Beyond the Clinic Walls

Health care organizations form novel partnerships to push physical therapy services into the community

"We believe the hospital as we know it is going to change. We are evolving to more and more outpatient care."

So predicted Maria Flannery, director of physician practices and ambulatory care at Main Line Health in suburban Philadelphia. Three years ago, Flannery and her colleagues began a conversation with the Exton Square Mall in Exton, Penn., about leasing space where they could provide medical services, including outpatient physical therapy.

The healthcare system already had a presence in the community, but their existing medical buildings were off the beaten path. "We wanted to be in a spot that was more accessible and visible to our patients," explained Flannery.

And with a location at the intersection of two major thoroughfares, in a mall that receives over two million visitors annually, they have achieved that visibility. "The feedback that we're getting is that it's easy to get to and easy to find. It's very patient-user friendly," said Josh Davidson, PT, DPT, SCS, CSCS, off-site outpatient rehab supervisor, Bryn Mawr Rehab Hospital, part of Main Line Health.

One user-friendly attribute is complimentary valet parking for patients. Parents of adolescent patients coming in for repeat visits appreciate that they can check items off their shopping list when their teens are in physical therapy sessions.

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Embodying a shift in consumer preferences, forward thinking health systems are moving toward outpatient and ambulatory care centers in convenient spaces, said Maria Flannery, director of physician practices and ambulatory care at Main Line Health in suburban Philadelphia. Main Line Health leases space at Exton Square Mall in Exton, Penn., where patients enjoy a range of services including physical therapy under the watch of Troy Norton, PT, OCS, ATC, CEAS, (below, dark blue shirt) and Josh Davidson, PT, DPT, SCS, CSCS (light blue shirt). Photos by Kyle Kielinski

Therapy Across the Gamut

"There's very little we don't have the capacity to treat," noted Davidson. "It really runs the gamut from pediatrics to geriatrics." Davidson and his physical therapy colleagues see patients after joint replacements and fractures. In addition to handling general musculoskeletal treatments, the mall location includes sports performance enhancement, return-to-play services, and post-concussion rehab. There is also an onsite lymphedema specialist to provide targeted physical therapy interventions to cancer survivors.

The space that Main Line Health leases in the mall includes a full rehab gym with typical therapy equipment and private treatment rooms. It was specially designed with high 16-foot ceilings that allow therapists and patients engaged in sports rehab extra space to practice sport-specific exercises and activities that wouldn't fit in a typical rehab gym. Main Line Health's space leaves them with room to grow and add additional services - something they are actively considering.

One of the draws of the location of the Main Line Health Center at the Exton Square Mall was the opportunity to offer a wide range of medical services under one roof - services that prior patients had to travel between different buildings to receive.

In this model, a patient can go from urgent care for a diagnosis, to radiology for an X-ray, to physical therapy to begin rehab, all on the same day. Representatives of the different medical disciplines benefit from not having their practices in separate silos. Interdisciplinary care is easier to coordinate. "Patients and staff benefit from the ability to have face-to-face conversations," explained Troy Norton, PT, OCS, ATC, CEAS, outpatient therapy operations manager for Bryn Mawr Rehab Hospital.

Like Attracts Like

Nearly 600 miles away, the Detroit Medical Center's Rehabilitation Institute of Michigan has its own community-based business partnership, dating back to 1998. The organization was looking for ways to bring therapy into the community, and building freestanding health centers was prohibitively expensive.

"We wanted to partner with people with like-minded missions," explained Patty Jobbitt, PT, MSA, COO, and a relationship with the Macomb Family YMCA in Mount Clemens, Mich., was born.

The YMCA is an attractive business partner because, like the Rehabilitation Institute of Michigan, "They are looking to provide health and wellness services for people from all walks of life," Jobbitt said. The healthcare system leases a dedicated space for therapy within the Macomb Family YMCA, but physical therapists and patients are allowed access to the entire facility and its amenities.

Eileen Zelenak, PT, has been there almost from the start, working as an onsite physical therapist at the YMCA for 15 years. Commonly she treats orthopedic injuries, including work-related injuries and post-surgical rehab. "We have all the traditional physical therapy equipment," she explained, such as foam rollers and therapeutic balls. The patients can also use the exercise machines in the YMCA.

Additionally, Zelenak and her patients have access to the Olympic-sized pool, where they can complete more exercises than in the smaller therapy pools typically found at physical therapy clinics. They can also use the full-sized basketball court for sports rehab for middle- and high-school athletes.

Having everything in one spot makes it convenient for the patients. Physical therapy services at the Macomb Family YMCA largely align with the PT services offered throughout the healthcare system.

Spirit of Cooperation

The Macomb Family YMCA, however, has the added bonus of being a more home-like atmosphere. "We tell our patients, we're small but mighty," Zelenak said. "Patients seem to like it because it's not that hospital setting. It's more positive." Zelenak frequently observes camaraderie among patients not often seen in more traditional locations.

That same spirit translates into cooperation among YMCA and Rehab Institute of Michigan staff. Zelenak partners with a certified athletic trainer from RIM to treat patients. "We have a really good relationship with the staff here at the Y," she noted. Personal trainers at YMCA will refer their clients to physical therapy. Recently, she treated a swimmer who needed more care than the personal trainer could provide.

And the pendulum swings the other way, with patients becoming YMCA members. "Patients can take responsibility for their recovery," Zelenak explained. After their therapy ends, Rehab Institute of Michigan physical therapy patients receive a 30-day free trial membership at the Macomb Family YMCA. For those that decide to sign up for a full membership - and, according to Zelenak, many do - the sign-up fee is waived.

Building a Presence

In central New Jersey, another healthcare system has realized the perks of being associated with a local YMCA. Princeton HealthCare System had been offering community-based health education programs for many years, in locations including the Hamilton Area YMCA in Hamilton Township. When the YMCA renovated and expanded about five years ago, the healthcare system sought to expand their partnership.

"We thought it would be a terrific place to serve people," explained Barry Rabner, CEO. "We [Princeton HCS and the YMCA] have similar values in how we interact with members, patients and families."

Offering physical therapy services in the Hamilton Area YMCA allowed the healthcare system to create a presence in southern Mercer County, N.J., an area formerly dominated by a competitor. "It brought knowledge of our services to a wider audience," said Linda Lucuski, MPT, Cert. MDT, rehab director. She was in from the ground floor at the YMCA location.

As is the case with the RIM/Macomb Family YMCA partnership, the Princeton HealthCare System leases a dedicated therapy space and has access to the complete YMCA facilities, including the pool for aquatic therapy. Physical therapists also commonly treat orthopedic dysfunctions, but the services go beyond that.

"We have an excellent program for patients with MS who need to work on gait, balance, and pain relief," said Lucuski.

There is also a vestibular rehab program for dizziness and vertigo, and a program for injured dancers looking to return to teaching and/or performance. One of the few patient populations they don't treat are children with developmental disabilities, as there is no dedicated pediatric PT at the YMCA.

Promoting Movement

Many physical therapy patients at the Hamilton Area YMCA are part of the senior population. "There's a beautiful relationship back and forth, with us receiving patients from the Y and our patients going on to join the Y," explained Lucuski. Physical therapists teach patients safe, gentle exercises, and patients realize they can continue those exercises at the YMCA after therapy is over. "We want to move people from being patients into rehab, into routine physical activity to maintain their health," Rabner explained.

"The beauty of the YMCA for the senior population is that it's very economical to join," Lucuski explained. From the standpoint of the healthcare system, partnering with the YMCA meant less overhead, as they didn't have to purchase expensive exercise equipment. The YMCA gets the benefit of potential new members. "It's a very good situation for both parties involved," she said.

Indeed, these physical therapists and executives all predict novel business partnerships will be the wave of the future. "There's an advantage to decentralizing services," noted Rabner. "It's much more efficient and seamless for the patient," commented Norton.

Jobbitt concluded, "It's been a positive model for us to get out into the community."

Danielle Bullen is on staff at ADVANCE. Contact: dbullen@advanceweb.com.

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