Professional- licensure, reimbursement, other

Dr Dennis Kerrigan,

It is fascinating to me the program you have created here for oncology rehab and utilizing CEPs to run the program. That is by far probably my biggest dream as a career. I've been ACSM RCEP certified since 2006. But personally we entered the oncology world 8 years ago and I am forever a cancer mom. Hearing the words your child has cancer and watching them fight cancer, will honestly change a parent's life forever. While I've worked with cardiac and pulmonary as well as s/p Physical and Occupational therapy patients for 25 years, I truly feel my passion is oncology. I work for a large hospital system, but they have no exercise oncology program available. I would love to start one, but honestly I don't even know where to start. But the need is there. My daughter was 15 yeara old at her diagnosis of Very High Risk Tcell Acute Lymphoblastic Leukemia with metastasis to the brain. At the end of her first year of intense chemotherapy and cranial radiation her body was beaten down and she was 5'6" and weighed 72 lbs at her lowest. She was skin and bones. She wasn't even strong enough to go to outpatient therapy, but yet somehow did not qualify for home health. She couldn't go to inpatient rehab because she was still in active treatment receiving chemo infusions several times a week. I had to do my own exercise perscription with her to get her strong enough and to start participating in therapy at the outpatient level. When she was strong enough to go to therapy it took forever to find a therapist who had any experience with a port-a-cath being accessed or chemo therapy drug side effects (such as vomiting in the middle of a session). I never found one with any experience like that, so I had to go to every therapy session with her and make sure she didn't have any side effects the therapist was uncomfortable handling. I had to find a therapist who had worked with youth, not geriatrics or the older adult, but you can imagine the atmosphere she was exercising in. She was a bald sixteen year old girl trying to gain back strength, after fighting over 2 1/2 years for her life, just to be able to walk a short distance without getting winded. She was surrounded by young athletes her age who had sprained an ankle or torn a rotator cuff or had an ACL repair. It was not the right environment, but it was the only option we had. As a mom watching it, it broke my heart. She wanted so desperately to get back to playing soccer by her senior year, but she was never able to. As a professional Exercise Physiologist, it frustrated me there was not a program I could have taken her to. It also brings empathy to my heart knowing without a shadow of a doubt there is a HUGE need out there. The need is evident. I watched it and lived it. And know I truly do wish I could do it for a living. It would be my life's calling, I am sure of that. I just thought I'd share my perspective and heart as a cancer mom and a CEP who has tried to fight the system and knows there's a huge need out there for oncology rehab.

Good luck with your meeting Amber! If I can be any assistance I would be happy to help you!

Dennis

Hi Dr. Dennis Kerrigan,

Thank you so much for your wonderful response. I had already visited the Henry Ford website prior to your response to learn more about it, as on other forum with AACVPR had mentioned your program. I very much appreciate your insight and suggestions. I will look at the link and see if I missed anything. Hopefully more to come!

I begin my first administrative discussion today to see where this may lead.

Thank you Yvette for the info. Do you happen to know which CEP billing codes are being used?

I watched the ACSM webinar that mentioned ~30 codes were available, however no CPT. Hopefully by 2027!

Hi Amber,

I have directed an exercise oncology program at Henry Ford Hospital for the past 15 years that is run exclusively by clinical exercise physiologists.

We started the program with philanthropic funds and continue to rely on that as well as with research funding. That being said, what drives our program is that it is a huge patient and physician satisfier. A few years ago Henry Ford built a new cancer building and our program, not physical therapy, was given space and new exercise equipment because of the value that we have been able to show.

In addition to funding, it is also important that you have both physician and administrative champions who will advocate for you. Another important strategy is to partner with similar specialties. Our number one partner is cardiac rehabilitation as our staff is also cardiac rehab staff, thus exercise oncology is not a stand alone program.

We also teamed up with cancer integrative services (i.e. massage and acupuncture) and share the same office, space, equipment, and receptionist.

I hope this response is helpful you can check out our program at the link below. Another successful program run by Clinical exercise physiologists is Karen Wonder's Maple Tree Cancer Program located at several cancer locations in Ohio.

https://www.henryford.com/services/cancer/support/excite#g=0|0

i created a program with my Cardiac, Pulmonary, and vascular program. We had CEPs conduct the sessions.

you are correct there are not reimbursable billing codes. However there are codes that the CEP can use for an assessment. We had the patients pay or used philanthropy funds. The patients paid $45 for 12 visits ($3.75 a visit) if the couldn't afford that, we had a scholarship from the philanthropy funds.

I don’t know any run by exercise physiologists mainly due to that billing factor. Most facilities where I’m located in Florida refer to physical therapists. I have been in connection with an Audiologist in the area to overcome the same thing. Please inform!

I am looking for information on beginning an oncology rehab program, being run by Exercise Physiologists. I have the ability to use a PT if needed. If you happen to have knowledge on this service, I'd greatly appreciate it.

What I have learned thus far is:

- No billing codes available by Exercise Physiologists

- Most programs offer it as a Cardiac Rehab Phase III variation, therefore self-pay with different pay structures

- Grant funded or large hospital funded to cover program session costs

Thank you for your time reading and responding,

Amber Sanguinetti, DHSc