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.
