Mobile Physical Therapy, Balance Training, and Home Safety
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Trends in Physical Therapy
Why have PT's started looking for a new business model?
Why did providers start looking for a new business model?
The short answer is that it works out better for both the providers and for their patients.
​
In the past, insurance companies reimbursed private practice owners well enough to make a living wage, but over the years, reimbursement has decreased and coverage for certain services has been eliminated as they are deemed “not medically necessary.” In addition, the cost of running a physical therapy practice has risen.
​
Providers working from a medical model are paid according to the patient’s diagnosis and authorized treatment plan - i.e. the insurance company says how fast you should heal and how many visits you get, based on a computer-generated estimate of “other people who are similar to you.”
From the patient’s perspective, insurance premiums and deductibles have risen. Often times, what is best for the patient and will help them achieve their goals is not longer a covered "medically necessary" service. This adds up to a worse experience for the patient for several reasons.
-
therapists must see 2-4 patients at the same time
-
therapists must document on their computer while they are with you, decreasing eye contact and true listening
-
decreased patient outcomes
-
decreased patient satisfaction
-
develop the belief that physical therapy is not valuable
From the insurance company's perspective, the goal isn’t full recovery, it’s functional. The patient progresses to an extent and does feel better than when they came in, but overall it’s a very average experience. A course of PT is generally much more ineffective, time-consuming, and costly than it needs to be. In some cases, it can cause re-injury, re-hospitalization, and wasted money for everyone involved in the system.
My Personal Experience as a PT Patient after being a PT for Several Years
To start, I must make an important distinction. The PT that treated me in this story is an excellent, highly-skilled clinician and I did get good results, but my daily experience in my sessions opened my eyes to the patient experience.
The quality of care received in therapy clinics often has nothing to do with the skills of the therapist, but with the demands placed on them by insurance companies if they are to stay in business. To adapt they must increase the volume of patients seen in a day and thus, lower the quality of care. Another option is to commit fraud. This is a dynamic seen in every sector of health care system, not just therapy.
The first thing I noticed as a new patient was that I had been "double-booked." On my initial evaluation, my very first visit, my therapist kept stepping away to tend to the other patient. The constant interruptions were frustrating but the therapist did a good job of remembering where we left off each time.
Then, at every follow-up visit, I was told to warm up on the elliptical while my therapist performed another task. This is a practice that is common but whether it's an effective treatment is controversial.
​
My therapist did progress my exercises most visits, however I usually performed the majority of them unsupervised. At some point, my therapist would catch me doing an exercise incorrectly and give me feedback, and I wondered if I'd been doing it incorrectly all along.
But the day that stands out - my PT was working on my neck while shouting instructions to another patient across the gym. I felt uncomfortable and worried that my therapist was distracted while performing manual therapy on my neck. And then I thought…"oh my goodness, I used to work in an outpatient clinic and do the exact same thing with my patients!” At the time I always swore I was good at multi-tasking and truly believed I was providing high quality care to both people. But this solidified by belief that PT treatment should be done one-on-one.
As an outpatient PT looking for a job, it's often seen as a luxury to get to work with your patients one-on-one. This is an unfortunate truth but thankfully people are starting to do things differently.
Is the trend toward preventative medicine and self-pay going to continue?
My guess is yes and this is why. As health care opens up to preventative medicine, more individuals are opting for higher value services and investing in themselves earlier in life. That is to say, they are spending money proactively on the preventative side of things, in hopes of spending less money treating injury and sickness on the back end.​
​
People are spending more money out-of-pocket to take care of their physical and mental health, including chiropractic services, massage therapy, acupuncture, and mental health counseling.
This is also because people today have the knowledge and opportunities that previous generations of aging adults didn't have. With science and technology advancing as quickly as they have, we have access to so much more information than in the past. We can choose to do things differently.
​
So which model is better, the preventative or the diagnostic model? Wellness or pathology? Eastern or western medicine? I believe they both have their place and the best approach is a balance of the two.
My Personal Experience as a PT Patient after being a PT for Several Years
To start, I must make an important distinction. The PT that treated me in this story is an excellent, highly-skilled clinician and I did get good results, but my daily experience in my sessions opened my eyes to the patient experience.
The quality of care received in therapy clinics often has nothing to do with the skills of the therapist, but with the demands placed on them by insurance companies if they are to stay in business. To adapt they must increase the volume of patients seen in a day and thus, lower the quality of care. Another option is to commit fraud. This is a dynamic seen in every sector of health care system, not just therapy.
The first thing I noticed as a new patient was that I had been "double-booked." On my initial evaluation, my very first visit, my therapist kept stepping away to tend to the other patient. The constant interruptions were frustrating but the therapist did a good job of remembering where we left off each time.
Then, at every follow-up visit, I was told to warm up on the elliptical while my therapist performed another task. This is a practice that is common but whether it's an effective treatment is controversial.
​
My therapist did progress my exercises most visits, however I usually performed the majority of them unsupervised. At some point, my therapist would catch me doing an exercise incorrectly and give me feedback, and I wondered if I'd been doing it incorrectly all along.
But the day that stands out - my PT was working on my neck while shouting instructions to another patient across the gym. I felt uncomfortable and worried that my therapist was distracted while performing manual therapy on my neck. And then I thought…"oh my goodness, I used to work in an outpatient clinic and do the exact same thing with my patients!” At the time I always swore I was good at multi-tasking and truly believed I was providing high quality care to both people. But this solidified by belief that PT treatment should be done one-on-one.
As an outpatient PT looking for a job, it's often seen as a luxury to get to work with your patients one-on-one. This is an unfortunate truth but thankfully people are starting to do things differently.
Is the trend toward preventative medicine and self-pay going to continue?
My guess is yes and this is why. As health care opens up to preventative medicine, more individuals are opting for higher value services and investing in themselves earlier in life. That is to say, they are spending money proactively on the preventative side of things, in hopes of spending less money treating injury and sickness on the back end.​
​
People are spending more money out-of-pocket to take care of their physical and mental health, including chiropractic services, massage therapy, acupuncture, and mental health counseling.
This is also because people today have the knowledge and opportunities that previous generations of aging adults didn't have. With science and technology advancing as quickly as they have, we have access to so much more information than in the past. We can choose to do things differently.
​
So which model is better, the preventative or the diagnostic model? Wellness or pathology? Eastern or western medicine? I believe they both have their place and the best approach is a balance of the two.
The short answer is that it works out better for both the providers and for their patients.
​
In the past, insurance companies reimbursed private practice owners well enough to make a living wage, but over the years, reimbursement has decreased and coverage for certain services has been eliminated as they are deemed “not medically necessary.” In addition, the cost of running a physical therapy practice has risen.
​
Providers working from a medical model are paid according to the patient’s diagnosis and authorized treatment plan - i.e. the insurance company says how fast you should heal and how many visits you get, based on a computer-generated estimate of “other people who are similar to you.”
From the patient’s perspective, insurance premiums and deductibles have risen. Often times, what is best for the patient and will help them achieve their goals is not longer a covered "medically necessary" service. This adds up to a worse experience for the patient for several reasons.
-
therapists must see 2-4 patients at the same time
-
therapists must document on their computer while they are with you, decreasing eye contact and true listening
-
decreased patient outcomes
-
decreased patient satisfaction
-
develop the belief that physical therapy is not valuable
From the insurance company's perspective, the goal isn’t full recovery, it’s functional. The patient progresses to an extent and does feel better than when they came in, but overall it’s a very average experience. A course of PT is generally much more ineffective, time-consuming, and costly than it needs to be. In some cases, it can cause re-injury, re-hospitalization, and wasted money for everyone involved in the system.
