Vol. 15 •Issue 8 • Page 53
Marketing Pulmonary Rehab
Patients improve, but why doesn’t the phone ring?
Without fail, Vickie Klein, CRT, RCP, plays the lotto every Friday. If her lucky numbers hit, the money won’t go toward a fancy car, 30-room mansion, or luxury yacht.
Klein said she will use the windfall to promote pulmonary rehabilitation.
Her facility, like many others around the country, doesn’t attract the number of patients it should.
People who go to pulmonary rehab have improved sleep, enhanced breathing, increased exercise tolerance, and superior knowledge of lung disease and how best to manage daily activities. They also make fewer (and shorter) trips to the hospital.
“We should be busting through the seams,” said Klein, director of pulmonary rehab, Heartland Therapy Centers, Kansas City, Mo. “It’s always a struggle to get patients, and I don’t understand it.”
Discouraged but not ready to fail, the passionate (but not yet filthy rich) respiratory therapist feverishly discusses pulmonary rehab with primary care physicians and pulmonologists, visiting their offices and taking them out to lunch.
“They say, ‘This sounds great.’ But the fax machine is still silent,” she said. “It should be a no-brainer.”
The results, after all, are hard to question, Klein said. Prior to visiting her, patients often use their metered dose inhaler incorrectly and pant when they breathe.
“They couldn’t walk 50 feet,” she said. “When I’m done with them, they can go 20 minutes on the treadmill.”
Why then is getting a full patient load such a problem?
Not a last resort
A lot of times, primary care physicians (less so with pulmonologists) see rehab as a last ditch solution, said June Schulz, RRT, FAACVPR, pulmonary rehab coordinator, Sioux Valley Hospital, Sioux Falls, S.D.
She would prefer that rehab be partnered with medications and smoking cessation right from the start. If that happened more often, Schulz said, uncomfortable conversations and further lung impairment could be avoided.
“Patients know if they would have done this five years ago, their entire quality of life and lifespan would be different than what it is now,” she said. “I hear it all the time: ‘Why didn’t my doctor send me here earlier?’ It puts us in a bad spot. How do you answer that question?”
Doctors have nothing against pulmonary rehab, explained Marjorie King, MD, FACC, FAACVPR.
“We think it’s a great idea,” said Dr. King, president of the American Association of Cardiovascular and Pulmonary Rehabilitation. “In the office, we’re just so focused on the acute care needs that we forget the rehab.”
The trick, she said, is to seamlessly integrate rehab into the physician’s care plan.
“They need to be able to show doctors that what they do helps their patients and does not involve additional work by themselves or their staff,” Dr. King said.
Promoting patient outcomes
Physicians, obviously, love to see healthy-looking patients. However, they also look for detailed outcomes data, clinical trials, and scientific statements, Dr. King noted.
To this end, Heartland tracks 40 clinical indicators, which its staff reports to the doctors, said Chief Executive Officer Jeff Neustaedter. Measures include: dyspnea; weight; distance walked in six minutes; and oxygen saturation level, heart rate, and blood pressure at rest, exercise, and recovery.
Based on the overall scoring of the indicators, his patients improve an average of 40 percent to 90 percent. “The physicians are impressed by it, but it hasn’t moved the needle like we would hope,” Neustaedter said.
As another promotional tool, he encourages all his patients to share successes with their physicians. These stories often become a facility’s best kind of advertising.
One of Schulz’s patients returned to his doctor with a book detailing all the steps taken at pulmonary rehab. Previously laissez-faire about the program, he started to pay attention.
“The physician has been so good about referrals ever since then,” she said. “All the calls and letters I sent didn’t do anything.”
Lana Hilling, RCP, FAACVPR, reminds her patients to thank their docs during every maintenance office visit for referring them to rehab. It doesn’t matter if they’re 15 years removed from their “graduation,” she said. Doctors, eventually, will notice.
“We should be at the top of the physician’s mind,” said Hilling, pulmonary rehab coordinator, John Muir Health, Concord, Calif.
She also tries to play off doctors’ competitive spirits. For example, at a local four-person practice, Hilling awards a plaque to the physician who has the most referrals for each quarter. She’ll follow-up with e-mails to let them know how far they lag behind the leader.
“It gets in their face,” Hilling said.
A simple plaque only costs $20 — a reminder that facilities don’t have to spend thousands of dollars on pricey TV, radio, or newspaper ads (although, an unlimited budget can’t hurt).
Sending out press releases prior to National Pulmonary Rehabilitation Week (March 18-24, 2007) is a smarter way to use the media, Schulz said. Volunteer your facility as a location for a shoot and offer your staff as expert sources.
To help programs along, the members-only section of AACVPR’s Web site (www.aacvpr.org) features a forum to discuss more marketing ideas.
In addition, the organization has a slideshow and newsletters for referring physicians and patients, and a joint statement with the American College of Chest Physicians touting rehab’s benefits will be published in the journal Chest this fall.
“You just have to plug away. You can’t be passive,” Dr. King advised. “It’s salesmanship and marketing for the benefit of our patients.”
Programs could get a nice assist if some pending legislation passes.
Currently, there’s no national coverage benefit policy for pulmonary rehab, Dr. King said. Intermediaries recognize it, though, and cover it in different ways.
“That means what we do for reimbursement in South Dakota is different than what my cohorts in North Dakota can do,” Schulz said. “It varies from state to state. It’s crazy. There’s just no standard to it.”
The Pulmonary and Cardiac Rehabilitation Act of 2005, introduced in both the Senate and House of Representatives, will put an end to the patchwork coverage, Neustaedter said. Medicare contractors will have clear guidance regarding who, when, and how much rehab is covered.
If Medicare properly recognizes pulmonary rehab, codes can built in “so at least there’s a chance for us to break even,” Schulz said. “Hospitals who were shying away could now look at it.”
Klein can’t help but get emotional when thinking about the possibility of more rehab facilities opening around the country.
“I just tear up,” she said. “So many people out there don’t realize they can better themselves through pulmonary rehab.”
Mike Bederka is senior associate editor of ADVANCE. He can be reached at firstname.lastname@example.org.
Patients Usually Rush to Cardiac Rehab
While pulmonary rehabilitation programs struggle with enrollment, the problem isn’t as pronounced for their brothers and sisters in the cardiac rehab business.
Patients, most likely, feel a greater sense of urgency with problems surrounding the ol’ ticker, explained Lana Hilling, RCP, FAACVPR, pulmonary rehab coordinator, John Muir Health, Concord, Calif. “If you have a heart attack, you’re scared to death, and you want to do anything you can to get better.”
In contrast, patients can languish with chronic obstructive pulmonary disease for 20 years before they’re motivated to take action.
Also, with more research and scientific evidence behind it, cardiac rehab has a greater history in the medical community, said June Schulz, RRT, FAACVPR, pulmonary rehab coordinator, Sioux Valley Hospital, Sioux Falls, S.D.
“It’s becoming standard care rather than something over and above,” she said. “We need to get to the point where if you’re diagnosed with COPD, emphysema, or bronchiectasis, the automatic standard of care is pulmonary rehab.”
Exercise is crucial for chronic obstructive pulmonary disease patients. Stretching and breathing exercises, plus a daily walk, is a good start.
Over time, three distinct kinds of exercise should be incorporated into the patient’s regular routine:
1. Stretching. It relaxes the patient and improves flexibility. Stretching also is a good way to warm up before and cool down after exercising.
2. Aerobic exercise. This improves cardiovascular fitness, allowing the body to use oxygen more efficiently.
3. Resistance training. When all the muscles are stronger — especially in the upper body — the breathing muscles have an easier time.
Source: The Canadian Lung Association