Rethinking Musculoskeletal Care

In tune with an earlier post about choosing out-of-network providers, there is another method we can employ that can help to lower healthcare costs across the industry. The real kicker is that we already know how and where this model works. First, let's consider the typical route the average American might go through when some ache or pain pops up. If they're established with a primary care provider, they might be able to get in within a few weeks to chat about their issue. If they're not already established, push that to a minimum of a few months. From there, their provider might prescribe anti-inflammatories and refer them to PT, if not to an orthopedic specialist first. That physical therapy company will need to then verify the patient's benefits and potentially submit paperwork for authorization to treat this patient. At this point, we're a minimum of 2-3 weeks out from theoretical injury and a lot of admin work has gone into the process.

Now let's consider the alternative that is used widely in New Zealand, Australia, Norway, and the UK. Physical Therapists, or Physio's in those countries, are often looked upon and utilized like primary care physicians. Patients go straight to the their PT's when they have an ache or pain and are seen much faster. Physicians and the public recognize that Physical Therapists are the preferred providers for first line musculoskeletal care. The benefits here are numerous, including: better outcomes due to those shorter wait times, decreasing the load of primary care physicians, saving the industry money by utilizing conservative management rather than surgery, and overall improved satisfaction for the patients and providers.

Now the issue in the US is both our insurance system and some state regulations. In certain states, direct access to Physical Therapists is limited, but this is improving slowly. Washington state thankfully does allow direct access. The other issue, insurance, depends heavily on your carrier and specific plan. Generally speaking though, insurances usually want to see a script from a physician, and they often put limitations for how long we can treat a patient. Ergo, why we have chosen not to contract with insurance.

By being an out of network provider, we accomplish a few goals: providing timely care that results in better outcomes, greater flexibility in how long we can treat a patient, and driving down the cost and burden of seeing primary care physicians first.

The other component of establishing PT as a first line provider is rethinking the model of what PT care looks like. I can't tell you the number of times early in my career that I would see a patient for 6-8 weeks, discharge them, and then see them come back six months to a year later. Sometimes it was for a different injury that they let go on for too long, but oftentimes it was for the same issue that they completely ignored after stopping PT. The model that we can work towards as a private pay company allows us more flexibility in how we treat so that we can avoid this whack-a-mole treatment style.

You might be the type who is young, motivated, and learns really quickly, allowing you to only need 1-2 sessions of PT before you get the idea and you can take care of whatever ache or pain has shown up. But for most of us, we fit in the 'getting older and things are falling apart and you can't keep up' type. For this vast majority of patients, having you show up 3 times per week for 2 months and then discharging you back to your regular habits without following up is only going to result in you injuring something else, ignoring something you shouldn't ignore, and bringing you right back for intensive PT. The better option? Come see us once per month. Let us know about that shoulder twinge you felt when reaching into the cabinets last week, or that knee popping when you're getting into a low seat. Let us give you some targeted exercises to try for the next month, and then let's see where you're at when you come back. We might move on to the next painful site, or we might tweak what's working or not working. The benefit is that you have someone constantly in your corner that you can reach out to, and a much smaller chance of letting some small injury balloon into a real issue.

So come try out some Physical Therapy. Let's fix that shoulder that grabs when you overhead press or loosen up that knee that aches when you get up in the morning.