Facility Profile: National Rehabilitation Hospital and Physiotherapy Associates

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June/July 2000

By Liz Finch

Molding a Symbiotic Partnership

Mark Valente, PT, John Battinelli, PT, and John Brickley, PT.

John Brickley, PT, Mark Valente, PT, and John Battinelli, PT.

Two organizations committed to setting high standards for rehabilitation for more than a decade have pooled their resources in hopes of creating an effective, expansive network of rehab services in the mid-Atlantic area. As the new millennium began, so too did the affiliation between MedStar Health’s National Rehab Hospital (NRH), Washington, DC, and Physiotherapy Associates (PA), Memphis, Tenn.

Both partners in the deal have an esteemed history in the rehab world. PA was established in 1985 as an outpatient physical therapy division of the Stryker Corp, an international manufacturer of orthopedic and medical instrumentation. Now it has more than 250 facilities in 25 states—a network of clinics providing orthopedic care, sports medicine, industrial rehab, a speech language program, hand therapy, wound care, women’s health, retirement community rehab, a Parkinson’s program, and neurological services to patients around the country.

The 14-year-old NRH is the Washington area’s only freestanding, comprehensive medical rehab hospital, and has been named to US News & World Report’s list of Best Hospitals six times. The hospital offers acute care rehab, inpatient medical rehab, day treatment programs, a driver training program, an amputee program, and specialty inpatient programs dedicated to stroke, spinal cord injury, brain injury, and musculoskeletal conditions.

Building a Network

According to John Brickley, PT, NRH’s vice president for the ambulatory network, NRH realized that only being an inpatient hospital was not the safest thing to do for a facility that wanted to be the regional leader in comprehensive rehab.

“We knew that we needed to go out where the patients were and open more sites, and we needed to do that collaboratively,” he says. “We started working with other acute care hospitals that needed a stronger rehab presence, and had a community presence and desire, but no experience.”

NRH collaborated with area hospitals to build an outpatient network called Regional Rehab that encompasses 18 outpatient sites in Maryland and the Washington, DC, area.

“The whole idea was to begin to generate a network of sites large enough to be viewed positively and have an influence over how therapy is done,” Brickley says. “There were some existing networks composed of loosely structured sites, but there was not the kind of consistency and quality an integrated network could provide,” he comments.

So together, NRH and PA are building a far-reaching regional outpatient medical rehab network designed to appeal to patients, caregivers, insurers, and employers alike. With an investment of $1 million, MedStar/NRH became co-owners of PA’s Mid-Atlantic Network for Physical Therapy (MAN PT), which contracts with managed care insurers for outpatient rehab services in Maryland, the District of Columbia, northern Virginia, Delaware, and Pennsylvania. NRH is now part owner of five PA outpatient rehab centers in Maryland, and there are plans to open additional clinic sites in the Washington/Baltimore area. In some situations, clinics will be staffed with PA employees, while others will be with NRH/Medstar staff. Brickley says it depends on whatever makes most sense in each venture.

Brickley notes that NRH chose PA as a partner because of its strong national presence and strong network in the mid-Atlantic region, as well as the fact that it owned and operated its own sites.

“It is easier to have consistent quality when one group manages those sites rather than when they are owned and managed by 100 different people,” Brickley says. “PA has 120 locations, over 50% of which are owned and managed by PA. Together it is easier for us to deliver what we promise: consistency.”

Mark Valente, PT, regional manager of the mid-Atlantic region for PA, says his company was likewise looking for a way to provide consistency of care in that region. PA has done other ventures in northern Maryland, Atlanta, and further west, and in all of those situations Valente says PA was able to raise the level of rehab care and provide great service to physicians in those hospitals.

“PA had owned MAN PT for 4 years, but it needed areas filled around Washington, DC, and eastern and western Maryland. We knew that together with NRH, we could build and manage to provide high levels of rehab,” he says. “PA has 45 clinics and NRH/MedStar will have 32. That is a big area to serve and to serve that many people with quality care that is consistent and fairly priced for third-party payors is a lot of hard work. To find two groups that really agree on how to go forward took some time,” Valente says.

While other hospital systems had come to PA in the past with similar offers, Valente says PA believed it had to look at how quickly they could move in today’s rehab environment.

“In most cases, we felt we would have had to drag them along too much to feel it was a good match,” he says. “PA’s structure is very nimble, with a small headquarters in Memphis, and 35 support people for 200 offices around the country. It moves quickly, and we saw that MedStar was still able to be that nimble even at its size. We had to have that; we cannot be bogged down with a dinosaur that cannot move quickly,” Valente says.

“This kind of integrated model makes a lot of sense, because as the market matures, we can push quality at a fair price and if we can continue to do that, we will have better staying power,” Brickley says. He acknowledges that such a model makes sense virtually anywhere.

“Anytime you can deliver a win-win scenario with a couple of large partners with common philosophy and commitment, it makes sense,” he says. “It takes a while to put together, but it is hard to find a matching group in terms of strength and commonality. There are a number of big names out there that we wouldn’t want to have anything to do with.”

John Battinelli, PT, works with a patient at a Physiotherapy Associates clinic.

Incorporating Workers’ Compensation

In addition to NRH’s ability to bring every aspect of rehab imaginable into PA’s clinics, it also opened doors for PA to accept a key clientele it had not been able to serve before: workers’ compensation patients.

“We knew that if we were all-encompassing, we would be able to provide all the services needed to injured workers for a fast recovery and a fast return to work,” Valente says. “Rehab is a big part, but it is not the only thing that they need. Having access to sites and building this network will allow us to cover workers’ compensation in a way that PA would not have been able to do completely on its own.”

That aspect has been an incentive for others involved in the deal as well. John Battinelli, PT, is clinic director of the Laurel, Md, PA clinic, which he and a senior partner sold to PA in December 1995. The office provides general orthopedic outpatient services with a heavy emphasis on spinal care and manual therapy, and typically sees 40 patients per day. Battinelli says the most appealing aspect of the partnership for him was that it would situate the Laurel clinic to accept workers’ compensation patients, without taking away from either the clinic’s staff or management.

“MedStar has a workers’ comp network in place and is looking for outpatient physiotherapy sites to provide that care,” Battinelli says. “NRH also has a lot of programs in place that we can tap into for collaborative training in servicing.

“In this stage of vertical integration and networking providers, I think it is a forward step on PA’s part and as an employee I am happy to see them taking this step,” he says.

Physician Needs Are Met

As far as the area physicians are concerned, Brickley says they have been enthusiastic about the direction PA and NRH are taking rehab.

“The more physicians are seeing it, the more they like it,” Brickley says. “They do not have to think any more about where they want to send patients for good care. They know they can send patients to any one of these sites because there are protocols and lines of communication. They also like the fact that there are many programs, and that there are not types of therapy that are not being delivered. This way they can always refer into the network to best meet their needs no matter what their need is.”

Since a structure is needed to support consistency across the network, program specialists travel from site to site serving as clinical coaches and mentors to make sure delivery is what is expected. The clinics also have established peer reviews, clinician training, and workshops.

“The primary way we are growing and educating our therapists is through consistent training programs,” Valente says. “We already have had one on manual therapy techniques and over the course of 3 years, we will be systematically picking programming in all areas and presenting good quality courses to our staff. All the clinics’ directors also meet on a quarterly basis to share ideas.”

“We are definitely pushing the value of rehab, which looks at cost, outcome, and quality,” Brickley says. “It is hard to deliver care at $30 per visit, and you cannot provide for a community with diverse needs.

“One of the primary intentions, therefore, was to become a preferred network of managed care payors and try to generate leverage to obtain contracts, negotiate reasonable rates, and other provisions,” he continues. “We want to commit to a reasonable price but we also expect reasonable compensation for what we do. We wanted to be strong enough that we would not be crippled when we have to say no to an entity that will not pay a reasonable rate for what we do, and we do not want to be forced to accept rates that are not fair for what we do.”

“There always will be bottom feeders out there and we have walked away from contracts and we will again,” Valente says. “We are neither the cheapest nor the most expensive care. We just run as operationally and fiscally sound as we can.”

From NRH’s perspective, the affiliation is part of a larger plan to establish itself as the premiere rehab provider in the area.

“Acute care hospitals, home care agencies, and other hospitals in more rural areas that are not part of MedStar look to NRH for rehab expertise,” Brickley says. “In order to expand in the fashion we wanted in the Baltimore marketplace, PA was absolutely critical to us.

“We have been talking through this for about 3 years, and it took that long because we wanted to make this a win-win situation, and think of all the angles,” Brickley says. “What is nice is that when the deal was inked, there was not a face in the room that was not smiling because we knew it would have a positive impact in the community.” N

Liz Finch is a contributing writer for Rehab Management.

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June/July 2000