Physical therapy insurance visit limitations are a real concern, especially after surgery.
In this week’s podcast, we talk about when you should try to conserve visits, but more importantly, when you shouldn’t.
To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.
#AskMikeReinold Episode 257: Conserving Patient Visits After Surgery
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Show Notes
- 6 Keys to the Early Phases of ACL Rehabilitation
- How to Prepare to Transition to a Cash-Based Physical Therapy Practice
Transcript
Student:
So Dominic from Phoenix. With Champion being cash based, how do you typically go about scheduling visits with post-op patients such as an ACL reconstruction or rotator cuff repair, where they will be there for many months? Are you going less visits initially when the focus is mostly with range of motion and then begin to ramp up as post-op restrictions ease up?
Mike Reinold:
Solid question, Dominic, I like it. It sounds like Dominic’s starting to plan a little bit, has been working in the insurance model a little bit. So very good questions. I feel like most people have very similar questions with this. I’m going to start it off with this and then let some of you guys jump in a little bit. Maybe especially to the PTs that have transitioned from insurance to cash a little bit too, how you guys manage this a little bit. But I would say the first thing is that don’t assume you always have to manage visits.
Mike Reinold:
So here’s my treatment approach, right? I consider myself an expert at my profession, right? I consider everybody on this Zoom, and probably most of the people that are listening to this are experts at their profession, right? We went through a lot of schooling and education for that. I’m here to provide a service for you. When you come see me, I tell you exactly what I think you should do. You have to figure out if that’s financially feasible for you or whatever. If you tell me you can’t, right, or like, “Oh, we can’t.” Then we can talk about a compromise, but I always start off with, “Here’s what I think is best.”
Mike Reinold:
And I actually, I always tell people, “I think this is…” Let’s just say one time a week as an example, right? “One time a week’s probably not enough for you. Three times a week, to be honest with you, you probably don’t need that much right now. Let’s slot in at two times a week.” That’s how I would start a conversation. And maybe you’re having that for a duration conversation too. But let’s start off with just saying is I want you to do what you think is best and let your patient population tell you if that’s feasible financially for them.
Mike Reinold:
Realize that in a cash based setting, you might be a PPO where they get reimbursement. They might have an HSA where they get a tax rebate for this. They may have a huge deductible and copay if they went elsewhere. So heck, they would’ve paid a thousand dollars anyway. You know what I mean? So I guess what I’m getting at is don’t assume. That’s the first thing you should do is do what you think is best. And then when you’re having an issue with the person, then you talk about how to manage that. That being said, who wants to jump in? Dan, you want to jump in from your experience a little bit on how you manage this?
Dan Pope:
Yeah, for sure. I guess I just wanted to say first, I don’t think it’s a bad thing to sell yourself a little bit. I came from that insurance model and I’m just super frugal as a person and I think that sometimes I don’t value myself. So I’m trying to go out and try to save these guys money before they even want to save money themselves. But the other piece is that you’re cash based, because you’re probably going to be a little bit better for that person, have more time. Maybe you have more experience in that niche. You’re probably going to do a better job. So I think it’s okay to let them know that it’s important to do physical therapy at a good place and it’s their health, right? I think people undervalue their own health and it gets a little bit confusing when people pay insurance and they want to be able to use it.
Dan Pope:
But at the end of the day, health is very, very important. So I think it’s good to let your patients know that and let them know they’re probably going to have a better experience. To touch on the point that… Who was the question asker?
Mike Reinold:
Dominic.
Dan Pope:
Dominic was saying, “Do you do less visits upfront?” I used to kind of think this way. I used to sometimes say, “If you want to do your early rehab with someone else.” A couple of mentors of mine have told me that in the past, “You can do your rehab elsewhere and then come here towards the later stages.” And that course can work, but you have to assume that the other place you’re sending the person to is good.
Dan Pope:
Post-op knees, I know that was one example that you had talked about. If you’re not doing the right things early on and trying to maintain, let’s say as much quad as possible, doing things like BFR, making sure you’re looking out for red flags, then they’re not going to do particularly well and we end up seeing a lot of those folks later on. And if they had good PT to start, they may not be in that same situation. So I agree with Mike, set the best possible plan of action for them patient and then let them make the decision because I think all stages of rehab are going to be really important.
Mike Reinold:
Yeah. And I kind of liked what you said there. I like the concept too, let’s say ACL reconstruction, which is one of the things that Dominic asked. But even a rotator cuff repair or something like that, I almost think the opposite. I don’t want them to get behind. I want them to be on pace. I want them to do a really good job at the beginning. I almost want to see them more at the beginning and less towards the end. And then when they get to the progressive loading phase, man, that is something they can do a little bit easier on their own or they can do in a supervised environment or even just refer to a gym based setting or a fitness professional that you collaborate with. I would almost kind of flip that a little bit, but I don’t know good stuff. But let me see, Mike, do you have some thoughts?
Mike Scaduto:
Yeah. I would say even in a cash based setting and even though we have direct access to PT in Massachusetts, oftentimes these people have a physical therapy prescription from their doctor that says, “two to three times a week for post-op care.” So I think a lot of them are expecting to come in two to three times a week after they just had surgery. And then if you say, “Oh no, I think you only need to come in once,” they kind of look at you like they’re a little bit confused.
Mike Scaduto:
So I think, getting an idea of what their mindset is going in, setting the expectation. And if they came to see you for their first post-op visit with a script from the doctor, assuming they’re going to come in two to three times a week and you think that’s what they should be doing, then I think you should value yourself and not try to dissuade them or not try to talk them out of doing that just because it’s maybe financially a little bit more expensive for them.
Mike Reinold:
I like it. What’s up Dave?
Dave Tilley:
Yeah. I just wrote a blog post on this and we kind of talked about this, not the cash based aspect, but just the how important the first six weeks are that Mike and Dan had mentioned. I think it’s critical to set the tone for rehab, especially with a cuff or an ACL, the big surgeries, where you need to get motion going and get them established and get their pain down. If you try to undercut them and only do once a week, you may set things up for a long road of trying to get their motion back and their pain under control. So I would front load them a little and then they see the value and they get their motion back and they start feeling good. So I definitely think what we’ve said is critical to kind of flip your thoughts on it, or Dominique, whatever their name is.
Mike Reinold:
Yeah, Mike, did you have a little more? I know Dave wants to jump in.
Mike Scaduto:
Cool. Yeah, go ahead, Dave.
Mike Reinold:
I feel like you guys were conversing.
Dave Tilley:
Correct. Mine is just that my 2 cents is what I’ve learned from Lenny and Mike and everybody else is we’re not uncomfortable having that conversation about time or money or finance and stuff like that. And I think that’s the only time it becomes weird is when you’re dancing on eggshells and you don’t want to talk about it and the person’s asking you, “Oh yeah, well maybe we could do this.” But you just tell people straight up, Mike has said it before, but like, “We don’t want to waste your time, nor your money, but after surgery you need… That’s where my expertise is. You can’t range your own arm, you have precautions and limitations and you don’t know what motions might be irritating what structures.” And so those are really, really important barriers and things that people have, is to not understand that.
Dave Tilley:
And I think that’s where one of our biggest roles as PTs come in is one, the hands-on skills, but two, is the education because people are really nervous. They’re really scared about, “Is this normal pain? Is this not? What can I do? What about the brace? What about this? Should I unlock it?” And so I think telling people upfront, “Hey, I don’t want to waste your time and your money, but I think you really need me quite a bit on the front end.” And like Mike had just said, “As we get farther out, you can work out on your own. You don’t need to sit here and watch me do you a bunch of clamshells. You can do all this stuff on your own at home. Let me just use my expertise of creating a program for you at that point. And then we’ll go once every week, once every other week or whatever else it is via email, Google docs, stuff like that.”
Mike Reinold:
Yeah, but they had to earn the right to go once a week or every other week, right?
Dave Tilley:
Correct, right.
Mike Reinold:
It’s like, again, almost the opposite. Think about it too, I think we underestimate. We’re just like, “Ah, it’s isometrics and passive range. That’s easy.” Right? But that’s probably the timeframe where their head is spinning. Right? They woke up and they were hungry one morning and they were like, “Uh-oh, did my surgery fail?” Right? I mean, we deal with so much aspects of the mental side of that. They have so many questions at the beginning. So many things that we take for granted that I think just being with us helps settle them down quite a bit, so.
Lenny Macrina:
Oh, I was going to say, just access to us too, sorry. Just for us, I know all of us, we are text message available. So if somebody, once we get them in and we know what they present like and their surgery and their personality, they can text me on a Saturday or a Sunday and people do. They don’t abuse it, but if something’s wrong and they feel like something’s wrong, I have to kind of talk them through it. And so that access, I think, is critical too. And people appreciate that and I think that’s part of the value add that we provide. Sorry, go ahead, Lisa.
Lisa Russell:
No, I mean, I was just going to say I feel like I am still learning all of these things. I feel like this has been a hard thing for me and granted, I don’t have a ton of immediate post-op people at the moment, but this is definitely a hard piece of transitioning into cash base, is understanding everything that we’ve already talked about. And I feel like I always default to you all when I don’t totally know exactly with a particular person, what frequency. I’ll be like, “Hey, what would you do?” And it’s just been very helpful to be able to do that.
Mike Reinold:
Yeah. So reach out, right? Maybe Dominic, you get some other people to help. Hopefully this episode helped, right, a little bit, to give you a little bit more. But I think that’s good advice from Lisa is try to have a network of some peers or something or some mentors that can help you answer those questions. The transition to cash is weird. We’ve all been through it. Everybody on this podcast has been through it and we’ve all struggled with something, right? We’ve struggled with lots of aspects of that. And it takes time, but over time you’ll realize, “Wow, I’m delivering an exceptional value that people really want and people really expect.” I think that’s great. So, keep that in mind. I think that’s the goal.
Mike Reinold:
Remember, they’re hiring you. Think of that, Dominic. They’re hiring you to fulfill their functional goals, right? Just lay out a plan that you think is going to do that as quickly and safely as possible and that’s what they’re paying you for, right? And then let them figure it out. If they have restrictions, then you start trying to manage that. But don’t assume. I think that’s a great synopsis of this episode. So, awesome. Great question, Dominic. Good luck with your transition if that’s what you’re about to do.
Mike Reinold:
If you have questions like that, again, head to MikeReinold.com, click on the podcast link, fill out the form and we will answer away. We love getting all these amazing questions from you guys. So thank you so much for that. Head to Spotify, Apple Podcast, rate, review, subscribe, and we’ll see you in the next episode. Thank you.
