Craig Hospital Outpatient Services

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Craig HospitalOutpatient Services

• George Richardson, MRCDirector Outpatient Follow
  up Services

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SCI and TBI Outpatients Served
2004-2008 16,187
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• INJURY-AGING
• SCI TBI is a Lifelong Catastrophic devastating
  medical condition which interferes with all
  aspects of life.
• SCI can exacerbate physical physiologic
  declines
• SCI age faster than able bodied population
• Severe TBI-poor cognitive psychosocial outcome
• TBI-greater degree of post injury cognitive
  impairment the lower level of post accident
  productivity

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Spinal Cord-Post Injury Complications

• Most common morbidity in SCI is Pressure
  Ulceration
• Most common cause of death is Respiratory
  Complication
• Other Long Term Complications are
• Urinary Tract Infections
• Autonomic Dysreflexia
• Osteoporosis
• Spasticity
• Heterotrophic Ossification
• Sexual Dysfunction
• Syringomyelia
• Chronic Pain

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Traumatic Brain Injury- Post Injury Consequences

• Neurological Impairment
• Cognitive Impairment
• Personality and Behavioral Changes
• Lifestyle Consequences
• Ongoing Medical Concerns
• Less Independent
• Less Active in Work/Productive Activities

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Lifetime Costs Estimates

• SCI Injury at 25 years of age
  50 years of age
• High Quad (C1-C4) 3,059,184
  1,800,958
• Low Quad (C5-C8) 1,729,754
  1,095,411
• Paraplegia
  1,022,138 697,163
• Source   The University of Alabama National
  Spinal Cord Injury Statistical Center, Centers
  for Disease Control and Prevention
• TBI
• 600,000 to 1,875,000

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Continuum of Care

• Injury
• EMS Support
• Acute Care
• Rehabilitation
• Long Term Support Services
• Prevention of Medical/Psychosocial Complications
• Greater Independence, Productivity
• Life Satisfaction Health Stability

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• Outpatient (OP) SCI/TBI Evaluations
• Value Types of OP Evaluations
• OP Teams
• Components of OP SCI Evaluation
• Median Charges
• Planning, Scheduling SCI/TBI Evaluations
• Long Term Staff Support

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Outpatient (OP) SCI/TBI Evaluations

• Natural Valuable Extension of Inpatient Program
• Help Insure Outcomes Achieved Investment by
  Insurance Company
• Craig Hospital Staff Experience Wisdom by
  Focusing Only on SCI and/or TBI
• SCI Patient Normally Discharged Home

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Outpatient (OP) SCI/BI Evaluations (continued)

• Contact with Patient by Counselor First Six
  Months to Review Discharge Planning Goals
• Patients at Inpatient Discharge Often Have
  Continued OP program
• Intensive OP Program Followed by Gradual
  Reduction of Clinical Services

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• Outpatient (OP) SCI/TBI Evaluations
• Value Types of OP Evaluations
• OP Teams
• Components of OP SCI Evaluation
• Median Charges
• Planning, Scheduling SCI/TBI Evaluations
• Long Term Staff Support

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Types of Outpatient Evaluations

• First Re-evaluation
• Re-evaluation
• Clinic Check
• Specialty Clinics
• TBI Group Evaluation

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• Outpatient (OP) SCI/TBI Evaluations
• Value Types of OP Evaluations
• OP Teams
• Components of OP SCI Evaluation
• Median Charges
• Planning, Scheduling SCI/TBI Evaluations
• Long Term Staff Support

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Outpatient Teams- SCI

• Dedicated Staff for Craig Hospital SCI OP
  Services
• Nurse Manager
• Physician
• Nurse Practitioners
• Physical Therapists
• Occupational Therapists
• Social Workers
• Program Director

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Outpatient Teams- TBI

• Dedicated Inpatient Staff and OP Staff
• Physicians
• RN
• Physical Therapists
• Occupational Therapists
• Speech Therapist
• Social Worker/Counselors
• Community Re-Integration Specialist
• Community Resource Coordinator
• Outpatient Coordinator

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• Outpatient (OP) SCI/TBI Evaluations
• Value Types of OP Evaluations
• OP Teams
• Components of OP SCI Evaluation
• Median Charges
• Planning, Scheduling SCI/TBI Evaluations
• Long Term Staff Support

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Essential components of SCI Re-Eval

• History and Physical
• Urodynamics Testing
• Physical Therapy Occupational Therapy
• Social Worker Assessment Nursing Assessment
• Ancillary Services Based on Patients Clinical
  Condition/Needs
• Team/Patient Discharge Conference

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• Outpatient (OP) SCI/TBI Evaluations
• Value Types of OP Evaluations
• OP Teams
• Components of OP SCI Evaluation
• Median Charges
• Planning, Scheduling SCI/TBI Evaluations
• Long Term Staff Support

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Median Charge for OP Re-evaluations

• SCI 1st Re-Evaluation 6000.00
• SCI Re-Evaluation 4500.00
• SCI Clinic Visit Appts 600.00
• TBI 1st Re-Evaluation 8500.00
• TBI Re-Evaluation 4500.00

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• Outpatient (OP) SCI/TBI Evaluations
• Value Types of OP Evaluations
• OP Teams
• Components of OP SCI Evaluation
• Median Charges
• Planning, Scheduling SCI/TBI Evaluations
• Long Term Staff Support

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Planning/Scheduling OP Re-evaluation

• Craig Alumni vs New Patients
• OP Admissions for SCI Alumni-Gale Powell
  303-789-8215
• OP Admissions for SCI New Patients-Maggie Rose
  303-789-8289
• OP Admissions for TBI Alumni-Autumn Schmid
  303-789-8298
• Selecting OP Evaluation Date
• Verification of Benefits/Coverage
• Pre-Assessment call to patient
• Alignment of Expectations call to Case Manager

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• Outpatient (OP) SCI/TBI Evaluations
• Value Types of OP Evaluations
• OP Teams
• Components of OP SCI Evaluation
• Median Charges
• Planning, Scheduling SCI/TBI Evaluations
• Long Term Staff Support/Patient Concerns

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Long Term Support/ Patient Concerns

• Long Term Support/Patient Concerns
• Craig Hospital Staff Availability
• Nurse of the Day Line (NOD)
• Treatment Innovations-
• Diaphragm Pacing System
• Bladder Botox Injections
• Mitrofanoff Urology Procedure
• Baclofen Pump for Spasticity

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Long Term Support/ Patient Concerns

• (continued)

Future Considerations- Stem Cell
Research Develop Coordinated Health Care
Systems Increase Lifetime Insurance Caps Remove 2
Year Waiting Period for Medicare Remove the
Current Medicare In-Home Rule Increase Insurance
Coverage for Outpatient PT, OT ST Insure That
Health Care Policies Have Adequate Catastrophic
Injury Rehab Coverage Pass The Community Choice
Act
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Questions?Thank you!
George Richardson, MRC 303-789-8336 grichardson_at_cr
aighospital.org