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Raising the Bar in Rehab

Unlimited Therapy

Published July 19, 2012 11:43 AM by Lisa Mueller

We often hear a lot about the limited number of visits many insurance companies place on physical therapy benefits. Medicare, for example, allows $1880 maximum allotment annually for physical therapy coverage.

It's hard to work against the clock. There are patients who need a lot more physical therapy than their coverage allows, and the therapist knows this. The therapist then spends each session cramming as much information as possible into the patient, as well as providing interventions.

As the visits get closer to the maximum limit, the therapist may offer family teaching and other community options for patients to at least maintain their progress with the tools they have. It is fairly easy to recognize the drawbacks of limited therapy visits because that is the overwhelming issue most physical therapy clinics face. Often it isn't only the third-party payer mandating the therapy caps; sometimes patients don't have the time or finances to continue therapy.

Imagine for a moment that things were different, or even the opposite. What if patients could have as much therapy as they needed? Or as much therapy as they wanted? What if there was no limit to the number of visits per year, or per diagnosis? Is that an ideal situation, or would it create as many problems as limiting the number of visits?

With a limited number of visits, therapists have a very clear plan of what each treatment session will include and are extremely efficient at providing interventions. Integrating research into practice becomes a necessity because therapists need to know what works and how to weed out practices that are not highly reliable. Many times, home programs are emphasized due to the limited clinic time, giving patients more responsibility and thus, collaboration into their plan of care.

With unlimited visits, clinicians have more time for trial-and-error practice, and plans tend to be more vague. There can be greater patient dependency on the clinician due to prolonged care. Patients may not exhibit a strong work ethic because instead of working harder to see results, they will instead continue going to therapy for a longer duration.

I think the answer lies somewhere in the middle -- the dreaded gray zone. While practicing under a deadline can be stressful, having no structured guidelines can also be problematic. From some of the reading I have done recently, it appears the average number of visits for an outpatient orthopedic physical therapy practice ranges from seven to 12. What do you think about those numbers? Does it seem low? High?

3 comments

I agree with Dean's comment except it wasn't only Home Health that abused the system. When i graduated from PT School in '71 (1971, not 1871!!) we pretty much had unlimited visits AS LONG AS THE PATIENT WAS SHOWING PROGRESS. I think the big difference now is not the limited visits, but the patient's ability to pay the co-pay. PT has to be cut down to 1-2X/wk if the patient has a co-pay. With that few visits/wk, it's difficult to get the patient to be compliant enough with the home program, so the pt

Al DiMicco July 20, 2012 8:16 AM

Would unlimited visits provide the patient with significant progress?  I believe the answer is yes for most patients.

If I can see my MD unlimited times a year why is there a limit for my Doctor of therapy?

Jason Marketti July 19, 2012 9:44 PM

Unlimited therapy is what gave the home health field a really bad name in the early 1990's. PTs had carte blanche for 8 weeks and often renewed for another 8 after that. There was no incentive for providers to crack down on it because they got reimbursed by the visit. It was actually a tough time to be an ethical provider of treatment. Patients expected unlimited treatment and home health aides and agencies wanted you to renew so they could make more money.

As difficult as the early years of managed care were, and they were, I think it started a more appropriate trend of having to validate one's work. The pendulum may have swung too far the other way now. Let's hope it settles in a reasonable middle somewhere.

Dean Metz July 19, 2012 4:09 PM

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