Paul A. Rockar, Jr., PT, DPT, MS CEO, CEO Centers for Rehab Services Vice President, APTA Board of Directors
History and Background Four Physical Therapists in a Private Practice (certified rehab agency) providing PT, OT, SLP in a variety of settings (OP, LTC s, Hospital) Functioning fine and then managed care hit the area In mid 90 s became a part of a local l Physical Therapy Provider Network with little to no benefit Academic Chair of Dept of PT at Pitt approached this group to partner for source of clinical education sites and clinical research sites Group voted against this partnership (10 2)
At same time this was occurring the UPMC Health System was evaluating the status of their rehabilitation services Were facing challenges: staffing, administrative oversight, and productivity Wanted to expand OP services but were tentative in light of issues before them Had discussion with academic department regarding possibilities in light of needs of both entities Approached our practice due our past association with the program (alumni and adjunct faculty) and 10 year history of successful private practice
After long term discussions the end result was the formation of a 50/50 partnership between the private practice and the health system with the academic department becoming an integral part of the arrangement Key elements: the private practice had an equity interest; the physical therapists would run the practice and be ultimately responsible for the day to day operations; there would be ongoing collaboration with the health system regarding expansion and development; and the mission would include practice, education, and research
Organizational Structure Highlights CEO: Physical Therapist CFO: Physical Therapist 2 Executive VP s: Physical Therapists 1 VP Professional Development and Research: Chair, Dept. of PT, Pitt 1 VP Quality Improvement/Utilization Review: Faculty, Dept. of PT, Pitt Other split positions to handle Clin Ed, QI/UR functions, etc.
Where did this take us? In 1996 we began with 10 OP sites (primarily musculoskeletal), 2 hospital contracts, and 2 LTC contracts As of October 2009: 45 OP sites, 8 hospital sites ranging from community based to academic based, 5 LTC contracts OP now includes Neuro and Women s Health in addition to the musculoskeletal Have APTA credentialed residencies in Sports, Ortho, and Neuro with ih Women s Health in the mix for 2010
The hospital sites include acute, TCU, and IRF beds Employee base has grown to 670 FTE s (980 employees) In our immediate future is expansion into Northwestern Pennsylvania which will move us to not only include urban settings but rural as well
Key Elements/Benefits for Clinical Staff In addition to standard benefits we have been able to maintain other key professional benefits These include: $1500 con ed monies per calendar year or $3500 academic tuition per calendar (can use a combination) Professional membership dues Licensure renewal Access to Pitt Health Science Library System online In addition to clinical supervision of students have ability to participate in didactic portion of curriculum as adjunct faculty
Ability to collaborate with faculty to solve critical patient management issues through welldesigned QI initiatives that are evidenced based Ability to participate in ongoing clinical research projects (e.g. lumbar stenosis, OA of Knee, post partum LBP) Participation in and adherence to a thorough, ongoing compliance monitoring program Have the resources available to answer clinical questions that arise and feel a part of moving the profession forward
Key Elements for Academic Program Extensive clinical education site base in varied settings Clinical research sites Pool of qualified adjunct faculty Pool of qualified clinicians to carry out clinical research protocols Access to management and clinicians to pose new clinical questions and develop methodologies to answer those questions Opportunity to collaborate with other disciplines (PM&R, OT, SLP) Ability to conduct clinical research that is true health policy research the setting is prime for evaluating not only efficacy but also cost and other parameters of care
The End Result for Our Practice and for the Profession The advancement of practice through the collaboration with education and research Contributions i to the literature Professional development that is well thought out, meaningful, and contributes to not only the individual but the practice as well Creates an environment that identifies and develops Creates an environment that identifies and develops future faculty as well as researchers
Some Examples of Researchers and Clinicians Working Together Low Back Quality Improvement Initiative: Preliminary data indicate patients that are managed by an evidence based classification protocol incur approximately $1000 less in downstream medical costs Post Partum Partum LBP: significant number of participants had a 50% reduction of Modified Oswestry score after one session utilizing thrust techniques Physical Therapy management of post concussion patients: development of clinical protocol and clinical questions