Expensive Physical Therapy - A Discussion

Today we have Terry L. Whipple, MD, Chief oftherapy-compromised result for him, but I lose
Orthopedics at American Self, author of severalproductivity in new patient visits, subpar outcomes and
journal articles and textbooks, inventor and patentpossibly development of chronic pain conditions.
holder, entrepreneur, businessman and last but notQ- How does TPT address this problem?
least, vigorous patient advocate.A- Patients can now have a home based active
Dr. Whipple is here to discuss Transitional Physicaltherapeutic experience every day. With a DVD I
Therapy, a DVD.address correct rehabilitation exercise techniques
Q- What is TPT?affecting recovery more consistently, inexpensively
A- TPT is a rehabilitation concept on DVD thatand independently. My patients are now engaged in
empowers patients to manage their own fullmaking outpatient PT more personally beneficial. They
recuperation from surgery or injuries and return toare more accountable. They do this for themselves.
independent function. It supplements or extendsAnd because it's on their own schedule, they are more
supervised physical therapy that is limited by insurancelikely to comply.
allowances. And it stimulates patient recovery in theirI can now recommend 1-2 PT visits for 8-10 weeks. I
own home settings, using common household objectsdecrease my frequency but increase duration if my
without professional equipment to gain the mobilitypatients need it because they have varied but
strength and balance needed for work and play.beneficial therapy routines each day. It also allows for
Q- Are patient's denied Therapy today?better utilization of our therapists.
A- Denied, no. Limited, yes. I've been in practice overQ- How did the concept develop?
25 years and there are several realities we face. First,A- I met with the principles of OrthoCareRN; the
when patients are released from physical therapy theynation's only dedicated Orthopaedic Rehabilitation
usually aren't fully recovered to resume normal lifestyle.Home Health Agency. Their patient care experience
Therapy continuation as an out-of-pocket expense isconfirmed the deficiencies I found. We needed to
prohibitive. Compliance with and correct techniques foraddress cost, convenience, compliance and motivation
home exercise programs (HEP) are inadequate. Wein optimizing patient outcomes. I believe we
believe the value of Xerox copies of exercises isaccomplished this as well as assisting physicians with
wishful thinking. Patients and employers have too manytheir productivity.
expectations and too little guidance. Patients need aQ- What exercises are on the DVD?
transition period.A- We address the recovery process for each group
Q- Should APTA revisit its own recommendations?the DVD covers. There is a variety of exercises for
A- No, but as providers we should understand thepatient ability and preference, each with demonstration
different treatment modalities as well as limitations ourfor perfect technique. For example, our Spine DVD is
patients experience. Under the best insuranceappropriate for everything from chronic lumbago to
coverage possible, patients are asked for $90 a weekdiscectomy and fusion. The Knee DVD is designed for
in co-pays for up to 6 six weeks. This can lead to twopatients with any knee injury, surgical procedure or
potential problems: patients dropping out of therapyreplacement. Hip covers joint replacement and
limiting recovery and development of complicationsfractures. All cover arthritis. Each DVD focuses on the
from too much demand too soon in the workplace,essential components of comprehensive therapy-
playing field or home. Re-injuries are compounding andSSSRB: stretching, strength, stamina, reflexes and
expensive...and frustrating to the patient.balance.
Q- What's the economic impact to our patients?Q- Why the Home Setting?
A- Chronic pain conditions from incomplete rehabilitationA- People today turn to their DVD players for
can severely limit function. Productivity drops andeducation, fitness, entertainment. It addresses the
absenteeism increases. Loss of income is no lessconvenience factor our busy lifestyles demand. How
important than repeated co-payments for additionaloften can a parent leave his or her work, family and
medical or therapy visits. Self-esteem is diminished.social obligations for a two hour trip to therapy three
We all see patients returning to clinic with the sametimes a week. It's no wonder compliance is
complaint 6-12 months following discharge. I've foundcompromised when convenience is an issue. And
the vast majority dropped out of therapy because ofdone right, no expensive professional training or
cost, inconvenience, inefficient or non-productiveexercise equipment is necessary. The DVD shows
sessions.how to use everyday household items for benefit.
Q- What's the economic impact to your practice?Q- What role can a physical therapist play?
A- Repeat and extended visits by those sameA- They understand this situation better than most. If
patients cost me and my practice in new referrals,patients can't afford to visit my clinic we can't expect
time for new patients, and reputation. Consider thethem to afford PT clinics.
patient that can't continue outpatient