Falls, Exercise and Evidence in Physical Therapy

Does exercise really help reduce falls? As physical therapists, we educate our clients in the importance of exercise daily.  Of course, we know that exercise truly does reduce fall risk.  Some clients are eager to exercise, experiencing an increase in energy and improved confidence with their mobility and walking. However, others need some convincing to jump on the exercise bandwagon.  As a physical therapist, I love to educate my clients in strategies to keep them as independent and active as possible.  Utilizing medical research studies provides great evidence to support exercise for independence.  Here we will review the correlation between older adults, falls, healthcare and exercise.

According to the Centers for Disease Control and Prevention (CDC), 1 in 3 adults over age 65 years falls each year, in the United States.  Almost half of individuals over age 80 fall each year.  Falls are the leading cause of injury-related death in this age group.  Falls not only impact the independence and quality of life of individuals as they age, but they also are very costly to the healthcare system.  According to the CDC, the direct medical costs of falls among older adults in 2013, was $34 billion.  Because of an aging population, this figure is likely to continue increasing.  The direct costs are calculated by insurance reimbursements for treating fall-related injuries.  This does not include the long term costs for future disability, dependence on others, lost work time and lower quality of life.  It is estimated that the average hospitalization cost for a fall injury is over $35,000.  As therapists, we know that conservative treatment through physical therapy can reduce healthcare costs drastically.  It is much less expensive for insurance companies to pay for 12 visits of physical therapy, than to pay for a hip replacement and all the aftercare necessary.

physical therapy for falls

Those staggering statistics can be a bit discouraging for older adults.  By educating clients in the modifiable risk factors, they can take an active role in reducing their own fall risk.  Research shows that risk factors highly associated with fall risk include: history of falls, balance problems, leg muscle weakness, vision problems, taking more than 4 medications, and difficulty walking.  Many of these factors can be significantly reduced through exercise.  Exercises should focus on leg strengthening, balance training and flexibility.  There are many published medical research studies to support this claim.

In a study systematic review of literature performed by Gillespie et al.(1), 111 clinical trials were reviewed to analyze the efficacy of exercise in reducing fall risk.  The authors concluded that exercise interventions reduce both the risk and rate of falling in older adults.  In another review of literature, Powers et al.(2) examined what type of exercise has the greatest impact on reducing falls.  They found that a program of muscle strengthening and balance training that was individualized to a person’s need (one prescribed by a trained health professional, such as a physical therapist) was highly beneficial.  In addition, they found that Tai Chi group exercise was shown to reduce risk of falls, as was participation in a home hazard assessment and modification session.  Group exercise classes were beneficial, but not as beneficial as individualized exercise programs.  As therapists, we should consider incorporating Tai Chi as part of home exercise programs.  Also, we should educate our patients in home safety strategies to reduce environmental hazards.

In another systematic review of the published literature, 54 trials were analyzed by Sherrington et al.(3), and found that exercise was the single best intervention to prevent falls.  This study noted that the exercise program must challenge the balance and improve muscle strength through resistance training.  The exercise program should be progressive and individualized to the client’s needs and limitations.

The main learning points of these research reviews are that the exercise programs must be tailored to individual limitations.  If the client has limited strength in their hip flexors and trunk, then they will not be able to properly elicit a hip strategy to maintain balance.  Therefore, the exercise program should focus on strengthening those areas of weakness.  In addition, the client’s balance improves, you will need to progress the difficulty of the exercise for continued improvement.  These strategies all seem like common sense to an experienced clinician.  However, sometimes patient’s need to see the proof that therapy can improve their safety and independence as they age.

As therapists, we must be our own advocates.  The physical therapist is a vital component of the healthcare team.  We are the most capable healthcare experts to reduce the risk of falls in aging adults, through a thorough evaluation and treatment plan.  We should empower our clients with a comprehensive and easy to follow home exercise program, in order to further improve their confidence and independence after completion of physical therapy.  So, next time you have a client that is not a believer, show him the evidence that exercise truly does reduce fall risk.

Utilization of outcome measurement tools, functional mobility tasks and simple examination components such as single leg balance, and tandem stance are excellent means of demonstrating improvement in physical performance and reduced fall risk.  Through utilization of bestPT software, we can easily document objective measures and compare pre and post intervention outcomes.  These improvements can be easily faxed, printed and shared with our clients and their other healthcare providers.  You will be able to turn skeptics into therapy believers.

Disclaimer: For HIPAA compliance, all characters appearing in this post are fictitious. Any resemblance to actual persons or actual events is purely coincidental.

  1. Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2009 Apr 15;(2): CD007146.
  2. Powers C, Farrokhi S, Moreno J. Can exercise reduce the incidence of falls in the elderly, and, if so, what form of exercise is most effective? Physical Therapy. 2002 Nov vol 82; no 11; 1124-1130.
  3. Sherrington C, Tiedemann A, Fairhall N, Close JC, Lord SR. Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. N S W Public Health Bull. 2011 Jun;22(3-4): 78-83.

Caring for the Complex Pelvic Patient Part II: Treatment techniques

In the second installment of this three part series: Caring for the complex patient, we will review the patient’s presentation and discuss the treatment techniques employed and how documentation using bestPT supported the treatment.

The patient was a 34 year old female referred to physical therapy (PT) by her obstetrician-gynecologist (OB-GYN) for evaluation of pelvic organ prolapse (POP). The patient presented to physical therapy para 2 grava 2 (P2G2) indicating 2 pregnancies and 2 live births. On the day of evaluation she was 5.5 weeks post vaginal birth after cesarean (VBAC) of her second child. Her primary concern was a feeling of heaviness and a sense that her organs were falling out, especially during standing and lifting tasks. Her physician had not yet performed a complete six week post-delivery examination, though this appointment was scheduled for three days after physical therapy evaluation.

The patient reported neither pain nor unintentional loss of urine (incontinence), though she felt weak throughout the abdominals and pelvic floor. Pertinent past medical history consisted of cesarean section 11/19/12 (almost two years prior to PT evaluation date) with subsequent hematoma at the surgical site which resolved with use of an abdominal binder. She is otherwise a very healthy woman with no comorbidities. The patient lived at home with her husband and two children, works as a physician assistant specializing in hospital based gastroenterology which requires prolonged standing during procedures and patient rounds. She is an avid runner and aerobics instructor. Her primary goal was to be able to safely lift each of her children without the sense of heaviness in the pelvis. Secondary goals were to return to running and teaching aerobics classes which are her primary sources of recreation and stress reduction.

Physical therapy examination revealed abdominal strength to be 3+/5 on the Kendall scale. The Pelvic Floor Impact Questionaire (PFIQ-7) was utilized as standardized outcome tool. This patient received a score total of 0 on the bladder and rectum subsets, and a score of 19 on the pelvis subset for a total score of 19 on the scale. Internal examination and musculoskeletal physical therapy differential diagnosis included pelvic floor dysfunction resulting in prolapse, and increased abdominal pressure due to visceral adhesions from previous c-section.

The first priority of intervention was patient education to avoid bearing down and valsalva maneuvers. Discussion on the day of evaluation included contracting the pelvic floor prior to lifting her toddler or infant, safe lifting spinal mechanics, and breathing technique to avoid abdominal bulging or bearing down. Avoidance of constipation was discussed, though this was not an issue for this patient, nor was weight management. The patient was issued a copy of the American Physical Therapy Association’s postpartum health awareness information brochure to provide further education regarding postpartum back and pelvic pain, pelvic floor muscle care, post partum fatigue, posture, and cesarean scar management.

Following the internal pelvic exam, the patient was given a pelvic floor strengthening program. Given that the role of connective tissue in providing support to the pelvic floor has gained significant emphasis in the literature, it is understood that if the patient does not benefit from a pelvic floor strengthening program than other means of intervention may be warranted. The rationale for intensive strengthening of the pelvic floor muscle to treat POP is that strength training will build up the structural support of the pelvis by elevating the levator plate to a higher resting point, and maintain this position through hypertrophy and improved stiffness of the pelvic floor muscles.

As no single or absolute protocol has been reported to be the absolute gold standard in the literature, pelvic floor muscle (PFM) training was dosed based upon compilation of evidence in the literature, and patient response. Initially the patient was given a program of 80-100 kegels per day, with 4 sets of 10 being 5 second hold, and 4 sets of 10 being 15 second hold to address speed and endurance of the muscles. These numbers were calculated based upon her muscle test scoring durng initial evaluation. Due to her busy schedule and PFM strength of 4/5, she was advised that these could be performed in various positions, including supine hooklying, sitting, and standing. She was educated to gently draw in the abdominals during PFM contraction as transverse abdominis co-contraction has been demonstrated to enhance activation of the pelvic floor.

Progression of PFM exercise and lumbo-pelvic stability exercises were increased each visit as the patient became stronger. Progressions included diaphragmic breathing pattern with pelvic floor muscle contractions, sidelying clams while performing a PFM and transverse abdominis contraction, and quadruped PFM with transverse abdominis contraction. This exercise was progressed by adding an opposite upper and lower extremity lift (commonly referred to by physical therapists as a bird dog). Pelvic brace with cough was added to address co-ordination and timing of PFM contraction prior to increased intra-abdominal force.

Planks in the forward and side position were introduced at the fourth visit with instructions to contract the pelvic floor muscles and transverse abdominis. At this point, the patient was able to sustain this contraction and sense lift of the pelvic floor for approximately 20 seconds. Sit to stand with kegel and small range squats were added as well. At this point in treatment the patient reported that she was already feeling much better, noting a 50% improvement in overall symptoms during activities of daily living.

Manual therapy consisted of myofascial release (MFR) and scar mobilization, and was performed on the first several appointments to address restriction and adhesion from her cesarean scar. The scar was mobilized in all planes by applying gentle pressure to the scar itself and moving it in the caudal-cephalad, medial-lateral, and rotational planes. Myofascial release of the surrounding tissue was performed similarly. Tissue restriction was assessed to be restricted in all planes both above and below the scar.

Treatment consisted of applying gentle pressure downward with the patient positioned comfortably in supine-hooklying with a bolster under the knees. The theory behind MFR is that the pressure will stimulate increased blood flow and subsequent heat production, enhance lymphatic draining, and provide proprioceptive input into the tissue addressed. Treatment technique of this nature can be direct, wherein the tissue is mobilized in the direction of restriction, or indirect wherein the tissue is mobilized away from the direction of restriction, similar to sliding a stuck dresser drawer backwards in attempts to gain a smooth slide outwards.

Both direct and indirect techniques were utilized on this patient due to the fact that she tolerated both quite well. Once pressure was established and direction of restriction determined, which was both superior and inferior to the Pfannenstiel’s incision, and on the left of the incision, gentle pressure was held until a giving way sensation was felt. The patient was educated in self scar massage technique and advised to perform daily. Additionally, strain-counter-strain (SCS) technique was utilized to release tight and shortened iliopsoas muscles bilaterally.

Muscle energy technique (MET) was utilized in order to re-establish symmetry to the sacroiliac joints of the pelvis. The pubic shotgun technique was utilized prior to torsion MET to draw the left anterior innominate posteriorly and thus level with the right. The patient responded extremely well to treatment. The final installation of this three part series will discuss her outcomes and provide insight to other possible treatment techniques for this patient population.

-Amanda Olson, DPT

Caring for the complex pelvic patient with Physical Therapy

Physical therapists specializing in pelvic health are confronted with a myriad of pelvic floor diagnoses and impairments which may result in pelvic organ prolapse (POP). Pelvic floor weakness secondary to muscle fiber damage or connective tissue abnormality may account for this phenomenon. Extenuating circumstances, such as a vaginal birth after cesarean section (VBAC), add further dimension to the patient’s presentation clinically. A 2014 study suggests that 65% of women experience successful VBAC deliveries, and there seems to be a growing trend of women requesting them.

I recently had the privilege to treat such a woman in the clinic. The patient was a 34 year old female referred to physical therapy (PT) by her obstetrician-gynecologist (OB-GYN) for evaluation of pelvic organ prolapse. The patient presented to physical therapy para 2 grava 2 (P2G2) indicating 2 pregnancies and 2 live births. On the day of evaluation she was 5.5 weeks post vaginal birth after cesarean (VBAC) of her second child. This three part series will analyze how documentation supported the evaluation, treatment, and outcomes of the patient.

At the time of initial evaluation her physician had not assigned a grade to her pelvic floor prolapse. Furthermore, the patient had not been evaluated for prolapse during cough; bear down, or in standing position, per patient report. Her primary concern was a feeling of heaviness and a sense that her organs were falling out, especially during standing and lifting tasks. Her physician had not yet performed a complete six week post-delivery examination, though this appointment was scheduled for three days after physical therapy evaluation.

The patient reported neither pain nor unintentional loss of urine (incontinence), though she felt weak throughout the abdominals and pelvic floor. Pertinent past medical history consisted of cesarean section 11/19/12 (almost two years prior to PT evaluation date) with subsequent hematoma at the surgical site which resolved with use of an abdominal binder. She is otherwise a very healthy woman with no comorbidities. The patient lives at home with her husband and two children, works as a physician assistant specializing in hospital based gastroenterology which requires prolonged standing during procedures and patient rounds.

She is an avid runner and aerobics instructor. She reports that there is good stress in her life with the birth of her second child. She was concerned that she would be unable to safely lift her toddler, run, or teach classes in her current state. Her primary goal was to be able to safely lift each of her children without the sense of heaviness in the pelvis. Secondary goals were to return to running and teaching aerobics classes which are her primary sources of recreation and stress reduction.

Physical Therapy Electronic Documentation

Click to Enlarge the image.

 

Past medical history is easily entered and accessible in the electronic chart.

There is burgeoning evidence to support physical therapy intervention for pelvic organ prolapse. A Cochrane Database System Review analyzed three randomized control trials (RCT’s) and found that pelvic floor muscle training may result in prevention of symptom worsening, and better self-reported patient outcomes. Furthermore, there is Level I evidence via 3-D ultrasonography that supervised pelvic floor training can increase PFM volume, close the levator hiatus, shorten muscle length, and elevate the resting position of the bladder and rectum in patients with POP. The researchers noted improvement in muscle thickness in both stage I POP and in symptomatic women with stage II or greater as determined by the Pelvic Organ Prolapse Quantification Scale (POP-Q).

As a measure of functional outcome, the patient was asked to complete the Pelvic Floor Impact Questionnaire-short form 7 (PFIQ-7). This outcome measure is a patient report of impact of symptoms of bladder, bowel, and prolapse impairments, and allows the therapist to gauge the level of impact and frustration that the patient experiences due to their symptoms so that treatment may be tailored to fit their individual needs. The PFIQ-7 was found in long form to be valid and reliable for women with disorders of pelvic floor including urinary and fecal incontinence, as well as pelvic organ prolapse. It is internally consistent (0.96-0.97), and reproducible (0.77-0.92), and the prolapse section was found to be significantly correlated with the stage of prolapse of the individual. The short form is faster for the patient to complete, and was found to maintain excellent correlation with the long form (r=0.95 to 0.96), with test-retest reliability P<.001). The outcome may be analyzed in subsets for bladder, bowel, and pelvic symptoms, respectively. This patient received a score total of 0 on the bladder and rectum subsets, and a score of 19 on the pelvis subset for a total score of 19 on the scale.

Musculoskeletal screening included assessment of posture in standing and sitting as this can be beneficial as an assessment of structural alignment according to the American Physical Therapy Association’s Guide to Clinical Practice 2nd Edition. The patient demonstrated mild forward head, mild anterior shoulder positioning with mildly increased thoracic kyphosis and lumbar lordosis. Pelvic symmetry was assessed by palpating the bony landmarks of the anterior superior iliac spine (ASIS) bilaterally, and the pelvis was mildly anterior rotated on the left. This pelvic position was verified in the supine position to account for possible interaction of limb length discrepancy. Limb length was measured and found to be insignificant with the right lower extremity measuring 1 millimeter longer than the right. Abdominal strength was graded 3+/5 as she was able to lower her legs no greater than a 60 degree angle while maintaining posterior pelvic tilt, according to Kendall’s muscle testing scheme.

PT examination sought to determine the nature of the heaviness in the pelvis through observation and palpation of the pelvic floor in supine hook lying position. This is done in order to assess the response of the pelvic floor and determine which walls of the pelvic floor appear to be affected.
Musculoskeletal physical therapy differential diagnosis included pelvic floor dysfunction resulting in prolapse, and increased abdominal pressure due to visceral adhesions from previous c-section.

Physical Therapy Electronic records

Click to Enlarge the image.

Documentation to demonstrate verbal and written consent for external and internal pelvic floor examination are pertinent.

bestPT is able to create unique objective components to demonstrate that consent has been verified. Furthermore it is possible to scan in and attach release forms that have been signed by the patient.

In the next installment, we will discuss treatment techniques in this unique women’s health sub-population.

-Amanda Olson, DPT

Physical Therapy Software | Improve Patient Retention with Care Plans

Physical Therapy software_ patient-treatment-plansAre you worried about paying next month’s bills because your patients don’t show up for their appointments? If your patients are noncompliant with your prescribed care plans, you cannot predict the cash flow at your physical therapy practice. What’s even worse is that your patients won’t get better.

Without consistent patient flow your practice cannot grow or be profitable. But unfinished care plans can also cause compliance issues and hurt your cash flow even further when you have to return payments. You can figure out just how much money your practice might be losing due to unfinished or unused care plans. Simply replace the assumptions below with your own practice numbers and complete the calculations.

For example:

Assumptions:

  • 1 visit = $89
  • 1 care plan = 10 visits
  • Average number of no-shows per care plan: 5

Calculations: Potential income and losses from unfinished care plans per patient:

  • Potential income from 1 care plan: 10 visits x $89 = $890
  • Potential loss from no-shows per care plan: 5 visits x $89 = $445

Conclusion: You risk losing half of your income when patients don’t finish their treatment plans!

Identifying patients who don’t understand  the need for multiple visits to achieve their health goals is easier said than done, however. You really need to know what the entire plan looks like in order to track multiple visits. For instance, you need to track any patient that goes through a traditional  treatment step-down ladder, such as four visits per week for the first four weeks, then three visits per week for the next three weeks, and so on. Such unique nuances on many patient schedules are difficult to track manually, and this difficulty grows dramatically with each added care plan. Not to mention, tracking the respective discounts given for each care plan is nearly impossible without a tool.

Thousands of care plans are created for new patients every month to schedule multiple appointments and then track all payments and visits with your bestPT EHR software. When patients don’t show up for their appointments you can receive automated alerts on your physical therapy software workbench. You can also receive alerts via tickets when patients don’t have a future appointment scheduled or when they cancel their existing appointments. That way you can assign your staff the task of scheduling the next appointment. Another useful tool for helping your patients stay on track with their care plans are appointment reminders sent via phone, text, or email. bestPT physical therapy software has integrated several apps which serve this purpose.

Physical Therapy Software_ CarePlan

To set up care plans when your patients come into your practice, simply go to bestPT’s Scheduler and click on the “More” tab to open the wizard. You can also create a full care plan from the patient account. Make sure you turn on the settings in your bestPT physical therapy software for Patient Relationship Management and Reminders.

Physical Therapy Billing | Patient Education Improves Rehabilitation Results

Physical Therapy Billing_Patient EducationStatistics show that PT patients retain less than seven percent of what is explained to them through traditional methods of physical therapists. Surveys also show that the lack of understanding by the patient of their condition is the number one reason for patient visit cancellations, a poor clinical experience and inadequate treatment plan compliance.


Solution – Patient Education
When patients know why they tend to comply! 3D Animation is a tried and tested method of communication that allows easy understanding by the patient and longer term retention of the information presented them.

3DRX have created the most extensive and professional library of Medical 3D Animations along with a massive library of Rehabilitation Exercises and a fleet of other Innovative Patient Education Products. The survey results from 22 practices across three countries, over a 8-month period using the 3DRX Products have been staggering:

  • 19% increase in New Patients
  • 27% reduction in Patient cancellations
  • 36% improvement in Patient Satisfaction with their clinical experience
  • 94% overall Practitioner satisfaction rate by the clinics using the program

 

Solution Features
Some of the main features that Practitioners liked most about the product:

  • World’s largest library of Physical Medical  Animations Library
  • New Rehabilitation Component with extensive Protocols
  • The Ability to communicate both Animations and Rehabilitation Programs
  • Being associated with the high end technology and innovative program
  • Having a tool that differentiates your clinic from others
  • Marketing your clinic in a professional and non- over solicitorial manner
  • Marketing your practice without feeling
  • like you are selling something to the patient

 

What we have done – The first PT-specialized Practice Management System solution integrated with Patient Education

BestPT has integrated with 3DRX to provide you with the Leading 3D Physical Medicine Animation and Rehabilitation Products. Our current practices can have in one click the full functionality of 3DRX, being able to vividly educate their patient and build a training rehabilitation program that will be accessible to the patients through our Patient Portal.

Physical Therapy | Patient education improves compliance

Physical Therapy Billing | patient educationIn a recent survey on the benefits of patient education used by physical therapists the general consensus was that educated patients are more compliant with their care plans.

“It would add immensely to the comfort a patient has with his/her diagnosis and make them both more compliant in taking their medications as well as feeling more empowered about their own health care,” says Erin Stevenson, an independent Hospital & Health Care Professional. “Also, patients could ask more pointed, better defined questions regarding their present and future health around their current situation and finally, it could compress the patient-provider time required to get to the underlying cause of their illness and expedite not only the exam time, but deepen the provider’s knowledge about the patient’s past history and hopefully allow providers the opportunity to see more patients.”

Sixty percent of the survey respondents believe the greatest benefit of using a patient education system integrated into your physical therapy software is the improved compliance of patients to the treatment plan.

“The patient, seeing the added benefit would certainly let friends and family know and extol the virtues of their new found knowledge.” agrees Michael Hughes with Creative at Forte Holdings. “Patient Education system would act as a ‘wow’ factor to justify perhaps the cost of care to patients based off seeing what all goes into the care and what kind of conditions/solutions they can tangibly see.”

One-hundred percent of the survey respondents are certain that a patient education system is helping the PT do a better job and even expediting the patient’s rehabilitation.

Physical Therapy Billing | patient education SURVEY RESULTS

 

“When a patient actually understands the root cause of their symptoms and how the plan his physical therapist is recommending will help them regain the functionality in their lives, they will tell their friends and loved ones about it!” adds Jason Barnes, COO of Vericle, “This lays a foundation for healthy patients and a healthy practice.”

Physical Therapy Patient Care | Are You Ready for the Overwhelming Impact of our Aging Patient Population?

Physical Therapy Patient Care for Baby Boomers

By Thomas Champine

At the start of the new millennium 12.4 percent of the population in the United States was 65+. By 2030 that number is expected to rise to 19.6 percent, an increase of over 35 million people. The baby boomer generation, people born roughly between 1946 and 1964, is the largest generation in America. This group is better educated and will expect better physical therapy patient care from our healthcare system, including your physical therapy practice.

These facts bring three questions to mind:

  1. What are some of the anticipated results of these two facts? 
  2. Are you ready for a massive demographics shift at your physical therapy practice?
  3. Can your current physical therapy practice management program handle an increase in scheduling, records, and claim processing?
There are many more questions that come to mind, however, these first three will have a dramatic effect on your ability to stay profitable in tomorrow’s healthcare industry. We will explore these concerns, and any others that are brought to our attention, to help your physical therapy practice be prepared for the changes ahead.

What are some of the anticipated results of these two facts?

As a physical therapy practice management service, we keep ourselves close to the healthcare industry “pulse” so we can adapt prior to changes coming into your workplace.  One of the biggest challenges we see in the near future is the massive demographic shift that will occur in the next 15 to 20 years.  A highly educated, highly informed, aging population will be walking through your doors in rapidly increasing numbers. This patient group will demand more of you and your staff, better results of treatment, quicker than ever before. The effect this will have will be industry changing and could result in a number of effects.One result is that we will need an influx of professionally trained personnel, of all specialties, to meet the demand. For current practices to stay away from patient saturation the marketplace needs more PTs, OTs, SLPs and various highly trained support staff. Next, new practices/facilities will need to open to provide the physical treatment spaces for the influx of patients.


The fact that these patient are more educated and connected to education resources, sometimes appropriate and other-times detrimental (*as a former EMT/Firefighter, nothing was worse then hearing the phrase “I went on the internet and…”), means that the patient will expect better and quicker results from treatment.  Our ability to properly educate about, establish and maintain realistic patient goals will be heavily tested in the coming years.



This shift will also put a major strain on your payment structure for services.  All major insurance payers, specifically CMS, will see a sympathetic increase in claims submission based on the increase in patient services provided by you.  This inundation will increase the pressure CMS is receiving from its’ oversight committee, which will increase CMS’ likelihood of denial.



This is just a short list of the possible anticipated results of this known patient population shift.  Are you ready  for a massive demographics shift at your physical therapy practice? Do you have the tools necessary to continue an increasingly intense fight with payers to continue to operate your practice? Have you selected a physical therapy practice management tool that can adapt as quickly as you need to stay current with industry trends?…..

Physical Therapy Billing | Would you pay for your services?

Physical Therapy Profitability: Jack-LalannePhysical therapy profitability really depends to a great extent on how much your patients value and like your services.Harvey Schmiedeke, President of Survival Strategies and author of Keys to Private Practice Success used to have a client in a northern US border area (p. 134). “Canada as you know has socialized healthcare, supposedly offering everything for free. The large majority of his client’s patients were Canadians. They would go through the hassle of clearing customs and drive hours to pay him $78 US cash for treatment they supposedly could get for free in their own country. Why? Because he had the reputation of handling headaches and they knew if they went to him they’d be seen immediately and they’d get better!”

In every industry, regardless of geography, referrals, word of mouth are the strongest and most valuable source of customers and patients.

What services could you offer to:

  1. differentiate and elevate your physical therapy practice above the competition?
  2. attract highly motivated and loyal patients?
  3. cause patients to rave about your services to their friends and families?
  4. add significant revenue to your pt practice?

For instance, can you offer any one or a combination of these products:

  1. Equipment, supplies, or supplements
  2. Massage
  3. Wellness and Fitness Program
  4. Sports Enhancements Program
  5. Injury Prevention and Ergonomic Re-Design
  6. Vestibular Balance Program
  7. Weight loss Program

What are the steps to discover or invent a program that would really work in your area while increasing the profitability of your physical therapy practice?

Some coaches and practice management consultants suggest surveys are effective means of discovery– but do they really work?

I doubt Harvey’s client surveyed his Canadian neighbors prior to offering his headache handling services. Ford’s notorious quote is: “If I asked my clients what they want, they would ask for a faster horse.” Steve Jobs too is famous for NOT doing any surveys and trusting his intuition.

Apple Computer president Michael Scott in 1980 wrote a memo announcing that “EFFECTIVE IMMEDIATELY!! NO MORE TYPEWRITERS ARE TO BE PURCHASED, LEASED, etc., etc.” by the computer company, with a goal to eliminate typewriters by 1 January 1981.

In 1988, Microsoft manager Paul Maritz sent Brian Valentine, test manager for Microsoft LAN Manager, an email titled “Eating our own Dogfood”, challenging him to increase internal usage of the company’s product. The idea behind “dogfooding” is that if you expect customers to buy your products, you should also be willing to use them. Some people call this “do what you preach.”

Dogfooding needs to be transparent and honest: “watered-down examples, such as auto dealers’ policy of making salespeople drive the brands they sell, or Coca-Cola allowing no Pepsi products in corporate offices … are irrelevant.” (Wikipedia) A perceived advantage beyond marketing is that it should allow employees to test the products in real, complex scenarios, and it gives management pre-launch a sense of progress as the product is being used in practice.

“Microsoft’s use of Windows and .NET would be irrelevant except for one thing: Its software project leads and on-line services managers do have the freedom to choose.”

If you think about it, patients, like customers, seldom know what they really need or want. Surveys only help those who sell survey management services.

When it comes to your physical therapy billing and profitability, you and your staff need to be the final judge of your services. Steve Jobs wanted a computer that he would want to use instead of the typewriter. Ford wanted a car that he would want to drive instead of riding a horse. I want a software service that my staff and I would WANT to use to manage our company.  I want a blog that I choose to read it, that would teach me something new.

Think about it – if you cannot use it, why would anybody else want to use it? If you offered an weight loss program while you weighed 250 pounds, do you think you would attract any patients?

On the other hand, if your program was that good that you used it yourself, how easy would it be to tell your story and get paid for the your services? Would it really matter if insurance covered it?

Trust your intuition and you will have happy patients who tell their friends about your physical therapy services!

Physical Therapy Patient Care | New Milon Exercise Equipment

Physical Therapy equipment: Milon Circuit

By Steve Messineo

How New Milon Exercise Equipment Will Help Your Patients with Long Term Wellness and Increase Your Practice Revenues

In June of 2012 I met the President of Milon USA, a company promoting a line of circuit training equipment that has become extremely popular in European health clubs and physical therapy clinics. Milon is a German company that recently decided to test the vast US Health Club Market. What they did not expect was the opportunity to bring their product to a facility that houses both a physical therapy clinic and a fitness center.
So, after some education and negotiation, my business partner and I decided to bring Milon into our facility. You may be asking what is so wonderful about this circuit training equipment as compared to the various American-made lines.

Here are several features to the Milon exercise equipment that made it attractive to us and should be attractive to all physical therapy clinics that have 600 square feet of extra space to put this circuit in:
1) The equipment is easy for everyone to use. There are no weight settings – the resistance is provided electronically against both concentric and eccentric muscle contraction. This allows for a much more efficient workout and eccentric loading of muscles has been known to accelerate rehab from numerous conditions.

2) The resistance increments are offered at 2 pounds and resistance protocols are entered on a touch screen on each machine. Furthermore, because there are no weights, patients will not feel self-conscious about their resistance settings because no one else in the circuit will know what they are doing.

3) The machines automatically adjust to the user’s height and position after the initial set-up using a memory chip on a smart card – no more pulling knobs to adjust seat heights. This further increases the ease of use of the equipment making it perfect for PT patients.

4) The entire circuit takes less than 20 minutes to do but allows the user to get a fantastic workout. Patients who claim they don’t have time to exercise have no excuses if your clinic has a Milon circuit.

5) All of the equipment is attached to a computer that automatically documents a user’s progress. We can use that objective information in our reports to physicians and insurance companies documenting patient progress.

6) Finally, and most importantly, the addition of this equipment is going to create a long term revenue stream for our business as patients transition into long term exercise maintenance programs using the Milon equipment after they have been discharged. This increases customer retention and creates revenue via membership use of the equipment. We are projected to make an additional $20,000 in net revenue after the first year as a result of Milon implementation and this figure is conservative at best.

Anyways, I could go on and on about all of the fantastic benefits Milon offers both patients and physical therapy practice owners, but that would make this article extremely long. So, if you would like to learn more, email me at smessineo@allaccessfa.com and I will be happy to provide you with more information. Or you can visit www.allaccessfa.com/milon.

Active Physical Therapy for Low Back Pain Associated With Better Outcomes

active physical therapyA recent study published in Spine shows that active physical therapy for patients with acute low back pain is associated with better clinical outcomes. APTA concurs on decreased use of prescription medications, MRI, and epidural injections; and lower health care costs than passive physical therapy.

The study consisted of a retrospective review of 471 patients, ages 18-60. One hundred thirty-two patients received active physical therapy and 339 received nonadherent care. Patients receiving active physical therapy experienced greater improvement in function and a decrease in pain intensity, received fewer physical therapy visits, had a shorter duration of care, incurred lower charges for physical therapist care, and were more likely to experience a successful physical therapy outcome.

For pain of a “mechanical” origin such as low back pain, hands-on therapy to mobilize the spine and exercises designed to alleviate low back pain have been shown to be particularly effective and have long-lasting effects on patients. According to the study’s lead author Julie Fritz, PT, PhD, ATC, “Physical therapists are often one of the first health care providers that patients with acute low back pain encounter — whether they are referred by medical doctors or visit them directly — which offers evidenced-based PTs a tremendous opportunity to help patients recover.” Fritz received funding for her research from the Foundation for Physical Therapy in 2002. Her project was titled “Validation of a Clinical Prediction Rule for Identifying Patients with Low Back Pain Likely to Respond to a Manipulation Technique: A Randomized Trial.”

“The findings from this research can be applied throughout all fields of medicine, not just to physical therapy,” said Gerard Brennan, PT, PhD, a lead researcher on the study. “If all physicians and therapists adhere to their field’s recommended clinical practice guidelines, they, too, should see a decrease in subsequent health care utilization. It is our hope that this research will help physical therapists — as well as all medical professionals — do their job more effectively.”