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University of South Florida Health – USF Morsani College of MedicineOrthopedic and Sports Medicine ClinicFacilityBackground/DataYear usUSF Health is the partnership of theUniversity of South Florida Morsani Collegeof Medicine, the College of Nursing, theCollege of Public Health, the College ofPharmacy, the School of BiomedicalSciences and the School of PhysicalTherapy and Rehabilitation Sciences; andthe Doctors of USF Health. USF Health isan integral part of the University of SouthFlorida, a high-impact, global researchuniversity. USF was founded in 1956 andhas 3 campuses – Tampa, St. Petersburg,and Sarasoata-ManateeThe University of South Florida hastransformed a community medical school,established by the Florida Legislature in1965, into a major academic medical centerknown statewide and nationally for itsinnovative curriculum with an emphasis onimproving health through interprofessionaleducation, research and clinical activities.USF Health is part of the USF system, alarge ( 48,000 students), public 4-yearuniversity offering undergraduate, graduate,specialist and doctoral level degrees. Themission of the Morsani College of Medicineat the University of South Florida is toprovide for the education of students andprofessionals of the health and biomedicalsciences through the creation of a scholarlyenvironment that fosters excellence in thelifelong goals of education, research activityand compassionate patient care.
Location Geographic region,urban/rural Metro area populationLeadership structure/compositionUSF Health’s Morisani Center is located inTampa, FL (metropolitan area population2,824,724).Size USF operates 8 sites of care staffed by over750 health care providers, including over450 MD/DO/DC physicians. The departmentof Orthopaedics and Sports Medicineincludes five orthopaedic surgeons, oneprimary care sports medicine physician, onechiropractor and one physician assistant.The facility accepts a mixture of privateinsurance, Medicare, and nts/employeesRevenue sources (private,Medicare, Medicaid)Implementation ofchiropracticservicesNotable current initiatives/changes CAM, spine, pain/opiate Patient experienceImpetus/climate/backgroundPlanning process/timelineJudy L. Genshaft, PhD is the President ofUniversity of South Florida. Charles J.Lockwood, MD, MHCM is Senior VicePresident, USF Health and Dean of USFHealth Morsani College of MedicineThe DC had been associated with theuniversity for many years as a volunteerphysician for athletes and then part-time asadjunct faculty. One of the reasons the DCwas officially brought on board to expandaccess to electronic health records.The DC’s long-term association with theuniversity provided exposure to chiropracticto athletes and orthopedic physicians.The Orthopedic Department asked thechiropractor to come on board full-time.There were a lot of administrative hurdles,particularly for a new program, with planning“We had buy in in part because of somelegislative support for this and dare I sayleverage with the senior vice president andthe president who wanted some things. Andthere’s high-ranking chiropractors at thestate legislative body at the time. So it wasgood timing.” (Staff)“the chiropractic clinic here has beenevolving for at least 20 years. At leastchiropractic presence; it wasn’t called achiropractic clinic at that time. It started withone practitioner who got her foot in the doorand provided great care for patients, waspersistent and took bumps and bruises for
Year clinical services ion Department/service line mentChiropractors Number/FTE/appointment Privileges/services Non-clinical activities Professional attributes Interprofessional attributesSupport staff Discipline/numberPatient access Referral, self-referral Appointment availability/wait Appointment length, numberper weekRelevant partnerships Academic, researchoccurred at the upper levels of the universityto determine how to integrate the clinic, andespecially how to finance it.On-site clinical services began in 2015. For9 years prior, billing had been done throughthe chiropractor’s private practice.The chiropractor was located in theOrthopedic department. USF recentlyrestructured, chiropractic is now located inthe Neurosurgery department.Located on the third floor of the University ofSouth Florida campus health clinic.1 Full-time chiropractor2-3 patient exam/treatment rooms areavailable10-20 new patient visits per week and 80Follow-up patients per week1 clinical coordinator3 support staff with some duties workingwith the chiropractorPatients access appointments with thechiropractor through provider referral as wellas self-referral mechanisms.30 minute appointments scheduled for newpatients.15 minute appointments scheduledfor follow-up patients.The clinic is located on the University ofSouth Florida campus.The chiropractor also works at the universityhealth center and at the university sportscenter with USF sports teams.Patient characteristicsthe profession, resulting in where we arenow.” (Staff)
ChiropracticClinicProcesses Population, conditions,complexityAccess patterns seenServices provided Diagnostic, therapeuticCase management CPGs/care pathways used Outcomeassessment/reporting Communication/collaborationwith other providersImpacts/OutcomesClinic function Use, utilization, performancebenchmarksThe clinic sees patients with a variety ofmusculoskeletal conditions, sports injuries,headaches, and post-concussion symptomsReferrals originate from primary care,neurological surgery, and orthopedicsurgery. When requested by referringphysicians the clinic provides expeditedaccess for urgent cases, often on the sameday. There have been challenges withbilling and reimbursement for chiropracticservices compared with surgical servicesGood communication/collaboration withmany physicians is a key to team basedcare. However the large size of institution,with only one DC on staff poses a challengein reaching all physicians.Since this is a teaching facility, someattendings commonly refer to andcollaborate with the chiropractor, thus theirresidents gain experience with chiropracticcare.The facility includes DOs who perform somespinal manipulation, yet also refer somecases to the chiropractor for management.There is also strong collaborative casemanagement between chiropractic and PTproviders.From a fiscal perspective, the clinic ismeeting its production and collectionstargets, and is perceived to be budgetneutral or slightly positive. Acrossstakeholders there is common perception[The PT department] is a wonderfulprogram. They do some mobilization, butthey've sent me a lot of peoplewhom they feel would benefit fromchiropractic care, and I send them,obviously, the people who I think they've gotthe machinery to do it.that's very goodcare.(Provider)I know that [the chiropractic clinic] doesn'tcost us much and doesn’t make us much.You can't really compare an ancillaryservice of chiropractic medicine to surgery;any surgical specialty. They make a lot of
that the chiropractic clinic adds value for thefacility's patients.The facility initially encountered challengeswith billing and reimbursement forchiropractic services. This was partly due tothe novelty of implementing the businesspractices associated with this new service,and partly due to the wide variation inchiropractic reimbursement among payers.Patient status Outcomes, satisfactionPatients expressed high satisfaction withthe quality and outcomes of chiropracticcare. Patients greatly appreciated that thechiropractor communicated andcollaborated with other providers involved intheir case management.Patients expressed perceptions that allphysicians at the facility are high-quality,and that this favorably influences theirperception of the chiropractor,System status Facility actual (or impressionof) value Non-DC staff impression DC staff impressionValue of medical residents and fellowsrotating through chiropractic clinicNotes: Population data from 2013 US Census Bureau estimatemoney.and it's much easier to bill fororthopedic services than it is forchiropractic.(Staff)As far as I'm concerned, I feel thatchiropractic is what keeps me going.I reallyfeel these doctors work more closely withone another. There's not that -- I don't know,would you call it jealousy maybe -- betweenhow big your {private} practice is and thiskind of thing.All these people are teaching in some way. Ifeel that the doctors here are on the leadingedge of the newest and best methods to dothings.(Patient)I think it is beneficial. It brings in goodpatients. [The chiropractor] gets referralsfrom us, [and] gives referrals to us. So it isa good holistic approach to the care of thepatient.(Provider)
President, USF Health and Dean of USF Health Morsani College of Medicine Size Beds/catchment/enrollees Departments/employees USF operates 8 sites of care staffed by over 750 health care providers, including over 450 MD/DO/DC physicians. The department of Orthopaedics and Sports Medicine includes five orthopaedic surgeons, one
