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Raising the Bar in Rehab

Limiting Therapy

Published July 2, 2014 6:04 PM by Lisa Mueller

A friend of mine recently asked for my opinion about how much therapy she would need following a knee arthroscopy. I talked with her for some time about her symptoms and which PT clinic she was going to work with. She then told me she was worried the physical therapist wouldn't be able to help her within the 20-visit limit of physical therapy her insurance company had for her annual rehab benefit. I reassured her that her physical therapist wouldn't need 20 visits to help her meet her goals, but she was clearly concerned.

I've thought about therapy caps from the perspective of the physical therapist many times, and my thoughts are usually surrounding the paperwork associated with requesting more visits. It can seem like one more barrier getting in the way of direct patient care, and that's what physical therapists love to do. However, what do these limits mean for the patients? Like my friend, does it mean fear that their injuries will continue if they surpass their limit?

While some physical therapists may be frustrated by third-party payers for adding these guidelines to patient benefit plans, I think there's also an underlying opportunity for PTs to demonstrate their effectiveness and efficiency within therapy visit limits. The American Academy of Orthopaedic Surgeons recommends patients find a physical therapist who averages nine visits per patient (there's no detail about whether this number is for surgical, non-surgical, or simply an average of orthopedic PT visits overall).

Is there an area for opportunity here? If a new patient is scheduled for physical therapy with a diagnosis of plantar fasciitis, could you anticipate the patient reaching his goals and continuing independent management after three visits? If so, can we share that information with the patient during his first encounter, to ease any concerns he may have about limits on physical therapy visits?

I've seen what the other end of this spectrum can look like -- patients with no payer limits on physical therapy who may develop an unhealthy dependence on physical therapy. Who, when ready to be discharged independently, report symptom exacerbation and require more physical therapy to manage their symptoms in what seems like an unending cycle.

What do you think? Are therapy caps a barrier to your practice as a physical therapist? Can your practice effectively work well within the guidelines of payer benefits?

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1 comments

Every patient is different.   It is not a one size fits all so caps are a problem.   The variables of each patient's condition affect their time in therapy.   Osteoporosis, cognitive abilities, structural limitations, home environments, equipment needs, are just a few of the determinants for number of visits per diagnosis. As a professional, I do not allow an unhealthy dependency on physical therapy...it would be unethical in my opinion, no matter how much their insurance allows.  I do not speak however for facilities.  

Denise, , PTA Skilled nursing and outpatient July 3, 2014 12:05 AM
Yuma AZ

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