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Rehabs can place themselves in a position to provide services otherwise met on a limited scale — or not at all — in most communities.
That’s what Howard Young Medical Center of Woodruff, WI, did by establishing an incontinence program providing specialized services in treating pelvic pain, incontinence, bowel and bladder dysfunction, and bladder dysergia for children.
The 99-bed hospital, which has eight rehab beds, began the program with a goal to offer incontinence services not being addressed in the small resort community, says Susanne Porter, PT, CertMDT, a physical therapist with Howard Young. "We address any form of pelvic problem, whether its incoordination or weakness or hypertonicity," Porter says. "We had been seeing patients who had these complaints, but we wanted to address it in a formal program."
Porter spent six months marketing the program by meeting with urologists, gynecologists, family practitioners, and internal medicine doctors. "I also met with nurse practitioners, nurses, and the medical staff of various departments," she adds.
She met physicians for lunch or breakfast or for 15 minutes in a staff meeting. Porter gave them one-page handouts that identified the signs and symptoms of pelvic dysfunction the program could treat. It also described how Porter would assess the program and which ICD-9-CM codes she could treat, so they would know exactly how to write the order. (See sample marketing tool.)
"We only have 40 physicians in this community, and I met with 20 physicians," Porter says. "It took about a month for referrals to come in." She now sees about 10 patients a week in the incontinence program, an ideal workload since Porter also spends time doing regular physical therapy work at the rehab facility. "If I wanted to make this a busier practice, I could, because it’s being reimbursed by all payers," she says.
The program typically involves Porter meeting with patients for one to four visits. The initial evaluation lasts 45 minutes to an hour, depending on how complicated the problem is. Follow-up visits are 15 to 30 minutes, and some are simply phone checkups.
Porter teaches patients how to use their bodies, especially abdominal muscles, properly so they’re not putting increased stress on their pelvic area. She also teaches them how to do the Kegel exercise, a form of pelvic muscle contractions. "Most of the people I see are doing the contraction improperly, or they haven’t learned how to have the proper rest-contraction cycle," Porter says. "So I teach them how to relax and do it properly."
She also teaches patients how to perform self-massage to help their muscles work properly, and she teaches some patients how to improve bowel and bladder habits.
"The other component is prenatal instruction to teach patients how to relax for a delivery and to help them with bladder function," Porter says. "So I have a prenatal education and exercise class that I incorporate a lot of this stuff into."
• Susanne Porter, PT, CertMDT, Physical Therapist, Howard Young Medical Center, Department of Rehabilitation, P.O. Box 470, Woodruff, WI 54568-0470. Telephone: (715) 356-8870. Fax: (715) 356-8079.