Physical Therapists (PTs) are increasingly expected to deliver value (better patient outcomes with equal or reduced costs). This presentation will explore how altering frequency can contribute.
Our research identified a strong independent association between visit frequency and functional improvement and home discharge home among hospital patients across clinical subgroups. As a result, we now provide therapists with guidelines and frequency modes which they discuss with families at the outset of care to support optimal patient outcomes.
During Your Initial Visit
Physical therapists (PTs) are health care professionals uniquely qualified to understand patients beyond injuries or pain. Unlike physicians or nurses, most PTs prefer working one-on-one with clients for extended periods. This allows PTs to form personal connections with them as well as provide personalized treatment plans aligned with individual goals.
Physical Therapists don’t prescribe medicine or surgery like primary care physicians can, but they have an invaluable ability to diagnose movement-based problems. A great physical therapist understands how cardiovascular, neurological and endocrine systems influence movement patterns which is why they will usually check more than just the area of discomfort before beginning therapy sessions.
Physical therapists tend to approach the initial visit as an evaluation, much like when consulting with new physicians. At this session, your physical therapist will sit with you and discuss any pain or discomfort that led you to seek treatment as well as asking about its history and symptoms. Through conversation and Q&A-style questions, your therapist has the chance to fully comprehend what’s been going on and how it has altered your lifestyle.
After your evaluation, your physical therapist (PT) will evaluate your progress and create a treatment plan tailored specifically for you. This may include an estimate of how often treatment should take place per week based on how far along you have come since initial assessment. Frequency changes can be made based on clinical judgment without needing re-certification from physicians/NPPs.
Medicare Benefit Manual specifies in an SNF environment, the Medicare Benefit Manual requires physical therapy treatments on five calendar days per week for 60 consecutive days in order for Part A coverage to continue. While this number can be altered as needed by writing progress reports or the physical therapist providing services; ultimately it rests with them to decide whether continued care is medically necessary and continue.
One additional consideration to keep in mind when visiting physical therapists is that they often employ various modalities that could extend the length of your sessions, for instance if you’re being treated for a post-amputation condition your PT might provide prosthetic training as part of the appointment day.
After Your Initial Visit
Physical therapy is an approach used to reduce symptoms associated with health conditions like pain and stiffness or treat an injury. Physical therapy may also form part of a long-term care plan to manage chronic illnesses like arthritis or heart or lung disease.
Your first visit with a physical therapist (PT) will involve them assessing your symptoms, movement patterns and body alignment; functional tests to measure strength and ability are often done as part of this evaluation process. Your assessment involves three parts: subjective discussion with the PT about your issue; an objective evaluation of how your body moves including biomechanics evaluation; and final diagnosis/explanation of your treatment plan.
Once they understand your health situation, a physical therapist (PT) will tailor an individualized treatment plan to improve mobility and get you back doing activities you love. The exercises in that plan could take place both with them in clinic or gym settings as well as at home.
Exercise to enhance how your body moves and reduce pain, so that you can return to engaging in your favorite activities again. Your therapist might use other interventions, such as electrical stimulation or ultrasound, to target specific muscles or nerves for stimulation; or suggest changes to your lifestyle: for instance if your injury involves sitting all day at work, postural exercises might be suggested, along with encouragement to stand up periodically throughout the day and move around more.
Your physical therapist (PT) can work closely with both you and your physician to develop an individualized treatment plan and schedule. They’re also experts at getting insurance approval; for instance if you have an Aetna HMO plan with a 60-day limit for physical therapy sessions, their PT will coordinate with both to identify the ideal approach and timeline before you can resume treatments again.
High-Risk Cases
Physical therapy is generally considered medically necessary when it improves functional performance in activities of daily living such as bathing, dressing, grooming, eating, mobility and personal hygiene. Any new condition or exacerbation of an old illness would qualify as “new incident of injury”, qualifying the member for additional courses of physical therapy based on this criteria.
Hahn et al (2014) conducted a research study investigating the effect of physical therapy frequency on high risk patients by administering a case vignette to 714 clinicians who held either the McKenzie Institute Credential (MDT) or both the MDT+FAAOMPT credentialing. Participants were required to choose which examination techniques and interventions based on their decision-making processes, before selecting an outcome that fit each clinician’s decision making process.
Researchers found that those randomized to receive more frequent physical therapy sessions showed greater improvement on both HOS and iHOT-33 scores at 1 month when compared with those receiving less-frequent PT; however, due to a small sample size these differences weren’t reported as statistically significant by authors.
