Working as One

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November 2001

By C.A. Wolski

Working as One

A recent merger makes New Orleans' Ochsner Clinic Foundation one of the largest integrated health care systems in the Gulf South.

Most business mergers are initiated to help the bottom line. This was the case with the August 31 merger of the Ochsner Clinic, LLC, a 500-member for-profit physician group, with the nonprofit Alton Ochsner Medical Foundation into the nonprofit Ochsner Clinic Foundation (OCF). "From a business perspective, [it's] a very significant shift," says Joshua Kaufman, MD, chairman of the Center for Occupational Health, Physical Medicine and Rehabilitation. "From a practice perspective, it really has not affected our patient care at all. But my hope is, as one entity, we'll be able to work more closely together with the foundation that essentially owns the therapeutic component and the physician perspective, which prior to this have been somewhat independent. We have always worked closely together, but this essentially joins us not just from a geographical perspective...but also from a business plan with really one goal in mind, which is patient care as the primary issue."

The merger that makes the New Orleans-headquartered OCF one of the largest integrated health care systems in the Gulf South was spearheaded by Patrick Quinlan, MD, Warner Thomas, and Scott Posecai from the Ochsner Clinic and Frank Riddick, MD, and Bobby Brannon from the Alton Ochsner Medical Foundation.

Making It Official
Though the merger creates a new entity, the two organizations, including their rehab services and personnel, have been associated for more than 60 years. And while the merger was good for the bottom line, it was also good for the staff and patients. "The potential to do things that we've never been able to do before is certainly there," says Kaufman. "Without this merger, we would have been a much less competitive force within the medical community and we would not have been able to provide, I think, as full a range of patient care."

Joshua Kaufman, MD, treats a patient at the OCF's prosthetics and orthotics clinic.

The merger has blended the management structure into a new, unified entity. Mitch Wasden, vice president for clinical services, says, "The other thing that we really focused on is that both organizations have their own culture, and we tried to emphasize that we're not going to have a hospital culture or a clinic culture, we're going to have a new culture. A lot of it is just integrating us as a group, too, so we don't see ourselves as hospital or clinic administration-we're just one administration."

And this new culture has translated into a closer working relationship between the rehabilitation staff and the rest of the OCF. "The therapists who are treating patients in acute care, every morning they meet with the physiatrist in the rehab unit as well as the nursing staff from the unit, and they discuss the patients and who may be possible candidates for rehab," says Geri Calamari, director of rehabilitative services. "So the physicians are constantly updated on patients' progress and whether they are ready for rehab. I'm not sure that happens at many hospitals. I think the feeling now is that we're all one organization, so there's going to be more of us working together with the physicians and vice versa."

And this team approach does not just exist among the rehab staff, but throughout the entire hospital system. "Not only do we have a team approach on a small scale with [the doctors] and the therapists, but now we have a much larger team approach with us and the other medical specialties and the whole foundation-clinic group," says Kaufman. "We're the fifth-largest transplant hospital in the country, and we see probably far more heart transplant patients than many other rehab centers; we work very closely with the heart transplant team in getting these patients back to a quality of life that they haven't seen in a long time."

Because the physician group is now a part of the hospital staff, the interaction of the staff has moved to a higher level. "Now, for example, we're working on a system that gets the rehab notes into our clinical information system so the doctors have it online," says Wasden. "You're able to integrate your practice a lot better. "

The rehab department offers the whole gamut of services ranging from treating patients with head injuries or strokes to those with amputation, multi-trauma, or neck and back pain throughout the OCF's 21-bed inpatient facility and four satellite locations. Stroke and general orthopedics patients make up most of the caseload.

The physical design of the inpatient unit emphasizes treatment. "The rooms are...very large so there's a lot of space for the patients," says Calamari. "We can do a lot of training, bed mobility training...the rooms are really designed for the ease of the patient." In addition to the usual gym facilities with their weight equipment, there is a full-scale kitchen in which the occupational therapists can help patients relearn skills to make them independent again. Inpatient rehab services also include physical, speech, and recreational therapy.

Rehab is also conducted in satellite gyms on the skilled nursing and orthopedic wards. Main campus outpatient facilities are located on the first floor of the hospital. In addition to its 65 therapists-35 of whom are dedicated to the acute care unit-there are recreational therapists, three full-time physiatrists, one part-time physiatrist at the clinic's Baton Rouge location, and a physician's assistant assigned to the occupational therapy staff.

Of the 21 inpatient beds, about 15 are in use at all times. Last year, the rehab staff handled 83,000 patient visits-43,000 inpatient and 40,000 outpatient.

Customized Health Plan
The OCF's comprehensiveness includes its health plan, Ochsner Health Plan (OHP), which was founded in 1986 and is Louisiana's largest HMO. About 60% of all Ochsner patients are covered by the OHP, 30% are covered by Medicare, and the remaining 10% by other commercial plans. "The merger between the foundation and the clinic is much more important than just the New Orleans area, because not only did we have our own health plan but our plan was the largest in the region, certainly by far in the state," says Kaufman. "We also have another major clinic in Baton Rouge and a series of outpatient centers in southeastern Louisiana."

As part of the care plan, the therapists involve the patient's family and caregivers. "There's a big push for family education, especially from the rehab perspective," says Calamari. "If the patient is on the rehab unit, their whole day is geared to therapy, hopefully to get them back home. Before a patient is discharged, there's a lot of family training. The family or whoever is going to be the caregiver will come in and go through all the different therapies and practice transfers or dressing techniques."

After the patients leave the hospital, they can either return to the outpatient clinic at the OCF or go to one of its satellite facilities for additional rehab. As with all of the services at the OCF, the patient's needs come first. "If some people feel that they don't want to go across town to the main campus, but [prefer] to go somewhere close, we've tried to accommodate them," says Wasden. And sometimes the patient's needs are best served at the satellite locations. For instance, aquatic therapy is only available off-site, and several of the satellite locations specialize in particular injuries such as orthopedic/sports medicine and pediatrics.

For some patients, care begins even before they step inside the hospital. The rehab staff has developed a 5-day protocol with the Orthopedic Department for total knee and hip patients. As part of the protocol, patients take part in a 2-hour class that guides them through their upcoming surgical procedure and recovery. "That has been very positive with our total hip and total knee patients," says Calamari.

Another benefit of the merger is that new programs can be started more easily. "When we say we want to do a program, you've got all the people in the room that you need to make it happen," says Wasden. And this ability to put new programs into effect quickly has already had results. "We have a urinary incontinence program and we're already talking about a physical therapist going into the Urology Department 1 or 2 days a week and treating patients," says Calamari. In addition, she expects to initiate programs addressing women's health issues and more prescreening of job applicants by her occupational therapists.

Kaufman assists his patient who reported residual leg pain and irritation.

Full Speed Ahead
Kaufman has ambitions to start other programs as well. "We have the possibility of really spearheading major projects, to have much more significant impact on patient care," he says. "For example, we're working to develop a stroke team with the neurologists and the cardiologists where the patients are rapidly evaluated."

Although there promises to be more new programs, one thing that will not change is the comprehensiveness of OCF's care. "Personally, I like offering the whole range of services," says Calamari. "I like that we have orthopedic-trained therapists and neuro-trained therapists. We also have therapists trained in the treatment of lymphedema. There's a big push now for occupational health. So, I think we need to stay that diversified and I would hope that we would get better in everything that we do."

It is not just OCF's comprehensiveness alone that makes it stand out, says Wasden. "We've realized that we need to be as good as other places in a lot of things, but we think in total we have a pretty strong product line," he says. "We're comprehensive, but we also recognize the need to have satellite locations. And obviously the most important thing is having the best therapists, people the physicians have confidence in. We have a pretty strong group of therapists who are well educated and trained and function well together. When you look at how these programs get developed, it's because this physician took an interest in launching it or this therapist had an idea. Out of our three strengths, I think the physician and therapist leadership and direction are really at the top."

C.A. Wolski is associate editor of Rehab Management.

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