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, more pain free 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, chiropractors or other allied professionals, but their doctor(s), colleague(s), friend(s) or family member(s) strongly urged them to try us rather than “living with it” or opting for more invasive procedures. After continually evaluating patients that had gone through this frustration and expense, helping patients transition successfully during an out of area move, as well as countless friends and family members that live far away, I have compiled what I believe to be the top seven criteria which I hope will help you 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 physical therapist (PT) and the support staff to ensure a positive, valuable experience which yields results so you can return to the lifestyle you deserve.
Before getting into the criteria, it’s important to understand who a physical therapist is, especially one who specializes in outpatient orthopedic conditions. Outpatient orthopedic physical therapists treat joint, bone, muscle, tendon, ligament and nerve related dysfunctions. 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 as well as various anti-inflammatory and pain inhibiting modalities based on the needs of their patient. They are highly qualified and experienced in utilizing a holistic treatment philosophy to design custom programs to restore function. Physical therapists are also skilled instructors for their patients as each individual learns and responds in their own unique fashion.
Times are changing and you’ll have to choose an in or out of network provider or simply go on a cash/private pay basis. Due to the many restrictions insurance carriers are enforcing, increasing copays, deductibles and out of pocket maximums as well as lack of transparency during enrollment, many people in need are finding private pay to be the only way to get the care and results they need and want. At BreakThrough, we are helping increasing numbers of patients from Kaiser (no out of network benefits) and other carriers with whom we are out of network who are not getting the results they want elsewhere. When choosing any option for your health, it’s important to know that you are the captain of your health care team. 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 help you with the commitment 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!
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(s)
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. Insurances are changing and more information is now available online with reduced access to a representative. This may make it challenging for both you and the group with which you are inquiring. How do they handle this? How do they make you feel in regards to their intent for transparency?
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, how fast medical reviews will process, etc. There are simply too many factors involved and insurances are making things harder and harder for patients and practitioners alike. However, when you feel that they are up front with you and doing their best to work in your best interest, not theirs, can be a good sign of things to come.
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. At these facilities, they may have the per visit cost benefit of being in network, but it may take more than twice the visits to help you achieve your goals with minimal one on one time at each session and twice as many sessions to attend. As such, comparing costs on a per session basis can often mislead patients and be much more costly, stressful and frustrating in the long run. We use 40 minute treatment slots 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. Be sure to ask if their facility “double-books” appointment slots. In my opinion, your health should be taken seriously by you and any practitioner from whom you might seek help.
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. Saturday visits or random schedule conflicts may allow you to see another PT, but can run smooth in an organization that is committed to you and has taken the effort to put reasonable systems in place while hiring people that work well together for your benefit.
Do you employ “physical therapist assistants” and/or “aides/techs”?
• A physical therapist assistant (PTA) 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.
Typically touring websites of local facilities, as well as online review sites and social media, can help you do a preliminary search. 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 usually going to be visiting at least twice a week for 4-6 weeks, maybe more depending on your condition and effort, other conditions, work/travel schedule, etc. 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 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. Other good questions to ask might be:
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, personality and potential. The real question to ask is:
What support exists for me if I am not progressing?
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. At BreakThrough Physical Therapy, we have a system in place that encourages information sharing among therapists on a regular basis. All our therapists regularly attend continuing education courses on various topics and conditions. They return to the clinic and teach this information to others, furthering ongoing collaboration and maximal benefit throughout the organization. Although each patient is treated by the same therapist, constant communication between patients is occurring between our many therapists. Some organizations have few therapists while others have many who can collaborate and ensure you are getting the very best. The key here is to learn if they have sufficient mentors and a support plan for you.
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 a 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. While they may think that a certain technique seems cool, cutting edge or interesting, our patients enjoy a thorough evaluation prior to determining what techniques might be most useful to help you achieve your goals. In the end, 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)
- Certified Athletic Trainer (ATC)
- Certified Orthopedic Manual Therapist (COMT)
- Fellow of the American Academy of Orthopedic Manual Therapists (FAAOMPT)
- Certified Functional Manual Therapist (CFMT)
- Certified Hand Therapist (CHT)
- Sports Certified Specialist (SCS)
- Certified Strength and Conditioning Specialist (CSCS)
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.
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 your “per visit” financial responsibility based on the negotiated fee schedule to which the provider must abide.
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. Because an out of network is not bound by the rules and regulations and additional administrative burden contractually placed on in network providers, they can treat you the way they would treat their friends and family.
Let the buyer beware…Insurance companies often sell plans which state that you have “unlimited PT based on medical necessity”. What they do not tell you is all the things they do on the backend to find ways to limit your need for medical necessity, even when you, your MD(s) and PT are all on board and really the ones who know best. This can create a long, painful and stressful process for all involved and another reason we are probably seeing more people on a private pay basis as they just want to get better and not have more stress in their life. These processes usually reduce the continuity of your care and ultimately the momentum you may have had.
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 since your insurance company “holds the cards”.
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. Don’t go online and throw them under the bus unless you have made efforts to help them understand your experience. In addition, let the individual(s) who referred you know about this to help improve their referral patterns in the future.
Many of our patients report using multiple online tools such as social media, Yelp, intranets within larger companies, etc. Just like any prescription, you can be seen (have it filled) anywhere you choose.
Your health is important so take it seriously. While you might save $10-$50 per visit on an in network facility, how much does it cost you if they are unable to provide you the experience and results you desire? Because we want to provide the level of care and results you deserve, we strive to be in network with as many insurance plans as we can. Unfortunately it has become increasingly difficult to do so based on the administrative burden insurance companies are placing on the practitioners as well as the reduced reimbursements. Nobody can guarantee how you will progress, but a good facility will be forthcoming after the initial evaluation and provide you with a plan and maintain open communication with you about their thoughts and your options, including consideration of your financial concerns. 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