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Before creating a complementary medicine program at Fox Chase Cancer Center in Philadelphia, administrators allocated funds for a feasibility analysis. Therefore, a group of 10 people, including two to three outside consultants, headed by the vice president of communications spent a year and a half visiting other facilities that had implemented programs, gathering facts and numbers, and analyzing the information gathered.
The group even surveyed physicians on staff and found they were very supportive of complementary medicine services as long as they were included in the development process.
"We thought it was important to take our time deciding what we were going to do and if it was feasible or not," says John R. Martinez, MPT, director of cancer prevention screenings and customer service. Martinez worked as a consultant on the feasibility committee and later was appointed operations manager of the center and served in that position until recently.
In spite of the time spent, mistakes were made that had to be quickly corrected in order for the program to pay for itself. The facility was expected to break even in three to five years and that included recouping the start-up costs.
The first mistake was locating the center off campus, although the selection was based on information gathered from focus groups. Later it became clear that it was the cancer survivors who did not want to return to Fox Chase for complementary medicine services; however, the patients found an off-campus site inconvenient. "It is difficult to get patients undergoing outpatient service to get back in their car and come five blocks over," says Martinez. To remedy the problem, the center tried offering a van service and providing complementary services at the hospital.
A second mistake was in implementing a wide selection of services based on their national popularity. When the center opened, it offered about 10 to 12 services including fatigue management, dance, massage, music therapy, nutrition, yoga, and strength and movement management. Administrators discovered, however, that the clientele were not using all the services offered.
For example, people did not use the music therapy service even though the center conducted educational seminars to help people understand its value and how it worked. "We started to realize that our particular patient population was not interested in music therapy. [The patients] may show an interest in what it is about, but they would never pay for it," he says.
The music therapist was available twice a week for six months at The Complementary Medicine Program of Fox Chase Cancer Center and during that period only got about four patients. Yet, a facility in another part of Philadelphia had a full-time music therapist who was always booked. "We found out that what was of interest in one community was not necessarily of interest in another," says Martinez.
To correct for mistakes in programming, Martinez began to survey the people who came to the center asking such questions as what they were interested in and whether they would pay for the service because insurance did not cover complementary therapies. He conducted program reviews every three months and then made changes accordingly.
After the first three months, the center switched from one-on-one sessions to more group programs because the clientele couldn’t afford individual sessions. "We had to charge prices high enough to pay for the contractors since they were not employees," says Martinez. However, there were exceptions. For example, hypnotherapy is one of the centers strongest programs although the fee is $60 an hour for an individual session.
Continual surveys are a must for programs to be dynamic, he says. Yoga was very popular for a year and then attendance began to drop off. Hiring practitioners on a subcontractor basis worked very well for such a dynamic process because the hours of service could easily be adjusted.
"Facilities that don’t charge for programs have more room for error. I always had to go to our executive vice president and president and justify the continuation of a program," says Martinez. By the end of two years, he had established eight solid programs at the center, and many were reimbursed by insurance.
Physician referral is important for building clientele, and although physicians indicated support for complementary therapies during the feasibility study, Martinez found that they didn’t tell patients about the services.
"One of the reasons they don’t refer is that they don’t truly understand complementary therapies so they don’t know when to refer patients," he explains.
Therefore, he worked on educating physicians by talking with them in the clinic informally and attending rounds once a week with the attending physician and medical students to gain exposure. He could then identify a patient who could use hypnotherapy for pain or a person with fatigue issues who would benefit from the fatigue management program.
[For more information on Complete Care, The Complementary Medicine Program of Fox Chase Cancer Center, contact: John R. Martinez, MPT, Director of Cancer Prevention Screenings and Customer Service, Fox Chase Cancer Center, 7701 Burholme Ave., Philadelphia, PA 19111. Telephone: (610) 529-8565. E-mail: firstname.lastname@example.org.]