Filling the Void with Gap Care

Health care is in a transitional time in the United States. Patients are becoming more proactive and educated about their options for physical therapy. New physical therapy treatments continue to evolve.  There has been an interesting shift in the insurance market with Obamacare. Until recently, I have spent my career working for university based hospitals. I started my career in a fast paced sports medicine facility and home to a USA Olympic Development camp. My later years were spent working for a speciality spine clinic. Both were great experiences for varying reasons, yet there was a void in the care provided by these top notch facilities.

There were many benefits of the University Clinics in which I worked. The number of patients in which you see help you to develop strong clinical patterns and steadfast clinical experience. The collegiality of multiple disciplines working together-primary care physicians, surgeons, physician assistants, nurses, social workers, psychologists, fellow therapists is priceless as everyone has a different angle to contribute to the team.

In transitioning to a private practice, my goal however is to fill the void with where standard health care struggles. Many of my patients throughout my career have had to deal with long waits to access physical therapy. With increasing deductibles on health insurance plans, my hope is that patients will be more proactive in price shopping their care, educating themselves on various options for different physical therapy facilities, and also seek care when it appears to not be available through their insurance plans.

Flex spending and health savings accounts are helpful ways to help patients access care when they may be staring at a six week wait to use their insurance with their in network facility. Many clinics are also offering cash pay discounts to those who are not utilizing their insurance. These rates are typically significantly below that billed to insurance companies due to the time and challenges involved with billing.

Additionally, many patients are seeing increasing deductibles in which accessing the larger systems may be out of their price range and cost in some cases several hundreds of dollars for just one visit. Many patients still do not have insurance and can not afford the costs associated with physical therapy in larger systems.

Recently, I had a patient who came to see me based purely on timing. My role as his physical therapist outside of his network, was “not to replace his PT.” This client was looking for a different spin on physical therapy in returning to a gym plan and frustrated with his current physical therapy outcomes. He didn’t feel his recovery was what it should be post surgically.  He was about six months post op and had been discharged due to a plateau. However, if you have ever suffered an injury or had surgery, you will know that recovery can take well over a year and in some cases several years. Some clinics may better emphasize this than others, so he sought out someone who had a career in athletics for this job. Admittedly, he also tried to return to his prior PT but was told he would face an eight week wait to get back in as a “New patient.”  This patient was ready to now take the bull by the horns and seek other options to achieve the outcomes he anticipated.

We as physical therapists must do a better job marketing ourselves to help the medical community and future patients learn the benefits of gap care. For some patients with chronic conditions such as rheumatoid arthritis, ankylosing spondylitis, routine follow ups with a physical therapist can help to keep on top of the condition. Physical therapists can also serve to be the experts in musculoskeletal injury prevention. For other patients, we can serve as guides for general strength and conditioning programs. Physical therapists can play a key role in work place safety by doing musculoskeletal screening or offering injury prevention and ergonomic services. I can’t even count the number of times, I have had to educate someone on the benefits of joint mobilization, yet that person is familiar with other forms of manual therapy such as chiropractic manipulation or massage.

So let’s reflect on actions we can utilize to market our profession by becoming the experts in gap care. Let’s work together to better educate clients on seeking the care they need. It will be interesting to see the evolution of the primary care physical therapist and how we can help the public to perceive the profession as musculoskeletal experts.