Innovative Technologies Clear a Path to an Insurance-Free Model

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By Eric Oliver, PT

At its core, healthcare is a service business. And, as with every service business, connecting with the client is imperative. As a consumer, when I personally seek out services, I always gravitate toward a business that not only provides a good product or service but does so with personality and genuine care. In a traditional setting, where a physical therapist may be bouncing between two or three other patients, it can be difficult to provide a personal touch while showing genuine interest and care. It is amazing how much more can be learned about a person’s condition or response to treatment when the therapist can actively listen and communicate. When I give someone my full attention, I know that I can problem-solve much more effectively and efficiently. This is the way physical therapy was intended to be practiced, and by migrating my clinic to a self-pay structure, my staff and I are able to take this approach.

Succeeding In a World of Mega Hospital Conglomerates and Insurance Giants

My practice, Beyond Exercise, successfully competes against the mega-hospital, orthopedic gorilla and insurance-based private practices because of a strict focus on providing its clientele attention, detail, hope, options, results, and, above all, value.

In a traditional insurance-based clinic, one-on-one care for each session may be extremely difficult to provide when factoring in the usual operating costs such as front desk staff, collections staff, and therapist salaries. It is a tall order for insurance reimbursement rates to support such expenses. To deal with such circumstances, practices may be tempted to allow double- and triple-booked therapists and higher reliance on techs, aides, and assistants. Such tactics are not a good way to set up clients for success.

Patients today have grown quite savvy about their healthcare, and their expectations for services are high. When substandard care or inadequate attention is delivered, clients will seek services elsewhere. Understandably, clients want results, and they want to see them as soon as possible. Those results are more likely to be achieved when the initial visit begins on the right foot, delivered by a patient-centered business that deals with the individual from beginning to end.

In-Clinic Technology for Faster Results

Advanced technologies designed to serve the physical therapy market can be useful in helping private practices become more efficient in the care they deliver. They can likewise enable care to be tightly tailored to a specific type of clientele ranging from orthopedic and neurologic to pediatric, geriatric, or athletic. Treadmills, for example, are an equipment category where high-tech engineering certainly has left its fingerprints. This is apparent in the design of the AlterG anti-gravity treadmill, which considerably expands the function and applications of conventional treadmills.

In this clinic a regular treadmill and the AlterG Anti-Gravity treadmill are both used for assessment, treatment, and performance purposes. The practice’s specific client profile is the active individual looking to recover from an injury, prevent injury, or become stronger and faster. Among this client profile there is a subgroup of runners and triathletes, making this piece of equipment a necessity.

The AlterG is a specialized device that allows therapists to return people to walking and running when they are otherwise unable due to postsurgical precautions or limitations from pain. The ability to precisely control the amount of weight a patient’s body bears in the AlterG allows gait training to be performed in a safe and controlled environment that is comfortable for the patient. This has allowed us to conduct more intensive gait training sessions that allow the patient to reform their neuromuscular patterns into a normal gait pattern sooner than if they were practicing in a full weight-bearing environment.

The ability to teach a patient normal gait movements while working within their pain or postsurgical limitations allows them to work on the neuromuscular re-education so that when they are cleared to walk or run full weight-bearing, they have already practiced the normal patterns and can then apply it more easily. We have used this device in this manner for many types of people with gait dysfunctions, whether as a result from multiple sclerosis, post-lumbar fusion, various kinds of stress fractures, ruptured Achilles tendon repairs, post-ACL repairs, and everything in-between. We have found that these patients progress through achieving their rehab goals faster when the AlterG is utilized to promote normal and optimal movement patterns before they are fully cleared to weight-bear.

Another specialized use for the AlterG treadmill includes enhancing athletes’ running performance, whether it’s to supplement their volume of training, incorporate running mechanics re-training, or performing over-speed training in an environment that can be less stressful on the body. Whereas in a rehabilitation protocol in which a patient may be using the AlterG at weight-bearing settings as low as 25% of their body weight, we will only drop the weight percentage to 80% to 85% for an athlete looking to add more mileage or train their leg turnover at faster running speeds. The use of the AlterG in a sports performance manner is not just for athletes getting over an injury but also for healthy athletes looking to enhance their abilities. Currently, the majority of our athletic population that is using the AlterG in this manner are endurance athletes—track, cross-country, marathon, and triathlon. When the AlterG is utilized in this manner in our clinic, athletes purchase 10-session passes. Then, after they are instructed in the setup and operation of the treadmill with a tech or physical therapist, athletes reserve time on the treadmill and set themselves up.

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Traditional But Techy

The standard treadmill is used to perform gait evaluations, coach proper walking or running technique, or simply use as part of an exercise regimen. These treadmills are still built with a high degree of electronic user controls and tracking features that continue to be improved over older models. Without these advanced features, the practice would be unable to effectively and efficiently provide the holistic type of treatment it offers to active individuals and endurance athletes in particular.

Runners cannot be effectively evaluated, treated, or trained without a treadmill. Having a treadmill with which to perform a gait analysis—in combination with a movement and clinical exam—allows therapists to look at all aspects of a runner, thus allowing them to provide interventions based on a complete view of what the athlete is doing. This in turn leads to effective treatment planning and positive results.

Matrix Fitness USA, Cottage Grove, Wis, provides one of the practice’s treadmills that has become a staple among its rehab programs. The Matrix treadmill line includes the T5x treadmill which is built with a touchscreen display and fingertip controls to select workout, adjust inclines, time, and weight. A fan is also installed on the monitor housing to keep air moving onto the user. Other advanced cardio equipment is also available from Matrix that is appropriate for a variety of fitness applications. This includes the E7xi Suspension Elliptical with WiFi connectivity that enables it to be used with an app, as well as the company’s Workout Tracking Network. Several other manufacturers offer treadmills for use in the physical therapy setting, including Spirit Medical Systems Group, Jonesboro, Ark, which offers the MT200 Gait Trainer Treadmill. The MT200 is built with three motors that control speed, incline and decline, which can help achieve bidirectional training that combines with uphill or downhill work.

Billing for Higher Ticket In-Clinic Therapies

Billing for the AlterG can be made simple, and the practice has created several options based on the amount of time the device is used. Before a package can be purchased, the client must undergo an instructional session with a therapist or tech, which costs $20. Once the introductory session is complete, visits and packages are sold to the client in options of 30, 45, 60, 75, and 90 minutes. The 30- and 60-minute option is the most popular and with the majority purchasing the 10-session package, which runs $150 in the Beyond Exercise facility. Pay-per-visit options are available, but the package deal is more cost-effective. Within the practice’s region, it has been determined that clients will pay this amount as it is similar to the cost of attending a fitness class in a studio.

When the AlterG is used within the context of a physical therapy treatment session, its use is included in the cost of the physical therapy visit.

Setting Up for Success

Critical to succeeding in the physical therapy game is selecting the best products for a clinic’s therapists and clients. While evaluating expenses during the insurance-free transition, the purchase process should take into consideration client need and proven effectiveness for each relevant piece of equipment.

Much time is spent researching the products chosen for this facility, especially high-cost equipment and products. The first step of the purchase process is to determine whether the product or piece of equipment is consistent with the overall vision of how the customer base is to be served. If it is, a determination is made about whether the product or equipment is necessary for to provide services more efficiently or with better quality. If it will positively impact outcomes, ability to improve upon service delivery and/or create an innovative way to serve the client base then the final cost-benefit analysis is performed. If it makes sense financially and is in plan with the practice’s growth and values, the process moves forward with the purchase. The same approach is taken even for products as simple as massage cream, resistance bands, and cleaning products.

Updating the Marketing Message

Many physical therapy practices may use similar language to describe themselves—“one-on-one care,” “customized therapy plans,” “hands-on therapy,” “leaders in care.” The reality, however, may be quite different, especially among insurance-based clinics. This clinic strives to tell the story that shows it truly provides one-on-one care, is completely hands-on, and provides holistic care that focuses not on the symptom but rather on what the symptom prohibits a patient from accomplishing. This involves branding Beyond Exercise in a way that does not feel clinical but that tells patient success stories and demonstrates a holistic approach in returning members of its clientele to their normal life rhythm. PTP

Eric Oliver, PT, is founder of Beyond Exercise LLC, Cincinnati. For more information, contact PTPEditor@nullallied360.com.