Wednesday, November 27th, 2019
When deciding how to go about seeking treatment for an injury, one has many factors to consider including the following:
- What type of health practitioner should I seek help from?
- Once I decide which type of health practitioner I want to see (physical therapist, chiropractor, etc.), how do I discern which specific practice is the best fit for me?
- How much money will this cost me?
- How much of a time commitment will the rehab process be?
While all of these are very important questions that need to be addressed, many people tend to solely focus in on the amount of money they will have to spend to receive treatment. Many people will simply default to the cheapest option available assuming that they will receive the highest quality care from whichever practitioner they receive. However, this is not true by any means. When you buy consumer products, you typically tend to pay more money for a higher quality product. The same is often true for healthcare, specifically referring to physical therapy in this case. And what better reason is there to spend more money for a higher quality product than when it comes to your own health.
This brings me to the concept of cash physical therapy and why I believe it to be in the best interest of most people. As the name implies, cash physical therapy practices do not take insurance. At initial inspection, this seems like a hindrance to the consumer in order to benefit the physical therapist. However, it is exactly the opposite. You see, reimbursement from insurance companies for physical therapy is currently at a level where most physical therapists have to see multiple patients at the same time in order to bring in the revenue they need to be successful. However, this leads to a lower quality of care via decreased one on one time during physical therapy sessions. You can directly interact with your physical therapist for as little as 15-20 minutes of an hour long sessions due to how busy they are with other patients. Furthermore, patients are often passed around between physical therapists and physical therapist assistants from visit to visit which results in a lack of continuity in your interventions. All of these problems result in decreased efficiency and quality of care which can potentially lead to decreased outcomes and prolonged time to reach your goals.
A cash based practice costs more money per visit which allows for higher quality care via every visit being entirely 1 on 1. This allows the physical therapist to see every rep of every set the patient performs. More importantly, it allows the physical therapist to talk to the patient throughout the sessions discussing their progress and every aspect of their current plan of care (stress levels outside of physical therapy, patient goals, home exercise programs, patient fears/beliefs, etc.)
Also, for many people, cash based clinics are not much more expensive than other options. Many people have co-pays even if a practice accepts their insurance. Furthermore, lack of 1 on 1 time within normal clinics among other factors also leads to most clinics seeing a patient 2-3x per week, whereas cash practitioners often only see their patients once a week since the increased 1 on 1 time per session allows the physical therapist to more effectively direct the patient in their home exercise program and actions outside of the clinic. As an example, let’s say that a patient has a 30 dollar co-pay for each visit. An outpatient clinic that takes insurance wants to see the patient 3x/week. That adds up to $90/week for treatment which often lacks 1 on 1 time and offers a lower, less individualized quality of care. A cash physical therapist charging $100/visit will see you once a week and offer only 1 on 1 care that is totally individualized towards your goals. And in this setting, the physical therapist truly knows your goals because they are with you during the entirety of your appointment. At the end of the day, this patient would be paying $10 dollars a week more for a much higher quality of care.
Don’t always jump at the cheapest option when it comes to your health. Invest in a higher quality of care in order to reach your goals more efficiently and effectively. As with most things in life, you get what you pay for.
Wednesday, November 27th, 2019
As I’ve mentioned before, a cash practice setting allows for me to operate seeing only 1 patient per hour vs. insurance based clinic practitioners who can see between 2-4 patients per hour. In this scenario, it is guaranteed that the cash practitioner will spend more time with the patient per hour vs the insurance based clinic practitioner. How important is seeing a patient 1 on 1? It is arguably the most important aspect of a successful rehab process. Here’s a list of benefits that patients get from 1 on 1 time.
- The practitioner can see every set of every rep performed throughout the session. When a rehab program is made, each exercise is chosen to provide a certain stimulus to drive adaptation and improvement. Unless the practitioner can see how each rep and exercise is being perform, they can’t guarantee that the stimulus being created is the stimulus they intended.
- More 1 on 1 time = more dialogue between practitioner and patient. Dialogue is perhaps the most underrated aspect of rehab. With more dialogue between therapist and patient, the amount of patient education administered can be increased greatly. This means the patient leaves each session with a better understanding of how to go about the rehab process outside of each session via activity modification, avoiding painful triggers, controlling stress, prioritizing sleep, etc.
- More time for the practitioner to instill confidence into the patient. If a practitioner is able to continually build up the client throughout the rehab process, the patient will begin to feel less fragile and more confident in their ability to overcome their current pain. Along with patient education, patient self-confidence is what allows them to prosper functionally well after they are done with the rehab process
- The practitioner is more invested in a patient’s outcome. The more time you spend on anything in life, the more invested you become. Similarly, the more time a therapist spends with a patient directly, the more invested the therapist becomes in that patient reaching their goals.
The bottom line is that cash practices are a great match for those who value their time. It’s a great match for those who value the quality of care that a cash practice can achieve. When searching for your next health practitioner, make sure to consider how much 1 on 1 time you will receive.
Wednesday, November 27th, 2019
Many practitioners rely on some type of manual therapy interventions i.e spinal manipulations, massage, dry needling, cupping. There are several reasons why practitioners tend to rely on manual therapy including the following:
- It creates quick results that impress the patient and become a good selling point for follow up visits
- Many patients see it as a display of impressive skill leading them to believe this specific practitioner is exceptional in some way.
- It makes the patient feel that the practitioner is solely responsible for their health/recovery. This can lead to patients returning for visits consistently because they believe they are unable to stay healthy on their own.
However, the reasons I just stated above are actually the biggest reasons that I don’t like to use manual therapy as my primary form of treatment. Let’s take the reasons above and reframe them, so you can see how I look at them.
- The quick results that manual therapy create are temporary and short lived. Manual therapy essentially tricks the nervous system into temporarily relaxing and reducing pain. However, once the effects wear off, patients are very often right back where they started.
- Doing complicated techniques to patients only seem impressive because patients are untrained in such techniques. What I find truly impressive is when practitioners can make their treatment and interventions seem simple to their patients despite there being unexplained complexities of their choices and rationale.
- Making a patient rely on a practitioner is a sure fire way to hinder their recovery. Patients respond much better when they believe they can control the outcome of their treatment. Patient involvement in their own treatment via active interventions (exercise) is the best way to maximize patient self-efficacy and confidence in their own resiliency, health, and longevity.
Unlike the short term effects of manual therapy, active interventions aka exercise, loading/volume management, and activity modifications have the ability to yield long term health benefits and longevity in whatever activity the patient enjoys doing. If you lay on a table for an entire appointment with a health practitioner, consider investing in someone who values long term health and longevity over short term relief.