Rush towards Virtual Practice

Rush Presbyterian in Chicago has been refining a Virtual Integrated Practice (VIP) for the past four years.  The project has had multiple goals with the major goals noted as:

 

1. Refining the VIP intervention and implementing it over an 18 month period in four practice sites focusing on patients with diabetes type II, chronic obstructive pulmonary disease and urinary incontinence.  
2. Evaluate the efficacy of the intervention with regard to consistency, costs, patient and provider perception, selected patient indicators of health status and changes in disease specific health parameters.  
3. Promote practitioner usage of VIP locally and nationally and distribute findings of VIP intervention through a variety of collaborative activities.

Interestingly, the VIP team consisted of a nurse, a social worker/case manager, a physician, a pharmacist and a physical therapist.

Note that in a very recent meeting with the reimbursement experts with APTA, there was quite a bit of buzz about new CPT codes for telemedicine and internet consultation.....

Before you start ranting about the importance of seeing the patient in person and not trying to deliver care over the internet (please don't make me PT Whore of the Month!), I am curious if the group sees any use for this type of collaboration in the treatment of conditions like low back pain?

I see great potential for this type of system in enhancing the communication and thus the access to the services of qualified PT's in  a timely fashion.  If we can get the low back pain patient in front of us quicker we should be able to have better results in many cases?

This type of communication system also might allow for "pinging" the patient at defined intervals (3 months, 6 months....) to provide additional value (and gather additional data) to the patient over a longer period of time.

What do you think?

Comments

[Selena Horner]

It's too bad we aren't reimbursed for those types of activities.

For patient centered care, the definition of the codes need to be changed even more. Reality is that for communication between various providers face-to-face communication is only realistic if all are within the same facility. I know I lose chunks of my time because I am contacting a variety of other providers, such as those at: an oncologist office, a cardiologist office, nurse at a dialysis center, PCP. In those instances where there is communication for collaboration of care, we should be paid for that time on the phone or sending reports. And, sure, it's going to be a double whammy - both parties should be paid for their involvement.

There has been some research that supports follow-up communications to enhance adherence to recommendations. I see patterns here - every spring I have about 3 patients that were previous patients. They generally have back pain AND declining function. So... physical therapy is initiated. Well, during the winter they don't do a darn thing. So... I do think costs could be potentially reduced if a monthly contact could be set up and reimbursed to ensure that the person IS continuing to be active.

I believe that phone consults can occur (and I'd view it more like a "nurseline" kind of thing - some screening and general advice) - the main benefit would be to get the person going down a path of taking care of the current situation, reducing fear and knowing when to seek services - instead of putting off and putting off. No, I don't believe a phone consult can be as thorough, but it could be that first step in the patient being an active participant in resolving the current complaint. That type of thing though would need to be timely AND someone would need to obtain billing information.

[Eric Robertson]

On the whole collaboration between a defined health care team would increase the ability to provide care in a targeted fashion. The phone construct reminds me of the IM Doc model (http://www.npathinktank.com/2008/03/physical-therap.html). Finding a nice use for the phone might involve a change to the system with which we provide care. Selena further highlights this when she immediately responds with concerns for reimbursement, and rightly so!

The team approach used by Rush, and the individual approach used by Jay Parkinson, MD, make me ponder another point: In the evolution of care provision, and especially in the case of distance-based care, one model probably will not fit all. The VIP team makes sense for patients with multiple, or more complicated conditions, but young, health individuals with a bout of LBP may have no need for a nurse, a social worker, or even a pharmacist (but I am making a separate point with that one).