Updated list of responses-
ORIGINAL QUESTION:
Have any of you had experience with having a physical therapist on staff at your O&P facility? Conventional wisdom here has it that doing so might hurt referrals from other local PTs.
Randy McFarland, CPO
Fullerton, CA
RESPONSES: separated by a blank line
In my experience that is not the case. In fact a tame physio in hand can spread the word amongst his/her colleagues about ways in which you can be of assistance.
Might be a great opportunity to have a PT go out and market to local rehab hostials and facilities. We therapist always listen best to one of our own.
No, but I’ve definitely thought about it. Especially for gait training where it has been hard to find good experienced PT’s wanting to work with amputees. I would appreciate you posting or forwarding your responses.
On Mondays, I maintain a private practice here in DSM. We have 2 OT’s and 1 PT on our staff. Not only has it been an asset for us personally in our clinical care, the physician referrals increased due to our emphasis of a rehab team approach.
Pertaining to therapists, we had the same concerns and rectified the potential for conflict this way. Our main PT’s for referral are from in-patient, hospital based settings. From acute to sub-acute/SNF, once the patient goes home, our referrals no longer see them anyway. Let’s say the need for continued therapy as an out-patient still exists. Does it not make sense for the convenience of the patient to have rehab in the same building as where they receive their O OR P device? We frequently have the clinician in with the therapist for a few minutes each appointment until the device is completely broken in and adjusted.
Even then, weeks later, if a question arises or an adjustment is needed we are right there taking care of the problem immediately. Each therapy visit generates a follow-up letter to the attending physician. This not only gets your name in front of the doctor when they review the chart during the patient’s follow-up with them, it reminds the physician that you have out-patient therapy capabilities.
One of our physiatrists specializes in prosthetics and pediatrics. They loved this idea so much, they now come to OUR office once a month for a clinic and see 8-9 patients in a morning with us in the rehab gym. VERY successful as they also discuss this with their fellow physicians. We are the only OandP company in DSM with this option for patients. This uniqueness is one of the ways to set yourself apart from your competitors.
Physical therapists see us as a continuation of their care. Our PT will provide out-patient care until the patient no longer makes progress, NOT when their insurance runs out! We use this as a detailing point to referrals. If we make the device, we make sure they are safe and stable in it prior to our discharge. Once the O or P clinician takes completely over, our therapists continue to visit the patient in the room with us if necessary or even just to say hi when they come to see us just to maintain that continuity of care. Very welcoming environment for the long term. It has made me better clinically also since I always had this tendency to get my Allen wrench out to adjust an alignment problem; now I have a therapist who tells me to hold off a week. Let the patient try to practice something they assessed and made a muscle strengthening exercise recommendation. When they come back, several times the problem needed no adjustments. I often thought the device was the problem when it was actually a weak muscle group.
Therapy, especially for orthotics, is often not ordered at all. We intercept some of these and request the patient go visit the physiatrist for evaluation. We enhance their mobility by recognizing a problem that went unsolved by the local family doctor. Our therapists can bring them back to a level of independence because we saw the results of deconditioning and took action.
We work in low-income countries and our policy and the reality is that in all our supported projects the P-O’s are manufacturing and checking-out devices and the PT’s are doing the post-op pre-prosthetic and gait training. The last activity always takes place in the P-O facility. We promote the team approach (Medic, PT, P-O) I am convinced that the above is, practical, correct and for the benefit of the patients. Conventional wisdom here has it that any deviation from the above gives an incomplete treatment protocol (Clearly we deal with a different convention then in the USA) I hope that the above will convince you to take a PT into your facility.
Having followed the PT vs. P-O issues in the USA, I am convinced that in first instance you will loose some referrals from (then) competing PT’s.
Eventually, you will get more referrals from all over the place since you will simply provide better services with a PT in your facility.
Patients/consumers will experience the difference and in no time the word will be out that you provide better care/service then those without a in-house PT.
I think that in the end, affordable service provision and quality patient care will win from the intra- and extra professional power/provision grabbing struggle.
I know a facility that had a couple at his facility there in S. CA, which I visited during my residency. I would think it would hurt referrals too.
I’m an amputee physiotherapist working in a rehab centre with an outpatient amputee caseload. I work with 7 prosthetic firms. I have long held the belief that the prosthetic facility that provides in-house PT for their patients will take that next step beyond what everyone else is doing, raise the bar so to speak – you can provide a level of comprehensive team oriented service for all of your amputee clients. I have had such discussions with some of my prosthetic colleagues to feel out their interest – not much interest from one-man shops, but I believe a larger firm with branch offices in several cities would be the best match. I listen to my prosthetic colleagues complain about the lack of quality physios who understand amputation and prosthetics, particularly in acute care hospitals, and that the standard of physio care is not consistent. Why wouldn’t a prosthetic firm want to provide that consistent standard of care with great prosthetists working with great physios – the winner is the patient. When your patients win presumably that increases their loyalty to you. This is good for business.
Of course the topic of salary is an issue – whether you are an employee or subcontracted out for the physio service. Since I work in public practice I serve all amputees regardless of their ability to personally pay or whether they have an insurance carrier, and I work in Canadian health care, which is more socialized than yours. However with annual cutbacks and the emergence of more right wing governments, our public health care is being slowly broken apart. The one issue which is stopping me from really pursuing finding employment in the private health care world, and specifically with a prosthetic firm, is that 25% of my current patients would not have medical coverage for my service privately. I’m sure that I would get over this issue once I worked in the private sector.
I don’t think prosthetist owners understand the potential billings that a physio could bring in, if a comprehensive rehab plan was developed in concert with your provision of a prosthesis. Why wouldn’t an insurer pay for defined measurable physical outcomes?
I don’t have that specific experience but I have physical therapists who
are close friends and that I work very closely with. That makes absolutely no difference regarding referrals from others. I get the strong feeling that PTs are not nearly as competitive between facilities
as are O & P practitioners.
I worked in a facility in Albuquerque, NM several years ago. Our competitor had PT available on site I believe it was his wife although I am not sure. I know that our rehab referrals went up dramatically and more than one rehab group that I spoke with were offended that my competitor was competing directly with them. They were afraid that if a client were sent to our competitor for services that they would lose the patient all together so did not refer.
