Monthly Archives

March 2017

Why Use a Cash Based Model?

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Why did I choose a cash based Physical Therapy model for PT4EB? One reason:


PT4EB utilizes knowledge, experience, research, and patient preference to determine specific treatment plans to return each body to optimum performance. I do realize that is a hefty mission statement that may seemed filled with “buzz words” to sound good. Let’s break it down:

Knowledge – Amy is the only Physical Therapist with a PhD in Orthopedic Manual Physical Therapy in the Maple Valley, Covington, Black Diamond, Kent, and Renton area.

Experience – 16+ years of clinical experience in outpatient physical therapy with years of emphasis on military personnel/dependents and pediatrics.
Research – Writing your own dissertation helps one to understand and interpret the current research available.

Patient Preference – It doesn’t matter how good your treatment plan is if your patient doesn’t agree it is the right strategy for their body. Therefore, we discuss your treatment plan and come to an agreement of what works best for YOUR body.

The current insurance based model of physical therapy creates an emphasis on getting patients in and out as quickly as possible for each treatment session while performing the maximum number of treatment sessions that insurance allows. Physical Therapy Assistants (trained, 2 year degree program) as well as Physical Therapy Aides/Techs (on the job training) are utilized to move patients through their program which works well if patients are progressing on schedule through their treatment. But, Assistants and Aides are not able to make changes to the treatment plan set out by the Physical Therapist causing some patients to get “stuck” on a treatment plan until their next scheduled visit with their Physical Therapist.

I have obtained optimum patient outcomes with a one-on-one based treatment plan that allows one hour for each treatment session. Each session begins with a review of how the patient responded to the last treatment session and how their body is feeling now. Manual treatment is applied to restore normal joint motion, decrease muscle tension, improve fascial mobility, and retrain muscle coordination. The treatment is often concluded with a review and modification of the home exercise program to continue until the next visit. This is a very active treatment approach that requires complete patient participation in providing honest feedback, implementing changes to daily routine, and performing their home exercise program as prescribed.

Patients are usually seen once per week or even every other week as opposed to 2-3 times a week at a more traditional Physical Therapy clinic. This is to allow time for the body to respond to the treatment and eliminate any possible soreness or fatigue from the treatment. It also allows patients to try their home exercise program and see the effects the exercise has on their symptoms. Patients tend to require fewer visits which may decrease the cost of treatment. The following table provides a comparison of a cash based PT model versus a more traditional PT model.

Cost per visit

Cash Based                                                Traditional PT
Cost per visits                            $125       Co-pay                                             $40
Number of visits                              4        Number of visits                                12
Total Cost                                  $500        Total Cost                                      $480
Time Spent with PT                    240        (15 minutes per visit)                       180
Cost per Minute                       $2.08         Cost per Minute                           $2.67

As a patient, it is important to remember that insurances do vary. Some patients have a high deductible and will be responsible for their entire PT bill – even if they go to a traditional PT clinic that bills insurance. A cash based model allows patients to fully understand their costs up front and not be surprised by a large bill three months after treatment. All patients are provided with a superbill at the end of their treatment session that has the ICD-10 and treatment codes they can submit to their insurance for reimbursement. Of course, the time taken from work or school to attend 12 treatment sessions versus 4 treatment session also must be taken into the accounting for each patient.
If you are looking for improved outcomes in a shorter amount of time, I recommend a model that focuses on the quality of care versus the quantity of patients seen.

My Valentine’s Day Present from the American College of Physicians

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American College of Physicians Issues Guideline for Treating Nonradicular Low Back Pain

Be still my heart! The America College of Physicians (ACP) decided to give Physical Therapists (and other “alternative” treatment options) a HUGE Valentine’s Day present by issuing new guidelines for the treatment of nonradicular low back pain.
Okay, did I lose you at “nonradicular”? That just means low back pain that is in your back and does NOT radiate down to your leg! Radicular low back pain is pain that begins in your back AND radiates down your leg. Radicular low back pain is caused by a pinched nerve in your lower back and there are different treatment recommendations for that!
The ACP did a comprehensive review of the literature and concluded that acute low back pain (lasting less than 4 weeks) and subacute low back pain (4-12 weeks) are best treated by heat, massage, acupuncture, or spinal manipulation. While heat can be done at home and acupuncture must be delivered by an acupuncturist, the terms “massage” and “spinal manipulation” as they are defined in this guideline are treatments delivered here at Physical Therapy for Everybody. Two out of four options found in one location! For patients with chronic low back pain (longer than 12 weeks) the ACP recommended exercise, multidisciplinary rehabilitation, acupuncture, and mindfulness-based stress reduction. Again, “exercise” and part of the “multidisciplinary rehabilitation” are also treatments delivered here at Physical Therapy for Everybody. You can receive the manual treatment and exercise treatment recommended by the ACP in one place by one person!
On the pharmacological side, acetaminophen was not effective versus placebo, NSAIDs are first line therapy drugs, tramadol or duloxetine are second line therapy drugs, and opioids are the last treatment option, which is only used for patients who have failed other therapies.
And surgery? Forget about it, says the ACP. There is no research to prove that surgery decreases low back pain.
So, if you have low back pain that does NOT radiate down to your leg, the ACP (which probably includes YOUR doctor) recommend that you see a Physical Therapist (or an acupuncturist if you prefer the non exercise route). Want to read more? Please visit: