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The Fibromyalgia & Fatigue Centers: Bringing Patients Effective Treatment Across the US

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An interview with Mr. Robert S. Baurys, CEO and Dr. Kent Holtorf, Chief Medical Officer of the Fibromyalgia & Fatigue Centers, Inc. Please talk about how and when the Fibromyalgia & Fatigue Center was conceived, who was involved in establishing it, and what makes it unique.

Baurys: I first came down with Fibromyalgia five years ago, and like so many patients it took over a year and a half, many doctors, lots of tests and a lot of wrong guesses before I was properly diagnosed. But even then I still didn’t have any answers as to how to get my life back to normal. Having a strong background in health care I knew I needed to educate myself on this condition if I was ever going to find the answer to how to control it. And I also knew at that point, that if I ever did find treatments that would allow me to live a normal life again, I would do everything in my power to make it accessible to the millions of people all over the country who have FM and CFIDS. After a lot of research and time spent talking to doctors who thought they knew what to do to make it bearable, I realized that frequently I knew more than the doctors did and no one really had a good idea of what to do.

Until I found Dr. Holtorf. Kent was practicing in Torrance, CA and he specialized in FM and CFIDS patients. He himself has been struggling with CFIDS for 20 years and has spent much of that time researching and understanding exactly all the things that happen to the body when these conditions are present. He has treated over 3,500 patients and has remarkable outcomes with the majority of his patients able to lead normal productive and active lives once again. His approach made sense and so I became a patient. That was about a year ago. Within a few months I was feeling great and asked Kent if we could teach other physicians all the complexities of the conditions and train them how to treat them to achieve the same incredible outcomes he had been having in his own practice. His answer was yes, and so the Fibromyalgia & Fatigue Centers (FFC) were established.

I have about 20 years experience in business development and part of that time was spent creating and establishing wound care centers all over the country. So, with Kent and my long time business partner Sue Hrim, who is also a registered nurse, we began outlining the prototype for the Centers and assembling our management team. Sue and I have been fortunate to have worked with very talented people throughout our careers, and when we asked some of these people to come and work with us to establish centers all over the country, they said yes. That was in November 2003.

Dr. Holtorf: What makes us unique are a couple of things. First, we really do understand the conditions we are treating. With both the CEO and the Chief Medical Officer living with these conditions every day, we have a first hand understanding of what it is like for our patients to do normal every day tasks most people take for granted. We also have a unique integrated approach to treating the patient which involves looking in-depth at everything that is going on with that person and treating the causes of the symptoms, not just the symptoms that are presenting during their appointments. We only use medications to ease symptoms, not mask them. And we really take our time with each patient. Since the Center physician’s job is exclusively treating patients. He or she can take the time needed to really get to know the whole patient and create an individualized care plan for them. And finally, while there are a few physicians in the country that have pretty good outcomes in this field, they do not have the know how to replicate what they are doing in their practice to be able to reach out to patients nationwide and still maintain the quality of the outcomes. This combination of a unique clinical algorithm and the business savvy to expand nationwide is what really set us apart. Do you have a standard approach or program for treating CFS and FM patients? There is some information on your website ( regarding the "proven 6 step approach" that is used at your centers. Please describe the 6 steps.

Dr. Holtorf: As you may know, FM and CFIDS present differently in each patient. And even in each patient, the symptoms may vary in degree of severity from day to day, so there is no “one size fits all” treatment for these conditions. The treatment protocol is individualized for each patient, but we always follow our unique “six step approach” to determine what is wrong with each patient and then customize their treatment. This integrated program addresses the underlying etiologies that cause those symptoms with the long term goal being elimination and/or significant reduction leading to a long term maintenance plan. Since treatment needs to be individualized, phases may occur in different orders and multiple phases are often done simultaneously, but simply put these phases can be broken down as follows:
• stabilize the patient by addressing pain and sleep disturbances;
• promote energy by enhancing the powerhouse of each cell, the mitochondria;
• balance hormones by evaluating hypothalamus and pituitary function;
• enhance immunity and treat underlying viral infections;
• address unique etiologies such as neurotoxins and coagulation defects;
• provide each patient with an individual maintenance program with the minimally necessary medications and supplements to assure absence of symptoms.
With over 3,550 patients treated using this method, and the majority of them having a significant increase in energy and decrease in pain we know that when implementing the full six-step approach, significant recovery or complete resolution of symptoms is the rule rather than the exception. Are your treatments expensive compared to traditional doctor's office visits? Do you accept insurance?

Baurys: When you think about the fact that the standard office visit gives you 8-10 minutes at most with the physician, and the patient usually pays a $20 co-payment per visit and the insurance company pays the physician another $45-50 per visit that makes the payment rate of $65-70 per 10 minute visit or $390- $420 per hour visit, if you were allowed to have such a thing in today’s reimbursement driven society. At the FFC the patient spends between 60-90 minutes with the physician on their first two visits and the rate for those visits is $325. And then there is the additional time spent with the nurse and/or physician should treatments be given during those initial visits. After that each follow-up visit is $165 and usually lasts about 30 minutes with the doctor. So comparatively we are a bargain when you look at the time spent with the physician and the total cost and more importantly the outcome.

One of the reasons we can do what we do the way we do it and achieve the outcomes we do is the fact that we don’t accept insurance. If we took insurance payments we would be relegated to fall into the insurance model of the 10 minute office visit, since that is all the companies are willing to pay for. There is no way a physician can adequately get to know a patient and their condition in 10 minutes or less, and work out an individualized treatment protocol to get them on the road to wellness. It is just impossible. We do however provide our patients with the necessary documentation should they choose to submit their claim for potential reimbursement. Most PPO insurance plans will reimburse the patient for out-of-network visits and that reimbursement rate usually ranges anywhere from 30% – 80% of the cost of the visit. So when you think about getting reimbursed for even 50% of the visit that means the out of pocket cost to the patient is only $160 for a 60-90 minute visit. When you realize the average patient is probably seeing multiple doctors regularly for different symptoms caused by FM and CFIDS, then you know they probably spend that much every four to six weeks in co-pays alone and without improvement in their condition. To make it easier for our patients, we do have Quest Labs in each of our centers to do the blood draws and most of the lab work, and Quest will bill the patients’ insurance carrier directly. What do you believe are the biggest benefits of the Fibromyalgia & Fatigue Centers for patients seeking effective treatment?

Dr. Holtorf: The biggest benefits are the same things that make us different. Our patients are seen by health care providers who really understand their struggle and the challenges that living with FM and CFIDS brings to every day life. They ask questions and really get to the root of the problems and then aggressively work to get it under control. We are conveniently located and expanding all over the country so patients don’t have to travel great distances to get help. And we are affordable since treatment needs decrease as the condition improves and our goal is eventually for our patients to be able to live an active life with just minimal long term treatments to keep their FM AND CFIDS under control. But the most important benefit is our patients improve and regain quality to their lives, and after all, that is what it is all about. How many locations do you have so far, and what are your plans for adding additional locations in the future? How do you choose locations?

Baurys: We currently have Centers in Torrance, Dallas, Cleveland and Denver and we are opening in Atlanta, Houston, Long Island, Minneapolis, Detroit and Seattle by the end of 2004. Our ultimate goal is 30 Centers by the middle of 2006 and we are well on our way. City selection is based on a variety of things. Our first FFC locations were selected to offer a reasonable option for patients in all regions of the country. We generally pick cities with high populations, major airports and easy access around the local area. Our first goal is to make sure we have FFCs covering all regions of the country and after that in 2005 we will fill in with additional Centers in each region. We also look at where there are hot spots for FM and CFIDS. Weather plays a big part in severity of symptoms and so we look at where weather conditions make it worse and we will have a heavier concentration of Centers in those areas. What can you offer patients with more recalcitrant cases of FM and/or CFS?

Dr. Holtorf: The majority of our patients are the tougher cases. We get referrals from other physicians who can’t or don’t know what to do to help their patients feel better. We get patients who have been struggling for 10-15 years, or even longer in some cases, and who have just about given up hope of ever feeling somewhat normal again. When we review their medical history it sounds so familiar – years of struggle to figure out what is wrong, wrong diagnoses, at least 8-10 different physicians visited, hopes dashed and finally resignation that their life will be filled with pain and fatigue until the end. These patients are no different than those we see that have not yet been diagnosed or are newly diagnosed; the only difference is that the latter has not, in most likelihood, lost hope. So to all our patients we offer hope, hope that you can realize optimal results if we work together to get your body back in balance and correct the problems that are causing your pain and fatigue. We also offer our proven method to help you regain control of this condition that has taken control of your life. We know that mild cases or more established and complex cases can all benefit from our approach and treatments. How many physicians are staffed at each location, and are patients able to choose a doctor – or several doctors if needed, to work with them on their treatment?

Baurys: Currently, each FFC is staffed with one physician who is the primary health care provider along with the RN Case Manager, who oversees the coordination of the patients care plan. Since getting to know the patient and their condition in such detail is the hallmark of our approach and critical to the success of developing the treatment plan for each patient, we felt it was important to have one highly trained physician responsible for the care of the patients in each location. The “partnership in healing” relationship that develops between the patient and the physician is one of the keys to positive outcomes. We do however work with other healthcare providers outside our center in a cooperative collaboration for the care of the patient. If a patient is currently undergoing some adjunctive therapies that are proving to be beneficial to their condition, we will work with those health care providers to ensure a seamless integration of that therapy into the treatment plan. Occasionally, we will even recommend some therapies that require specialized treatment by other health care providers (i.e., sleep studies to pinpoint more complex sleep issues, etc.) and we will help coordinate that care. We also keep referring physicians abreast of patient progress if so requested. Do you think your centers work best for patients who take a more active role in their care and healing?

Baurys: Patients need to know they have a choice to live a full and productive life. It takes some significant level of commitment to get control of your life again but it can be done with the help of experienced and caring people. There are several steps to assuming a controlled pathway, all of which are critical to the outcome:
1. You must decide that you truly want control of your life again. This is important as it becomes very easy to get inwardly focused on controlling the pain and minimizing the exposure instead of living your life. You need to decide if you really want control of your life again.
2. You must select your support team carefully. As you have undoubtedly already heard, some physicians still think this is a mental condition, not physically based. Thankfully, the overwhelming research has shown most intelligent practitioners that FM and CFIDS in fact have some distinct physical abnormalities associated with them.
3. You must commit to controlling your destiny. Each day, the battle must be fought. You must stay committed to owning control of your life, on your terms, to effectively manage your conditions.
4. You must enjoy your life again. The strongest medicine in the world is the ability to be happy. Attaining the state of contentment is a powerful elixir that puts everything else into a manageable context. Patients who take this control and come to our centers are successful.

Dr. Holtorf: Bob is right. It is all about attitude in combination with the right medical approach. We think we offer patients who understand this, the best chance for leading a happy, productive and active life. Anything else our readers should know about the Fibromyalgia & Fatigue Centers?

Baurys: To our patients who are reading this, thank you for making our beginnings so successful and for encouraging us to grow and reach out to more people suffering as we have in the past. Thank you for trusting us with your wellness and for putting your faith in our proven medical protocols. Your smiles, hugs and shared stories of the active lives you are now leading are what motivate us to keep moving forward. And to those readers who are not patients, please know there is hope and help out there so you too can begin to really live the life you deserve. Never give up hope and if in anyway we can help, please don’t hesitate to contact us at 1-866-443-4276.

Dr. Holtorf: I only have one more thing to add. When you are told that “it is all in your head”, or “you need a psychiatrist”, or “your lab tests all came back normal”, or “there is nothing that can be done for the pain or fatigue” – keep searching for answers! You are not crazy. You do not need a psychiatrist. Your body is telling you something is wrong and it is more accurate than some lab tests can be. And you can do something about the pain and fatigue. Both Bob and I and all our patients are living proof of that.

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