Arizona Couple Shows Patient Advantages of O&P, PT Partnership

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By Tina Eichner

Orthotic and prosthetic professionals and physical therapists alike are quick to acknowledge the others clinical importance in the patient care value chain. It is in the politics and the legislation that defines each discipline where things can get a little sticky.
    Joe Pongratz, CPO, FAAOP, and Anissa Pongratz, PT, of Arizona, have taken the O&P, PT symbiosis to a whole new level by opening a private PT business within an O&P facility. The husband-and-wife team are the only providers in the state providing complementary services in the same facility--prosthetics, orthotics, and physical therapy. The innovative concept has received a warm response from the surrounding patient and medical community. In addition, Joe noted that he and his wife do engage in conversation about the current direct access debate--and he "is not sleeping on the couch."

Pongratz O&P was established by Joe in 1997 and now has three locations with a team of eight clinicians in Phoenix, Mesa, and Tucson, Arizona. In 2004, his wife Anissa opened a private physical therapy practice within the Mesa location.

"Anissa and I worked together for two years before we were married while she was a staff therapist at Barrows Neurological Rehabilitation in Phoenix," said Joe. "We were married in June 2004 and shortly after that she started her own PT clinic housed in the Mesa office. It is the only combined clinic in Arizona and one of a handful in the western United States."

Joe said Pongratz Orthotics and Prosthetics Inc. joined with Pongratz Physical Therapy LLC with an aim to provide the most complete prosthetic management for amputee patients with a team approach to managing patients, emphasizing continuity of care, and ensuring clinicians are up to date on each patient being treated. The providers are able to work hand-in-hand to customize a treatment program to better meet the patients' needs and help amputees progress to their full potential. The couple thinks that it is a logical business model for the future.

Patient Benefits

"It works so well because we don't have the borders to cross or consider. In our environment everything is available at our fingertips," explained Joe. "We do what is best to service the patient in the best environment for the patient, including on-the-spot consulting and alignments."

Both Joe and Anissa stressed that the greatest benefits of their business arrangement are to the patient. For example, rather than missing several critical days of physical therapy because of a needed mechanical adjustment, the prosthetist is able to make an adjustment immediately, physical therapy treatment can continue uninterrupted, and the quality of care therefore is improved as both team members are able to work together in an easily accessible environment.

"We know that our team approach is outstanding," said Anissa. "From the PT perspective, prosthetic adjustments are sometimes needed because of PT progress. At our practice this can happen on the spot. Get an opinion, make the adjustment, and move forward."

Anissa said that since patients are able to progress more quickly through the therapy program, they stay motivated rather than waiting weeks for an appointment with the prosthetist for a simple adjustment in order to continue therapy.

And as Joe said, the physical therapy available is tailored for the amputee patient. "Our therapy is very specialized. Not many PTs can brand themselves as O&P specialists. It is not a common treatment modality for PTs in general to be working with O&P."

Anissa has developed that expertise specializing in amputee gait mechanics and balance training, although she continues to treat neurological and orthopedic injuries as well.

Joe added, "We want to get the attention of the rehabilitation community that this is a smart business model for patient outcomes. We have strict boundaries [for who provides which services], but all the resources are there at our fingertips."

The Pongratz's don't just want to emphasize the benefits for the patient. The complementary business model also is cost-efficient for payers and insurers in time savings, transportation, and other costs, including fewer appointments.

On Direct Access

On the topic of direct access legislation and increased physical therapy scope-of-practice, Joe stated, "Fabrication and manufacturing is the line in the sand; dealing with materials, the hands-on skill and art and expertise in making these devices--that is what separates the professions."

He continued, "It is a warranted discussion. O&P knows what is needed. We know the clinical, technical background to provide exemplary care.

"I am not against qualified people providing service. Un­qualified people should not be able to provide service based on minimal education and experience. With every profession there should be a balanced blend of clinical application, education, and experience," he said.

Anissa commented, "Direct Access specifically just allows patients to receive an evaluation. The confusion is that PTs can provide care without a doctor's referral, and this is not the case. A doctor's order is required.

"I agree that unqualified medical personnel should not be extending their scope of practice. PTs are bound by their code of ethics that if they do not possess the clinical expertise and education to support their treatment, they must refer services elsewhere," said Anissa.

"Direct Access, however, seems often misconstrued," she continued. "Direct Access specifically allows a Medicare beneficiary to initiate and/or continue physical therapy interventions without the burden of waiting for the physician's prescription within the previously mandated 30-day interval. Physical therapists can evaluate a patient and make recommendations with regards to their care, but the plan of care must be signed by the physician. This does not mean that a physical therapist may prescribe and manufacture orthotics and/or prosthetics without a physician prescription, which is how it seems to be interpreted."