Expensive Physical Therapy - A Discussion

Today we have Terry L. Whipple, MD, Chief of Orthopedics at American Self, author of several journal articles and textbooks, inventor and patent holder, entrepreneur, businessman and last but not least, vigorous patient advocate.
Dr. Whipple is here to discuss Transitional Physical Therapy, a DVD.

Q- What is TPT?
A- TPT is a rehabilitation concept on DVD that empowers patients to manage their own full recuperation from surgery or injuries and return to independent function. It supplements or extends supervised physical therapy that is limited by insurance allowances. And it stimulates patient recovery in their own home settings, using common household objects without professional equipment to gain the mobility strength and balance needed for work and play.

Q- Are patient's denied Therapy today?
A- Denied, no. Limited, yes. I've been in practice over 25 years and there are several realities we face. First, when patients are released from physical therapy they usually aren't fully recovered to resume normal lifestyle. Therapy continuation as an out-of-pocket expense is prohibitive. Compliance with and correct techniques for home exercise programs (HEP) are inadequate. We believe the value of Xerox copies of exercises is wishful thinking. Patients and employers have too many expectations and too little guidance. Patients need a transition period.

Q- Should APTA revisit its own recommendations?
A- No, but as providers we should understand the different treatment modalities as well as limitations our patients experience. Under the best insurance coverage possible, patients are asked for $90 a week in co-pays for up to 6 six weeks. This can lead to two potential problems: patients dropping out of therapy limiting recovery and development of complications from too much demand too soon in the workplace, playing field or home. Re-injuries are compounding and expensive...and frustrating to the patient.

Q- What's the economic impact to our patients?
A- Chronic pain conditions from incomplete rehabilitation can severely limit function. Productivity drops and absenteeism increases. Loss of income is no less important than repeated co-payments for additional medical or therapy visits. Self-esteem is diminished.
We all see patients returning to clinic with the same complaint 6-12 months following discharge. I've found the vast majority dropped out of therapy because of cost, inconvenience, inefficient or non-productive sessions.

Q- What's the economic impact to your practice?
A- Repeat and extended visits by those same patients cost me and my practice in new referrals, time for new patients, and reputation. Consider the patient that can't continue outpatient therapy-compromised result for him, but I lose productivity in new patient visits, subpar outcomes and possibly development of chronic pain conditions.

Q- How does TPT address this problem?
A- Patients can now have a home based active therapeutic experience every day. With a DVD I address correct rehabilitation exercise techniques affecting recovery more consistently, inexpensively and independently. My patients are now engaged in making outpatient PT more personally beneficial. They are more accountable. They do this for themselves. And because it's on their own schedule, they are more likely to comply.

I can now recommend 1-2 PT visits for 8-10 weeks. I decrease my frequency but increase duration if my patients need it because they have varied but beneficial therapy routines each day. It also allows for better utilization of our therapists.

Q- How did the concept develop?
A- I met with the principles of OrthoCareRN; the nation's only dedicated Orthopaedic Rehabilitation Home Health Agency. Their patient care experience confirmed the deficiencies I found. We needed to address cost, convenience, compliance and motivation in optimizing patient outcomes. I believe we accomplished this as well as assisting physicians with their productivity.

Q- What exercises are on the DVD?
A- We address the recovery process for each group the DVD covers. There is a variety of exercises for patient ability and preference, each with demonstration for perfect technique. For example, our Spine DVD is appropriate for everything from chronic lumbago to discectomy and fusion. The Knee DVD is designed for patients with any knee injury, surgical procedure or replacement. Hip covers joint replacement and fractures. All cover arthritis. Each DVD focuses on the essential components of comprehensive therapy- SSSRB: stretching, strength, stamina, reflexes and balance.

Q- Why the Home Setting?
A- People today turn to their DVD players for education, fitness, entertainment. It addresses the convenience factor our busy lifestyles demand. How often can a parent leave his or her work, family and social obligations for a two hour trip to therapy three times a week. It's no wonder compliance is compromised when convenience is an issue. And done right, no expensive professional training or exercise equipment is necessary. The DVD shows how to use everyday household items for benefit.

Q- What role can a physical therapist play?
A- They understand this situation better than most. If patients can't afford to visit my clinic we can't expect them to afford PT clinics.