March 2001

Making a Difference

By Amy Paturel, MS, MPH

Making a Difference

The Rehabilitation Institute serves up sophisticated services to a rural population through good business acumen and a strong commitment to the community it aids.

A hospital offering physical therapy, occupational therapy, speech pathology, rehabilitation nursing, case management, athletic training, therapeutic recreation, psychological services, prosthetics and orthotics, social work, dietary services, and a driving program is typically located in a large metropolitan area or it is a teaching hospital. However, these state-of-the-art, sophisticated services are currently available in rural Georgia at the Rehabilitation Institute at Northeast Georgia Medical Center, Gainesville.

The Rehabilitation Institute provides services to the rural community so patients can get needed care closer to home. “We have the whole continuum of care right here,” says Judy Smith, PT, manager of the ReGain program. “We cover a 13 county plus area.” The location of the hospital is ideal for people from Tennessee, South Carolina, and North Carolina who do not want to travel to Atlanta or Augusta for needed services.

The Rehabilitation Institute began in 1988 with four employees as part of the Northeast Georgia Medical Center. After a community-needs assessment, a master plan was created and years of rapid expansion followed. Today the Institute has 170 employees and offers inpatient and subacute care and industrial rehabilitation and outpatient programs.

The inpatient rehab program opened on October 1, 1989, with 20 beds. Today it has 25 beds. Stroke patients are the mainstay with some brain injury and orthopedic patients as well. Closely linked with the inpatient program, subacute care opened in April 1991 with 16 beds. Most subacute patients are orthopedic patients who are medically stable but need continuing care. The industrial rehab program focuses on treating injured workers and people with orthopedic and sports injuries. The program includes physical therapists, occupational therapists who offer a specialized hand therapy program, and an athletic trainer. The program was so successful that it eventually outgrew its space and relocated to a new complex in the summer of 2000. This program also provides services in six satellite locations including Cleveland, Oakwood, Coal Mountain, Buford, Dawsonville, and Dahlonega, Ga.

Community Partnership

As medical director, Holmes Marchman, MD, ensures that the Rehabilitation Institute is visible to the greater community as well. “Our athletic trainer is often out in the community working with the high schools.” Marchman says.

In response to patient need for ongoing outpatient services after discharge, the Rehabilitation Institute introduced ReGain, in October 1991, a comprehensive neuro-outpatient program offering home evaluation, job-site evaluation, community re-entry, family education, support, and transportation services, including a driving program that debuted in 1999. Again, patient demand was so great that the outpatient program expanded in 1999 and relocated. In 2000, a 16 by 20 foot therapy pool was added. The program offers specialty clinics and services for: children; amputees; patients with arthritis, diabetic feet, and lymphedema; and those in need of seating clinics. Treatments range from therapeutic exercises to joint mobilization and include physical agents such as heat, cold, whirlpool, ultrasound, diathermy, and electrical stimulation.

Despite rapid growth, the Rehabilitation Institute has maintained quality services and support. “We were very careful about how we grew and developed the business,” explains Thomas Andrew Whitener, MS, administrative director. “When I came here, there were seven employees. When you have seven employees, you must have a vision to plan to grow 200% to 300%, which we did in our initial years.”

The expense budget for the Rehabilitation Institute is more than $8 million. By far the largest source of funding comes from providing services. According to Whitener, approximately 50% of patients at the Rehabilitation Institute are affiliated with Medicare, 5% with Medicaid, and 45% with private insurance and workers’ compensation. However, funding of services is likely to change with the implementation of the Balanced Budget Act of 1997 (BBA). The Institute has been preparing for the implementation of the inpatient rehab prospective payment system for almost 2 years. It has been working with other facilities to share ideas to reduce costs while still improving patient outcomes.

Whitener has taken steps to ensure that staff and physicians are educated about the upcoming changes. “I believe we will continue to be successful under the new reimbursement system because we are committed to finding ways to meet the needs of our community and to providing all the state-of-the-art services possible in our setting,” says Whitener.

Patient Mix

Most rural hospitals are equipped to offer only the most basic rehabilitation services. However, thanks to community demand and clever, careful business planning, the Rehabilitation Institute has been able to meet the needs of a variety of patients including those with spinal cord injuries, arthritis, developmental delays, traumatic brain injury, fractures, cerebral vascular accidents (CVAs), burns, open wounds, pain, and sprains. Approximately 50% of patients in the ReGain and inpatient programs at the Rehabilitation Institute are CVAs, 10% are brain injuries, and 3% spinal cord injuries; the remainder include pediatric patients, patients with Parkinson’s disease, and various other special populations.

“We draw from rural Georgia so we see a lot of sick people, and people who do not have insurance, people who have family to help them and that’s it, and some who have nothing,” says Marchman. “We get people plugged into the services they need. For example, in our ReGain program we have three wheelchair accessible vans that can pick up patients who do not have other transportation—we get them to the hospital and that is a huge help in itself.”

Patient demand is there, but how does the Institute attract the quality staff necessary to provide such sophisticated services in a rural setting? According to Whitener, it “attracts employees because of the diversity of work environments as well as the opportunity to specialize, the opportunity to work with students, involvement in research, and multiple avenues for continuing professional education.”

Previously, the only place staff could access good professional education was to go into Atlanta. “We recognized a need and we began offering courses here. We hold region-wide conferences two to three times per year,” says Whitener. Revenue from the conferences is used to fund other professional education opportunities for the staff.

In addition to educational activities, staff members have the opportunity to participate in clinical research efforts at the Institute, which actively pursues research opportunities and cooperative efforts with various academic institutions in Georgia. “Research stimulates thinking outside the box and promotes asking questions that are difficult to address,” says Marchman.

The Extras

In the fall of 2000, the Rehabilitation Institute introduced the first therapeutic pool in Northeast Georgia. In accordance with Marchman’s mission of incorporating the Institute into the larger community, the pool is open not only to patients, but also to the community. People can purchase a membership that includes a meeting with an exercise physiologist who will teach them the appropriate exercises for their personal needs. One of Marchman’s goals is to ensure that the community knows the pool is available to them. “I predict that the pool will be a full-service, 12-hour-a-day operation,” says Marchman. “People will begin to realize that they can get a great workout in the pool even if they have joint or back pain.”

The Institute’s wellness program also focuses on the community at large. Services range from the “Fit for Life” program to wellness screenings, including blood pressure checks, diabetes screening, and basic health maintenance.

Whitener is well aware that many challenges lie ahead. “We will be challenged to continue to provide our current services and create new sets of services with shrinking dollars; outcomes need to be improved; and we need to come up with new ways to provide the same stuff,” says Marchman. “We have to reinvent how we provide these types of services so we can stay afloat and continue to see the outcomes we are used to having.” The staff is committed to ensuring that their patients will not be forced to leave Northeast Georgia to access the services they need.

“We are blessed to have great services available in a large metropolitan city like Atlanta, but it sure is helpful when you can stay close to home and family, especially when a loved one is in need of intensive rehabilitation services,” says Whitener. “There is a large population to serve, and regardless of the financial constraints, the Rehabilitation Institute is committed to meeting their needs.”

Amy Paturel, MS, MPH, is a contributing writer for Rehab Management.

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