Delivery of Care

Creating a continuum of care in orthopedics in RI

With a new facility now under construction, Ortho RI continues to ramp up its physical therapy and express care services

Photo by Richard Asinof

Kyle Anderson, the regional director of rehabilitation at Ortho RI.

By Richard Asinof
Posted 1/13/20
A continuum of care that includes physical and occupational therapy is one of the cornerstones of the new model for delivery of specialty care being practiced by Ortho RI, now the largest specialty orthopedic group practice in Rhode Island.
Will other specialty practices in Rhode Island follow the innovative model of care delivery being pioneered by Ortho RI, in non-hospital centric fashion? How important is physical rehabilitation and therapy as a revenue stream for skilled nursing facilities? What kinds of data mining and analysis would provide a better understanding of the needs of post-operative patients? How can yoga and other modalities be integrated into physical therapy, with insurance reimbursements? What are the opportunities for collaboration with Health Equity Zones and Neighborhood Health Stations?
One of the peculiarities of the current health care system has been the adoption of a pain scale as a fifth vital sign, which forces providers to ask patients to rate their pain on a scale of 1 to 10. Chronic pain, however, increases what is known as the “allostatic load” – the wear and tear on a body when an individual is exposed to repeated, chronic stress. Diminishing the levels of stress can result in positive changes in the body’s metabolism, from blood pressure to weight loss to improved sugar metabolism. It remains an unexplored area in most physical therapy treatments, which focus more on coordination and muscular tone and strength.

WARWICK – A new kind of delivery service model for specialty health care in Rhode Island is rapidly taking shape, focused on orthopedic care, featuring express urgent care where a patient is seen within 15 minutes, and physical and occupational therapy, as Ortho RI, currently the largest orthopedic group practice in the state, works to expand its footprint in a continuum of care that is non-hospital centric. [See link below to ConvergenceRI story, “Creating a full service orthopedic delivery system in RI.”]

A new flagship facility for Ortho RI is now under construction across the street from 200 Crossings Boulevard, the current headquarters of Ortho RI, just down the street from the Crowne Plaza.

It will feature both an in-house surgical center and urgent express care center, and an expanded physical and occupational therapy facility, as well as complete imaging services. The new building is expected to be completed at the end of 2020 and will become fully operational in the first quarter of 2021, according to Mary Ellen Ashe, the executive director of Ortho RI.

The vision, as described by Ashe in a December 2018 ConvergenceRI story, is to create a full-service orthopedic delivery system that is driven by patient needs. “We have been leaders in doing bundled payments,” she said. “We were the first to do commercial bundled payments in this market; we were the first to do same-day urgent care in this market. We’ve been the first to do same-day outpatient surgery for joints in this market.”


Ashe continued: “As we have put together a statewide orthopedic practice, we look at patient satisfaction. Part of that is looking at the episode of care, [looking] at quality, being able to provide, and to have the protocols for, the entire episode of care.”

Signs of growth
The signs of rapid growth and expansion by Ortho RI can be seen not just with the new facility under construction, but with the ongoing renovation of the Providence facility, which inhabits a former restaurant site within the Foundry complex, in response to the increased demand.

ConvergenceRI recently sat down to talk with Kyle Anderson, who was recently promoted to be the regional director of rehabilitation at Ortho RI, to explore the growing demand in the marketplace for physical and occupational therapy and to better understand the competitive advantage that Ortho RI seeks within an expanding marketplace in Rhode Island. In addition to his training and certification in physical therapy, Anderson recently earned an MBA from the University of Massachusetts Amherst to increase his business management skills.

Here is the ConvergenceRI interview with Anderson, whose job responsibilities include managing the ongoing relationships between physicians, physical and occupational therapists, and patients, as well as the continuing professional development of therapists.

ConvergenceRI: How many physical therapy sites do you have in Rhode Island?
ANDERSON:
We have five different locations – in Providence, in Warwick, in East Greenwich, in Wakefield, and in Westerly.

At three of those locations, in addition to physical therapy, we also have occupational therapy.

ConvergenceRI: How would you describe the difference?
ANDERSON:
In outpatient orthopedic settings, the physical therapists are responsible for orthopedic issues that involve everything except for the elbow, wrist and hand.

The reason for that is that the elbow, wrist and hand are really a specialty in and of itself, and that’s really where the skills for the occupational therapists are. Most of our occupational therapists are also certified hand therapists, which is an advanced certification.

ConvergenceRI: How many people are employed at these five physical therapy sites?
ANDERSON:
All in all, we have about 50 rehab professionals. Between physical therapists, physical therapist assistants, occupational therapists, occupational therapist assistants, and athletic trainers.

ConvergenceRI: With your business model, how do you see physical therapy fitting in? Is there an increasing demand for physical therapy services?
ANDERSON:
That’s right.

ConvergenceRI: Why is that?
ANDERSON:
There is definitely an increase [in the demand] for physical therapy [services]. The reason for that increase, what people are realizing, is that it is a very cost-effective method of orthopedic care.

It is a good gateway before surgery; it is obviously critical after surgery, and it is an effective way to avoid surgeries as well.

What health insurers and people are realizing is that they would rather pay for physical therapy than have to pay for a surgery.

ConvergenceRI: How much of the demand is also driven by the fact that patients who have orthopedic surgery almost certainly will need to do rehab?
ANDERSON:
That’s right.

ConvergenceRI: You also have nursing homes that are beginning to cater to physical therapy and rehabilitation.
ANDERSON:
That’s right. As the population ages, the number of people that need physical therapy has continued to increase. So, the need overall continues to increase.

ConvergenceRI: Is it also true that the insurance companies are encouraging physical therapy?
ANDERSON:
There is sort of mixed support. On one side of the equation, they say they recognize that it is a cost-effective modality. On the other side, they are looking to make cuts in paying for these types of services.

Specifically, with the Ortho RI model, because we are so well vertically integrated between having rehab services and physician services in one location, it makes rehab services that much more effective.

ConvergenceRI: How much of the patient population for physical therapy and occupational therapy is from the outside coming in, or from the inside, continuing on an integrated path?
ANDERSON:
I don’t have an exact breakdown. But what I can say is that maybe 80 percent to 85 percent of our physical therapy patients and occupational therapy patients are originating from the inside. In other words, they are coming from our physicians as a referral.

With the remaining 15 to 20 percent being from outside referrals, [usually] from primary care providers.

ConvergenceRI: Are you conducting data analyses for the different kinds of patients you are seeing? And, if you see a spike in something, how do you respond to that?
ANDERSON:
You mean for a particular diagnosis?

ConvergenceRI: Yes. This fall, I published an article written by the chief medical officer of Blue Cross Blue and Shield of Rhode Island, using an analysis of nationwide data that showed that Rhode Island and the District of Columbia were the top two in the nation for diagnoses of MS by Blue Cross commercial insurance plans. Further, some 75 percent of the diagnoses were for adult women. [See link below to Convergence RI story, “Why does RI have the second highest MS diagnosis rate in US?]
ANDERSON:
That’s interesting.

ConvergenceRI: It was surprising. In my conversations with my physical therapist, I mentioned the story and that it had gone viral, with more than 2,500 page views in a week.

It seemed to hit a nerve ending. I tried to figure out: where else could I get data about the prevalence of MS diagnoses. My physical therapist said that she had seen an increase in the number of people she was dealing who had been diagnosed with multiple sclerosis.
ANDERSON
: That’s interesting.

ConvergenceRI: It made me wonder if there was an opportunity to capture that data through the work being done with physical therapy, and whether that was something that Ortho RI could capture through data mining, so you could identify those trends?
ANDERSON:
Most of the trends that we see are more anecdotal in our professional expertise, and most of them occur seasonally, but I wouldn’t be able to speak to what is happening from a larger viewpoint.

ConvergenceRI: Is that something that you might want to consider as you are ramping up, to build in the capacity for data mining and analysis?
ANDERSON:
Of course, data mining, with as many bullet points as you can, can make us more effective in determining how many of what type of providers that we need.

ConvergenceRI: If it is not proprietary, how many people do you see a year that come through your sites for physical and occupational therapy?
ANDERSON:
Certainly the number has continued to grow. And, every year, it continues to grow as our practice expands.

I would be comfortable in guessing around the 15,000 mark as the total number of patient visits that occur in a year at Ortho RI for rehab.

ConvergenceRI: Is there a lot of competition in the marketplace in Rhode Island?
ANDERSON:
There is, specifically, for rehab services, and for all the reasons that we discussed about why the demand for physical therapy is growing. People recognize that as an opportunity and try to capitalize on that opportunity.

As far as the patients that we see at Ortho RI, we do see the benefit of having patients stay within our network because of the continuity of care that is provided.

ConvergenceRI: Do you ever feel like you’ve gotten too busy?
ANDERSON:
I don’t think too busy. I think we value the opportunities that we have. Of course, we appreciate the business, and we appreciate the people of Rhode Island trusting us for these services. Because, a lot of times, they can be stressful scenarios.

ConvergenceRI: You are going to have a brand new PT facility right across the street here.
ANDERSON:
We’re very excited about it.

ConvergenceRI: In terms of your strategy for growth, what are your strengths and where do you see the opportunities for growth in the marketplace?
ANDERSON:
Rhode Island as a market is an interesting place, because while we are so small, geographically, people are not necessarily willing to travel to receive health services. Maybe they will travel for a longer distance to see a specialist if they are well recommended. But people in the surrounding work areas want to stay at work. People in Providence want to stay in Providence.

We are very well positioned being in Warwick. It is an excellent market for us. The patients are great in this area and we’re very excited to have that new state of the art facility to be able to serve them. [The current facility Ortho RI operates in Warwick will move into the new facility being built.]

ConvergenceRI: Is this a growth marketplace for people to seek careers?
ANDERSON:
Yes. We are certainly an attractive employer. One, we have beautiful facilities, state-of-the-art facilities, great places to work. The other thing that is very attractive to physical therapists is their ability to work in conjunction with physicians.

It provides a level of access that they would not have otherwise. It eliminates barriers to the source, so to speak, for operative and non-operative patients. Being able to work hand-in-hand with the referring provider and the surgeon who created that operation is really invaluable, and I think patients recognize that value as well.

ConvergenceRI: In looking at the future market, given that we have a growing demographic of people who are “old old” – older than 85 – are you looking at projections of increased demand? Is there a sense of growing competition from skilled nursing facilities that are ramping up their own physical therapy and rehabilitation operations?
ANDERSON:
In regard to nursing homes, they see a different population than we are looking at. Our [practice of] medicine is improving in such a way that not everyone has to go to a nursing home that previously would have gone, speaking strictly from an orthopedic perspective, people who would go for an orthopedic reason.

ConvergenceRI: How do you position yourself against competitors?
ANDERSON:
In comparison to some of our competitors, one of the things that set us apart is [our focus] on patient experience. Ortho RI has a different feel than our competitors. People notice it right away. They have an experience of trust and confidence as they determine what is best for their medical care.

ConvergenceRI: As the regional director of rehabilitation at Ortho RI, what kinds of regular meetings are there with your team of therapists?
ANDERSON:
There are monthly meetings to go over operational and logistical operations, items that need to be addressed. As well as overseeing continuing education, developing skills for therapists, facilitating dialogue between the providers. Often surgeons are involved.

When I meet with my team, I want to make sure that everyone is pulling in the same direction as far as patient experience and with revenue generation.

ConvergenceRI: How important is revenue generation?
ANDERSON:
At the end of the day, we are a business, and it is what allows us to keep the lights on.

ConvergenceRI: In terms of marketing and advertising, what has proven to be the most effective channel for Ortho RI?
ANDERSON:
Marketing is not part of my job responsibility. What I can say is that there is a lot of awareness generated through our in-house express care programs. With Ortho RI Express, we’ll see you in 15 minutes, and you’ll be seen by an orthopedic specialist – instead of waiting hours at an emergency room, only to be referred to a specialist. It streamlines the process, and it adds peace of mind to student athletes and parents.

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