If you considered yourself a car model – what car model would you be? Would you envision yourself as a Honda o something more like a Ferrari?
Now keep that thought….
I can’t tell you the discrepancies I have heard when I’ve asked the simple question, “what do you do in physical therapy?” Such a simple question should produce simple answers, right? Well, I’ve been told that Physical Therapy is where I:
- Get massages to help reduce my pain
- Get heat/ice on my region of pain
- Get electrical stimulation to my muscles to help reduce my pain
- Get ultrasound to help with my healing and reduce my pain
- Do some exercises to help with my pain
- Talk about posture to help with my pain
- Work on my “weak” muscles
Listen – I am not here to take a stab at my profession’s vast inadequacies in providing excellent care and promulgating fear-mongering with the general public (that’s another blog!). In fact, I view it as a huge opportunity to make a significant impact on changing the perception of physical therapy to anyone I am fortunate enough to treat! This is why I have decided to leave the traditional insurance-based model in favor of cash-based services as The Human Performance Mechanic. Let me explain why so you have a better understanding from my perspective.
The structure of the current healthcare system works as a barrier to the motivated and determined physical therapist, directly influencing quality of care. In a clinic that takes all forms of insurance, reimbursements to the provider for services rendered are not enough to cover the costs of overhead.
What’s the strategy then? Well, take more patients per hour! In-network clinics that take insurance are quite literally forced to take 2-4 patients per hour to keep the doors open. This is a huge problem!
What does this mean for the client looking to alleviate his/her pain? It means receiving sub-optimal care, regardless of how skilled the physical therapist is at his/her job. You (the patient) will be placed on electrical stimulation and ultrasound machines, ice and heat, as well as inevitably working with a physical therapy aide for the majority of your program. Yes, the majority of time spent in therapy will be spent by yourself or with a physical therapy aide. This is a problem. You come to therapy to get better, yet spend 45 minutes of the hour you’re there without the direct supervision of a physical therapist. You want to know why you’re put on those machines? They are reimbursed very well by your insurance company. The evidence of their effectiveness in relieving your pain is minimal to non-existent, especially with the ultrasound machines, but physical therapists within these clinics are basically “forced” to use them as a tool for time management. Yes, you heard it right, time management.
Physical therapists quite literally can’t afford to spend more than 15-20 minutes with you every session. As much as he/she wants to help you get rid of your pain, they are constrained by falling reimbursements and corporate/office policies and incentives to maximize “productivity” (which means seeing MORE patients per hour for increased pay). Unfortunately, this is the beginning of a negative feedback loop that influences your physical (think “pain”) and financial (think “co-pay”) well-being.
Typically with an in-network clinic, you will be told that your condition, whatever it may be, will take anywhere from 6-8 weeks at 2-3 visits per week. This is what I like to call “the volume threshold” of in-network clinics. It’s a double entendre. The easiest surface definition is that the clinics want to get you in as frequently as possible to maximize the potential reimbursements from your insurance. This is to maintain the actual financial health of the facility. The “volume threshold” also serves to ensure that you as the patient, receive adequate amount of cumulative time with a physical therapist to ensure positive progression of your condition.
Now hear me out…if you’re going to physical therapy 2-3x per week for 6-8 weeks and expect to see the physical therapist for specific progressions to your program, this amounts to about 3-6 hours total of one-on-one care over 24-32 sessions.
Consider your co-pay and what it is on a per visit basis. Now consider what the constraints are of the physical therapists working within these models. Is this a truly healing environment suitable for getting you better and keeping you better? If your co-pay is $30, you are paying at minimum $720 for a physical therapist to address your issue over 24 sessions. This includes use of ultrasound and electrical stimulation machines, ice and heat packs and time working with an aide – all things that may or may not actively contribute to alleviating your pain! This isn’t even addressing the time component (possibly up to 8 weeks in a traditional plan of care)!
I circle back to the original question I posed at the beginning of this blog – “If you were a car, would you consider yourself a Honda or a Ferrari?”
Hondas can be taken to pretty much any local neighborhood mechanic. They’re relatively common vehicles far outnumbering the amount of Ferraris on the streets, so the local mechanics can handle these vehicles when they’ve got an operational issue. They’re trained to specialize in the mundane and average. The maintenance would be low cost and easily available! Perks for choosing the Honda!
On the other hand, if you had a Ferrari (and maybe you do!), would you take it to just any local mechanic to fix the operational problem? Or would you take it to someone who specializes in Ferraris?
What would you pay to know that your car is receiving the best possible care to keep it in top condition?
Now, consider this – a treatment session where you spend the entirety of your hour session with a physical therapist. Increased one-on-one time with the patient facilitates a great healing environment for recovery. Unfettered from insurance, the physical therapist is able to do everything in his/her power to facilitate rapid improvement in your pain as well as work on other factors that may prevent your pain from ever coming back! Gone are the archaic ultrasound and electrical stimulation units, replaced with hands-on manual therapy to alleviate pain, targeted exercises to improve strength and function and most importantly, education on your condition to inform and demystify pain! A comprehensive, one-on-one program 100% tailored towards everything you would need to begin to experience “the joy of pain-free movement!” Better yet, because of the amount of time spent in a one-on-one model, the amount of sessions needed to completely fix the problem drastically reduces to ~6 sessions in most patients! What could be better?
“The Human Performance Mechanic” treats people who consider themselves Ferraris, not Hondas. These people recognize that in order to keep their bodies in a state of optimal performance to achieve their goals, they need a skilled “mechanic” on their team. I am proud to work with anyone who values performing at his/her highest capabilities as a “Ferrari.”
So I ask again, “which car are you?”