First of all, let’s dispel the myth that a patient must go to the physical therapy facility referred to by their physician. With most insurance plans, a patient has the right to make their own decision when it comes to selecting a physical therapy team. As a subscriber of health insurance such as Medicare, an HMO or private insurance, the high premiums you and your employer pay enable you to be part of a vast network of medical practitioners; therefore you have the right to choose within these networks and find the best possible care for your individual needs.
And with the recent prevalence of high deductible plans – in other words, paying more out of pocket – patients are now becoming healthcare consumers. As such, it is imperative that you understand the cost and value of medical intervention. That said, unfortunately patients often find themselves on an uneven playing field as many larger medical facilities and hospitals receive higher reimbursements from insurance companies. Translation? The allowable reimbursement for a physical therapy visit at a hospital could be up to three times what it would be for a private practice. Add a high deductible plan to the mix and the patient/consumer is paying the same amount the insurance company would reimburse the hospital for that procedure.
In terms of selecting the right physical therapy practice for you, it makes sense to start by asking your physician for several referrals. Again, it doesn’t mean you must choose among those recommendations, but it can be a good starting point. Even better, patients may opt to conduct some research and select the provider that best fits their needs.
Whether the physical therapy facility you are considering is a result of a physician’s referral or your own investigation, the following are a series of key questions that should be asked before signing on the dotted line:
• How long will it take to get an appointment? It should be less than 48 hours.
• How long will the average session run? Typically should not be less than 30 minutes.
• How many visits does a patient with your diagnosis typically require? Having this critical piece of information will provide you with an idea of how effective the practice’s treatment is and will also give you an idea of total cost. It should be noted that based on national averages, most diagnoses are treated in 11 PT sessions or under.
• What is the practice’s reputation? You can find reviews on most facilities posted on Google, Yelp or healthcare review websites.
• What does an initial evaluation with a high deductible cost? Price compare to other facilities.
• What will a typical follow up session cost?
• Can you have a tour of the facility?
• Can you meet the therapist(s) you will be working with?
Other equally important questions to ask are:
• What is the physical therapist’s education and training?
• Does the therapist(s) you’ll be working with have a solid understanding of your specific condition?
• Does the facility offer convenient days and hours to suit your needs/schedule?
Since physical therapy is a hands-on approach to relieve and treat pain, you will want to choose a physical therapist that makes you feel comfortable. Be advised that some forms of therapy require partial undress, so it’s important that you are able to relax around your therapist.
Patients are also better served if their therapist talks them through the treatment process prior to executing action. For some – particularly those who have little or no experience with PT – having a basic knowledge of what type of therapy will be performed and its expected result will decrease high anxiety levels.
A physical therapist should not only treat your condition, but also help you to understand it. Patients should never be afraid to ask questions about their treatment.
It should be noted that the need for transparency and accountability among health care providers has prompted the federal government via the Affordable Care Act to form Accountable Care Organizations (ACOs). The underlying premise is to have large networks of providers voluntarily join together and be answerable around three major categories: patient satisfaction, patient outcomes and cost effectiveness. Reputable professional physical therapy practices should welcome this important effort, for ultimately the public decides who to hire…and who to fire.
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Matt McManus is co-owner and regional clinical director of ProEx Physical Therapy (www.proexpt.com). He can be reached at mmcmanus@proexpt.com.