The PRAXIS Nexus The PRAXIS Nexus

The PRAXIS Nexus Brainstorm: A New Pulmonary Rehab Option

Posted on October 09, 2015   |   
3 Comments   |   
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pulmonary rehabilitation

Every few weeks, the PRAXIS team will present the community with a scenario designed to get us all thinking about inventive and original ways to approach everyday care and organizational challenges. There are no right answers to these; we simply hope that sharing our collective ideas will help all of us to expand our thinking and provide us with approaches and remedies that might not have been in our toolbox before the discussion. Let's get started with a situation that some of you may have encountered before: expanding a program with limited resources.

Scenario: Starting a new pulmonary rehabilitation program without additional funding

You are an RT manager working in a small suburban health system. You work with a very supportive administration that is open to innovative ideas that help your organization do more with existing resources. Given funding constraints, you are unable to build additional local pulmonary rehabilitation centers in your area. The demand for rehab is high; it will take seven years to see all COPD patients waiting for PR in your state. Assuming insurance reimbursement is there as well as adequate staff to see additional patients, how and where could you implement a pulmonary rehabilitation program in an innovative and effective way?

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  • What about partnering with a local organization? Could be either something nonprofit like the YMCA or even one of the smaller 'pop-up' gyms like Planet Fitness. Either group could be persuaded to help, either by appealing to their community mission or by potentially excellent PR in the community. Of course, some modifications would have to be made (hauling in extra tanks for rehab day, maybe bringing in portable monitoring equipment), but the details shouldn't be insurmountable, or would they?
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  • I think that it should be done at the hospital for the main reason that I wouldn't of gone to the Y to do something like this. I wanted to be monitored and have oxygen available to me. By combining a respiratory therapist and your local oxygen company to work together, this might be an option. Although I think it would then be come cost prohibitive.

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  • In this scenario, staffing isn't an issue. It sounds like what is needed is space and equipment. So, it would make sense to look for a place that had those two things. Perhaps a Physical Therapy location could be used at certain times. Local gyms, a YMCA, even a Community Center with equipment are options. The primary barrier I see to this approach is that a physician must be on-site "available and interruptable" in order to bill Medicare for PR. It would be tricky to get that criterion met at a gym. It would be worth pursuing this idea to see what is possible, though.

    We have a Pulmonary Rehab Program that is located in a rural FQHC (Federally Qualified Health Center--primary care for an under-served population.) While we did have to add a small addition and equipment, it has brought PR to an area that would not be able to have it otherwise. We are about 30 minutes from the nearest hospital. This model is wonderful because it offers truly integrated care. If a patient comes and is sick, or has an issue while exercising, their PCP is just down the hall. If a provider wants a patient to attend PR, I can come for a face-to-face discussion immediately, during their PCP visit. I can meet with the rest of the patient's team to discuss issues or treatment options. While this doesn't totally fit the above scenario, since we did build an addition, it is a model that is working beautifully for our patients.

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