How to Choose a Physical Therapy Clinic

Seven Topics to Consider When Choosing an Outpatient,
Orthopedic or Sports-Oriented Physical Therapy Clinic

You realize it’s time for a change. You want to decrease pain, improve motion, improve strength, improve endurance and/or learn better postures and body mechanics so you can live a healthier, happier life.  But where do you start?

There are many factors that make up an exceptional physical therapy experience.

Too often we see people at our facility, BreakThrough Physical Therapy, who have little faith in physical therapy. They have been to several other clinics, but their doctor or friend strongly urged them to try us rather than go the route of surgery. After over 20 years in physical therapy, I have compiled what I believe to be the top seven criteria to make an educated decision regarding the physical therapy portion of your health care team.  Once you decide on a physical therapist (PT), be sure you effectively communicate with your PT and those in the practice to ensure your experience and results help you return to the lifestyle you deserve. You should also make the commitment right now to play an active role to progress and, when necessary, to change the movement patterns and habits that have gotten you here.

Before getting into the criteria, it’s important to understand who a physical therapist is, especially one who specializes in outpatient orthopedic conditions. Physical therapists treat joint, bone, muscle, tendon, ligament, and nerve related dysfunction. They help their patients alleviate/eliminate pain, improve/restore range of motion, strength, endurance, and ultimately work to optimize their patient’s ability to function in all aspects of life. Physical therapists utilize a combination of manual and neuromuscular techniques based on the needs of their patient. They are highly qualified and experienced in utilizing a holistic treatment philosophy to design custom home- and gym-based exercise programs to restore function.  Physical therapists are also skilled instructors for their patients as each individual learns and responds in their own unique fashion.

When choosing any option for your health, it’s important to know that you are the captain of your health care team. You need to educate yourself and then make decisions for yourself.  The days of going to your doctor and telling him or her that you have back pain and asking for a solution are long gone.  You need to make the choices that make the best sense for you, your family, your finances, your schedule, and, most importantly, find practitioners or groups that are truly looking to work with you with the passion you deserve. While there is unlimited information available online, you cannot effectively evaluate or treat yourself. In regards to physical therapy, you may be spending a significant amount of time and ultimately money as you go through the process. This makes finding the right, supportive team critical.

Here are the things to consider when making that decision.  In my opinion, not one of these is the most important, but when you find an organization that can support the majority of these consistently you will have probably found a good fit for you and your family in the years to come!
Professionalism
One on One Treatment Time
Tour the Facility
Experience and Certification
Insurance
Location(s)
Value

PROFESSIONALISM

Keep in mind this all-encompassing aspect cannot be fully assessed during your first contact. Experiencing an organization’s professionalism first-hand, from the first call or contact with them, will give you a glimpse of what you might expect in regards to:
•    Your treatment
•    Their billing practices
•    Your future scheduling
•    Their reporting/communication with your referring physician 

If your first experience is by phone, did it seem like the front office staff was well trained?
A well-trained front office staff takes control of the call and engages in conversation with you to get all the information needed to make your first visit run smoothly. They may even take the time to contact your insurance carrier as a courtesy so that, hopefully, the information from your carrier is the same as what your carrier tells you when you call. If the information matches, you should be confident about details like deductible, copays, and visit or dollar limit on outpatient orthopedic physical therapy.

A simple way to test the professionalism of a clinic is how its employees treat you. Did they treat you properly and with respect?  Did they show legitimate interest in you while remaining efficient in obtaining all of your information and then inform you of the next steps?
It should be noted that any physical therapy clinic or medical practitioner cannot tell you up front what your exact out of pocket expenses will be or how quickly you will complete your treatment.  However, feeling that they were up front with you in a reasonable fashion based on the limited information they can obtain from your insurance carrier can be a sign of things to come from them. 
 

ONE-ON-ONE TREATMENT TIME

You could see the best physical therapist on the planet based on peer reviews. But, if they are working for an organization that does not support their skill set and only allows brief treatment sessions, then you may not receive their best or the best.

Consider the answers to the following questions when making your decision:

How much time will I get with my therapist during each session?
In this case more is not always better, but less than 30 minutes of one-on-one time may not be sufficient to reassess your condition and progress you during each session. We use 40 minute treatment slots at BreakThrough and have found that this is a nice balance for us and our patients.  Some clinics have one hour slots, but then include putting you on a stationary bike for 15-20 minutes as a part of that or don’t commit themselves to you as you deserve.

Will I see the same therapist on each session?
Staying with the same therapist offers you consistency and not having to explain yourself to a different person at each visit.  It also allows the therapist to better treat you. For example, if for some reason you felt great after the last treatment or worse, they can assess why. Seeing a different therapist requires him or her to rely on a limited amount of information from which to assess you and decide on an approach to this session and future sessions. If occasionally you do see another therapist, be sure that the organization has an effective means by which they are communicating with one another regarding your case.

Do you employ “physical therapist assistants” and/or “aides/techs”?
• A physical therapist assistant works under the supervision of physical therapists. They may assist in developing treatment plans and carrying out routine functions. They may also document the progress of treatment. PTAs usually have formal training and obtain licensure to practice.
• A physical therapist aide or tech works under close supervision of a physical therapist or physical therapy assistant. They perform routine tasks delegated by the therapist or assistant. They are not licensed and are typically trained on the job. 

If you do employ “physical therapy assistants” or “aides/techs, how will they help me? 
If used properly, aides or assistants can be of great benefit to you and the organization.  They can take you through your routine while under the direction and supervision of your therapist. This allows your therapist to spend as much time on the skills they feel you need rather than basic tasks. Note that some clinics will not employ aides or techs and argue that this allows them to provide 100% one-on-one care, but if a part of your physical therapy routine is to warm up on the bike then getting billed for 15 minutes of the therapist’s time while doing so, this may not be your best bet.  Physical therapists also often use modalities and aides. Techs and assistants are all well qualified to perform those tasks as it only takes good direction from the PT, not their one-on-one time to do this for you.
 

TOUR THE FACILITY

Typically touring websites of local facilities, as well as online review sites, can help you do a preliminary search (www.Yahoo.com, www.Google.com, and www.Yelp.com were commonly used as of the time of this publication).  Some organizations will have a virtual tour so you can get an idea of their facility without visiting.  Additionally, referrals from friends or family and from your medical doctor can help. But if you are going to sign up for a series of physical therapy, you are going to be visiting at least twice a week for 4-6 weeks there, maybe more depending on your condition and effort.  It is critical that you feel comfortable with the people, the way the organization appears to run, the space and amenities, etc.
If it is tight and crowded you may not have the ability to progress the way you would like, especially if you are sports oriented or have advanced goals for yourself. 

While a virtual tour can be sufficient, the best way to properly evaluate a clinic is to go onsite and take a tour. Look around and consider the space. Is there adequate private treatment space? It is critical that you can relax while under their care and feel safe and respected. When you go onsite, is the place physically clean and organized? Are there papers everywhere and is the front office staff frazzled? If so, this could be a bad sign if all the other factors correspond.  Who knows? It could simply be a busy day and they are not fully caught up with that part of the job due to caring for multiple patients and calls. We all have those days; but if the whole office seems scattered and nobody notes your presence, it is surely a red flag.

Is the equipment current and clean? 

Good therapy does not often require a lot of expensive equipment since the end goal of any physical therapy program should be that you can transition effectively to a home program at the end of your care without requiring such equipment or a gym membership. However, you should take note of squeaky, broken or outdated equipment that shows a total lack of effort to provide patients the best.
 

EXPERIENCE AND CERTIFICATION

How many years of experience does my PT have? 

If not much, that could be fine as all newer therapists (since 2000) have earned a master’s or doctoral level degree, have had internships, passed licensure exams and been successfully hired by the organization based on their confidence in the therapist’s skill set and potential.  The real question to ask is:
What support exists for me if I am not progressing?
At BreakThrough Physical Therapy, we have a plan in place to have one of our senior therapists if we are unsuccessful at making a change by discussing cases through chart review and regular in-house dialog amongst our treating team. There can be great benefit to working with an organization whose therapists are regularly interacting and sharing information to ensure that all patients are getting the best in care.  Additionally, if your care is still not progressing, at BreakThrough Physical Therapy, we have implemented a “co-treat” option which has been extremely beneficial for us and our patients. For example, a clinic or organization may block time on a senior therapist’s schedule for you to either see them one-on-one or with your therapist for one visit. This allows the senior therapist to work with you, discuss their thoughts with you and your therapist, and together come up with a plan based on the assessment to best serve you.  The key here is to learn if they have sufficient mentors and a support plan for you.

Experience is good as the longer a therapist has been in practice the better they have become at seeing different presentations of patients and conditions.  However, you should take note that some experienced therapists can easily rest on that experience and get stagnant in their approach.  Having a younger or less experienced therapist who is more “hungry” could be beneficial as well. So there is not an easy answer here, but you should know what you’re getting and know the benefits or limitations to each.

CERTIFICATION

Does the facility or therapist(s) have any special certifications that may suggest they might be more capable to take care of you and your specific needs?

Be aware that therapy should involve a comprehensive approach so seeking a therapist who has a specialty or certification in some technique can be of great benefit, but if too specialized, they may miss the big picture.  You aren’t typically going to therapy because you heard of the technique or specialty. Most of our patients call because they believe that with professional help they can be living a healthier, happier and more active lifestyle.  After research, you have to put trust in an organization that you feel has the best tools and environment to help you succeed.

Upon graduation, all therapists are generalists by degree.  They are able to successfully understand and perform evaluation and treatment for a wide variety of conditions (i.e. orthopedics, pediatrics, cardiac rehabilitation, neurological rehabilitation, wound care, etc).  At BreakThrough Physical Therapy, we focus on outpatient orthopedic physical therapy.  Orthopedics has its own growing list of specialty certifications, as well as other techniques that have their own independent certifications.  Commonly known certifications include:

•    Orthopedic Certified Specialist (OCS) – www.apta.org
•    Certified Athletic Trainer (ATC) - http://www.nata.org/athletic-training
•    Certified Orthopedic Manual Therapist (COMT) - http://www.aaompt.org/
•    Fellow of the American Academy of Orthopedic Manual Therapists (FAAOMPT) – www.aaompt.org
•    Certified Functional Manual Therapist (CFMT) – http://www.instituteofphysicalart.com/fellowship.php
•    Certified Hand Therapist (CHT) - http://www.htcc.org/

A physical therapist who has any of these is likely continually improving their skills and taking the time and expense to get tested to show a certain level of proficiency before a panel of experienced peers or leaders in their field. At the time of this publication, only a small percentage of the physical therapists in practice commit the time and expense to achieve full certification in any of these areas.  One certification is not necessarily better than another, just different in approach.  Specialist certification is certainly a good indicator of a therapist’s dedication to their field and their patients. However, you should also know that most physical therapists regularly attend continuing education coursework to steadily improve their skill set even if they do not complete the full certification process.  In California there is a minimum number of hours required for each therapist to maintain their license.  The key to your success here is that your therapist is not overly biased on certain techniques as a result of all the time and dedication such a certification might require and truly utilize what they feel is best for you on each visit.

The other common question is to simply ask yourself, “What is an expert?” By definition, an expert is a person who has special skill or knowledge in some particular field; specialist; authority. An expert in regards to your health is one who not only has such a level of expertise, but uses it effectively for each patient at each encounter.  For example, I could be rated by my peers as the best therapist on the planet, but if I do not provide you the best of what I have to offer or fail to truly engage with you and your condition, goals, external factors, internal factors, insurance or financial limitations, I may not be the right therapist for you.  I may also be working in an organization that does not allow me to appropriately utilize my full set of tools for you.  When it comes to your health, you need someone who is an expert, works for an organization that is focused on you and your needs as much as they can, and is engaged in your overall health and well being, not just your current symptoms.
 

INSURANCE

Being “in” network provides you a certain level of protection as the organization has a contract with your carrier and needs to abide by that contract which both protects and limits you.  It protects you financially based on the negotiated fee schedule that the provider must abide to. This means you can go to a quality facility that is in network and receive care for essentially the same cost to you as if you had gone to a lesser facility that is also in network. 

Contracts or “in network” status can also limit you. For example, say you just had a multi-level fusion of your lumbar spine (low back). Your contract could limit the number of visits to 12 or costs to $2,000 annually. But you could easily need a lot more to get your desired results.  Other plans require pre-authorization every three visits which can inhibit your ability to maintain a steady progression since your therapist must get pre-approval after every two sessions therefore focusing their time on the evaluation rather than your treatment.  If any of these limitations exist, the physical therapist may be limited in the way they treat you especially if you are not willing or able to pay out of pocket if visits get denied.

If you have a maximum dollar or visit limit then the therapist may be forced to recommend that you are seen only one time per week when in an ideal world they feel you would benefit from two or even three sessions in a week to get you through the early phase and then reduce the number of weekly sessions as you improve and gain confidence prior to discharge from their care.  If you are flexible and financially capable, opting for an out of network provider may allow you to have your doctor and PT guide your care and not your insurance carrier. 

You must check with your carrier to understand your physical therapy benefits.  Some organizations, like ours, contact your carrier to verify your benefits and then report that information back to you, but they are limited by what they are told by the representative. Unfortunately there are no guarantees in regards to the accuracy of that information.
 

LOCATION(S)

As you will be spending a significant amount of time in therapy, a certain level of convenience is certainly beneficial.  You will want to consider if you prefer to go before or after work or if it is best for you to go during the day. Location used to be the main criteria by which physicians referred patients to physical therapy.  Fortunately they are learning, like the public as a whole, that there are clear differences in regards to the overall experience and results between clinics and that where they refer you reflects on them. If you end up at a facility that is not helping you or provides a subpar experience then you should be sure to let them know so they can improve. In addition, let the individual(s) who referred you know about this to help improve their referral patterns in the future.
 

VALUE

A facility that you are choosing to go to via your insurance or on a “cash” basis may be further and charge more per visit. This may be better than saving $10 a visit and not getting better or getting better, but over a greater number of sessions.  Nobody can guarantee how you will progress, but a good facility will be forthcoming after the initial evaluation and provide you with a plan.  They will listen to and work with you for your benefit, not theirs.
 
At BreakThrough we hope that our patients view their time and monies spent here as an investment in their health, not an expense.  Please be aware of the difference between an “investment” and an “expense” as you make your final decision.


As you can see, choosing your health care practitioner and specifically your physical therapist is not an easy task. When it comes to your health, you need someone who is an expert, works for an organization that is focused on you and your needs as much as they can, and is engaged in your overall health and well being, not just your current symptoms. Ultimately you make the decisions about your health and need to take the necessary time to find an organization that you believe can best serve you and your family’s needs now and in the future.  I hope that this gives you some good ideas as to what to ask of a clinic you are considering and of yourself. 

For more information regarding BreakThrough Physical Therapy or other informational articles like this please visit:  www.BreakThroughPT.com

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