Rehab

Pediatric therapy at your clinic? It's not all kidding around

Rehab Regs, May 21, 2003

Source: Briefings on Outpatient Rehab Reimbursement and Regulations, June 2002

If you're running short on clients, think about treating short clients for a practice boost. Pediatric therapy can expand the focus of your practice.

Working with children is much different, and in some regards, more rewarding than working with adult patients. "Most of the people who work here will tell you that they wouldn't want to work anywhere else. You get to work with the people who have dedicated their lives to children-they are all concerned and compassionate," says Tracy Furr, MS, CCC, SLP, director of Cheshire Center for Communication and Rehab Therapy, in Greensboro, NC. Her facility services children from birth to the teenage years. Most of the PT and OT patients are babies.

The therapist's playground

Many of Furr's therapists, who include OTs, PTs, and speech language pathologists, do not see the children in their offices. They travel to the children's homes, day care centers, or preschools. "Speech is done in classrooms collaboratively with the teacher and other children involved," Furr says. "It's a more natural environment."

When working in the home of the patient, Furr draws an analogy to the "old home health" visits that physicians used to make. She chooses this setting to include parents and siblings and to create a more comfortable environment. This raised comfort level helps therapists deal with younger children in particular.

Not all children can be seen outside of the office, how ever. Furr says some of her payers require that children be brought to the facility and treated there.

Furr warns that home services have been more expensive because they have fallen under the auspice of "home health." This means that if insurance companies are paying for home health services, they are paying a premium rate.

Some insurers may not want to pay a higher rate. To avoid this headache, Furr's insurer pays the same for home and office visits. If you do have home visits, keep in mind that the burden of travel falls on your facility rather than the patient. This means you are going to have to reimburse your therapist for the miles traveled.

Claire McCarthy, of the Children's Hospital in Boston, says pediatric reimbursement can be tricky and to be absolutely sure of what your insurer wants before you enter the field.

Some insurance companies might balk at reimbursing pediatric therapy. One common reason is that most problems with children are developmental. Because of the growth process, children have to be seen for a long time, or on an intermittent basis at the very least. "This is not necessarily easily achieved with reimbursement," McCarthy says. "It's not impossible, but it's not easy. You have to abide by any rules that your insurer has come up with."

The differences between adults and children

A multitude of changes can occur between birth and the teenage years, and you have to be ready for any of those changes.

"Children aren't young adults," McCarthy says. "[Procedures] are applied differently to make up for the variation and growth processes that children go through. You have to know the normal skills and abilities that children go through."

For example, sports injuries in a young adolescent require particular care. The growth spurt that a teen goes through during puberty may not have occurred yet, so extra care must be taken not to irreconcilably damage bone and muscle structure. Even though it may be the same injury that your adult patient suffered, the approach-thought processes and clinical analysis-has to be different.

Another difference is the level of independence of the patient. For the most part, adults can come and go whenever they want. The only higher power they have to answer to is their boss. Children have a completely different set of rules. For them, everything be gins and ends with the parents, so although a time may be good for you to see a young patient, it could be bad for either the parent or the child, or in some cases, both.

Besides the time stipulations, you also have to get the signature of the parent or guardian in order to work with the child. Minors cannot sign a consent form by themselves.

Oooops! The problems that come with children

Besides tears and other uh-oh's, a therapist working with children is going to have to put up with certain problems that "traditional" therapists don't have to consider. And sometimes it can be a bit more serious than your patient spitting up on a new shirt. There are instances when a therapist has to work with a child who is either neglected or abused. These cases can often wear down even the most sunny-sided person.

"A really special caliber of therapist is needed for this kind of work, which is why not a lot of therapists gravitate toward this," Furr says. "There is a large amount of social work and compassion that comes along with this job . . . there are huge leaps in progress that the children make clinically, but the re wards are greater."

Tips to hiring or becoming a pediatric therapist

Tracy Furr, MS, CCC, SLP, maintains a staff of 35 therapists, not all of them full-time. Therapists work anywhere from two to 40 hours, with no special treatment for full-time workers over the part-timers. Her therapists receive a salary, with the average amount being between $25 to $40 an hour.

Furr, the director of the Cheshire Center for Communication and Rehab Therapy, in Greensboro, NC, welcomes therapists who work at other facilities but who are looking to make a few dollars by working some extra hours.

"Several people work for me in the summers or evening who are full-time therapists elsewhere," she says. "Actually, it helps me, because it reduces my [employee] benefits and gives me greater flexibility geographically. It cuts down on therapists' driving."

Although speech therapists are plentiful, pediatric OTs and PTs are a different story. If you have been thinking about establishing a pediatric department in your facility, and have been running into the same employment brick walls that Furr has, she offers this tip: try partnering up with area colleges to establish an internship with those students that may be thinking about becoming pediatric therapists.

When hiring a person, remember, not everyone can work with children. You have to be very careful whom you choose. "These are very important cases and difficult cases that I wouldn't just turn anyone loose with," Furr says. "These children are medically fragile."

Look for the following things when hiring pediatric therapists:

  • Internship experience.

  • Reference letters are also important.

  • Field experience. Have potential hires go out with the therapist and make sure they are aware of the pros and cons of the job. Furr counsels these candidates, especially the ones fresh from school, and tells them that they have to be absolutely sure they want to do pediatrics for the rest of their lives. Otherwise they should go to another facility that offers more of a mix.

  • Personality. Clicking with potential coworkers is important. Furr has each candidate spend time at the facility to make sure they get along well with others.

Furr closely monitors new hires over a nine-month clinical period.

If you don't want to hire another person, and feel pediatric therapy is something you would be interested in, use these tips to begin your journey:

    1. Go back to school. Even if it's just part time, you are going to need to take some classes in order to understand how a child's body is different from that of an adult's. One course Furr's PTs take deals with neurodevelopmental training for babies.

    2. Seek out a mentor. A therapist who works for Furr did this, and it has helped her immeasurably. Even if you work with the mentor on a part-time basis, Furr says the expertise you get from this person will be worth it.

Besides ordinary physician referrals, there are many places to find pediatric clients. Establishing a close relationship with a hospital by attending its meetings is one way to get referrals. Another place to find young clients is by establishing a relationship with early intervention programs. Some of Furr's therapists work with these programs, which cover children from birth to age three, before they begin schooling, and her facility has been able to garner more clients. "Over the years we have watched and really tried to involve ourselves in the community," she says. "We do lots of volunteering in and out of lots of organizations and there's lots of overlap there. There is lots of leg work and working side by side in the private sector."

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