT, operations manager, began looking at each program to see if it might be reimbursed through physical therapy.
For example, about 70% to 90% of cancer patients undergoing chemotherapy or radiation treatment experience fatigue and are sent to physical therapy with a prescription for treatment for deconditioning. Martinez discovered that if the prescription included treatment for fatigue, and the physical therapist incorporated the complementary medicine center’s fatigue management program into the treatment plan it would be reimbursed. He garnered this information simply by talking with insurance companies.
He also discovered that other programs could be incorporated into the treatment program, as well. For example, the dance class for mastectomy patients increases the range of motion in their shoulders and could be considered therapeutic exercise, which is reimbursed under physical therapy. "Yoga is the same way. If the physical therapist sees that yoga may increase flexibility or strength, which is part of the treatment plan for patients, then it could be billed under group therapeutic exercise," says Martinez.
After making this discovery, he began to educate physical therapists and physicians about the therapies available at the center and how they may be incorporated into treatment. However, as the therapies became part of the patient’s treatment plan, the focus of the center began to change. It became an integrative therapy center rather than a complementary therapy center.
The change also impacted personnel. It now made more sense to use employees skilled in the techniques such as massage, rather than hire outside practitioners who had to be paid their usual hourly rate to learn how to write a medical note and other medical issues.
"If you have employees such as nurses or physical therapists doing the therapies they are already medically trained," explains Martinez.
A survey helped uncover skilled staff who were quite willing to incorporate two hours of massage a couple days of week at the center into their job description, or some other complementary therapy skill they had.
Although finding ways to receive insurance reimbursement helped bolster the program financially, new management decided to take a second look at the Center’s future. They currently are re-evaluating each program and even looking at the possibility of focusing on research. "We are primarily a research institution, so one of the questions they are asking is should we focus on research, turning the programs into research projects with the cost covered by grants," says Martinez.
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