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Toni Talks about PT Today

Time and Money

Published January 29, 2013 1:55 PM by Toni Patt

Now that I'm home from CSM, I've had an opportunity to process all of the information. Most of the presentations were excellent. Those that weren't purely theoretical had a common theme. We have to maximize what we do because we're spending less and less time with patients. We have less time to spend because there isn't money to pay for our services.

More than ever, the underlying theme was get as much as you can as quickly as you can. Prioritize what you do. We no longer have the luxury of waiting on return of function to work on recovery. Now it's see what you have. Assess the length of stay and do the best you can. Among the unintended consequences is the difficulty in getting more heavily involved patients mobilized earlier and into acute rehab.

The problem isn't therapists. Payer sources aren't funding longer lengths of stays. They aren't giving us the number of treatments we need to accomplish our goals. In their zeal to cut costs, payers have forgotten that home is less expensive than long-term care. If we had more time acutely, or even subacutely, more patients could return home. That means no more paying for long-term care. I can't imagine another week of inpatient rehab is more expensive than months and months of nursing home care.

Money also affects staffing. Cutting staff levels means spending less money. Now fewer therapists must see more patients. Those that are heavily involved, in the ICU, or difficult to mobilize are the ones most frequently skipped. Sadly those are also the ones who need therapy the most. They don't demonstrate immediate gains, which creates the impression the therapy isn't helping.

We're getting better and better at what we do. Brains can only repair themselves so fast. Often they need more than seven to 10 days to reorganize. No matter how hard I, or anyone else tries, we can't speed the process along. The same is true of musculoskeletal injuries and disease processes. Yet somewhere along the line, someone decided that's all the time that's needed.

What if someone created an intervention to completely reverse the effects of a stroke? What if it took two weeks for the intervention to be effective? How would payers respond? I'd like to think they would make adjustments in their reimbursement structure but I doubt it. It would be too expensive. What if that intervention was physical therapy? PT can restore lost function after stroke. With adequate therapy, many stroke survivors can return to some level of their previous lives. Most don't get adequate therapy because it's too expensive.


Toni, your silo of work is not where the focus of better recovery of stroke survivors will come from. The neuroprotection therapies that don't exist yet, stopping the various causes of the neuronal cascade of death.

Excititoxicity, glutamate poisoning, non-release of pericytes clamping down on capillaries, inflammatory action leaked thru the blood brain barrier. This will result in less dead and damaged neurons allowing for a much easier recovery. But this will only occur when it is realized that the focus on tPA is preventing looking for those therapies that stop the neuronal cascade of death.

Dean, stroke - survivor, home January 29, 2013 11:21 PM
east lansing MI

How true this is!

I am not sure if I would chose therapy as a career if I knew that reimbursements for care would decrease or get cut.  It is the patients and families that suffer because of it.  And of course therapy is to blame for not getting the return from the patient no matter what research and evidence will suggest.

I tell every patient to appeal any denial of care and be vigilant and determined to fight with their insurer.  I have given evidence to a patient and family that "proves" therapy will help her so when she went to the care conference she can produce it and show the facility and nurse from the insurance company therapy is beneficial.  

This produced some controversy and the patients family was told they could pay for care out of pocket if they wanted her to stay and have therapy at the facility.  A lot of good all this evidence based practice does, the insurance company and facility didn't want anything to do with it.    

Karen January 29, 2013 10:15 PM

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