• Dr. Piotr Solowiej PT, DPT

Did You Get What You Paid For?


It is no secret that the healthcare industry is quite the mess for consumers. Premiums and deductibles are in the stratosphere which means people are paying more, for far less benefit. So what do all those dollars actually get you? And how do we get out of this mess? Those are billion dollar questions. The whole payment system is chaotic but there is some light being shed on it due to a recent federal mandate, which you can read more about in our post, here.

Healthcare is a business. At the end of the day, making a profit is part of the equation when it comes to healthcare delivery. And just like any other business industry, there are a variety of options as vendors of the service aim set themselves apart to meet different needs of their consumer base. In order to meet your physical therapy needs, and get the best value, you're going to have to do some shopping around.

One way of at least moving the healthcare mess forward is having smarter healthcare consumers. There is a lot of waste in the industry, and it is slowly being snuffed out. Educated consumers, I think, can naturally speed the process up. The more you know, the better equipped you will be to deal with and defend yourself against the trials of the health insurance world.

I can only confidently speak for the physical therapy industry, so here are some things to keep in mind when shopping around for a physical therapist (And please shop around. Find someone that fits your needs):

1) Physical Therapy Can Only be Practiced be a Licensed Physical Therapist (or Physical Therapist Assistant)

This seems like a no brainer, but you may be surprised to learn that there are other, lets call them opportunistic, individuals that claim to deliver 'physical therapy' services. Although some of the following may be included in a physical therapy treatment plan, these things (and I cannot stress this enough) ARE NOT CONGRUENT with physical therapy in and of themselves:

  • Modalities (ultrasound, E-stim, ice, heat, Kinesio-taping, etc.)

  • Massage and other soft tissue handling with the hands or tools (Graston, Astym, dry needling, 'thera'-guns, cupping, and others)

  • Exercise

Going somewhere and received any of the above without the discretion or supervision of a physical therapist means you did not receive physical therapy. You got: iced, stim-ed, needled, cupped, etc.

You. Got. Verbed.

Literally anyone can take a weekend seminar or a webinar and start dishing out modalities and exercises with minimal and sometimes no prior medical training. Although, well meaning, this sort of situation can have significant unintended ramifications.

So then what is physical therapy?

It is a partnership with a licensed practitioner (PT or PTA) and a client working to improve on identified movement or activity participation limitations. Physical therapists (and PTAs) are qualified to work with individuals in pain, with physical safety concerns, progressive neurological conditions, dizziness, vertigo, headaches, incontinence, open wounds, and many more. Treatment plans can and probably should look very different for people even with similar diagnoses, because everyone has different starting points and goals. As I said before it may include the above modalities/tools, but potentially none. It all depends on the specific needs and situational context applicable to the person.

2) Ask What Kind of Care You Will Receive

Every business operates a bit differently based on the demographics of their treatment population, as well as their business model. Some organizations have therapists that see multiple people each hour and may have clients that overlap. If you're okay with that, great. If not, look for a different model. Many companies provide 1:1 care, meaning the client is the only one they see for a given amount of time, without overlap with another. The client receives the full undivided attention of the therapist. In my opinion, this is where you get the most for your healthcare dollar. Which is why we only practice in this manner at Team Sapiens PT.

*The amount of supervision you receive during your physical therapy sessions is especially important for individuals with Medicare coverage. See #3 for why. So when you're shopping around for a provider, don't hesitate to call the clinic and ask what their model is to see if it is a good fit for your needs.

3) Check What You are Being Billed For

This is an especially important consideration for Medicare recipients, as the billing for a 1:1 therapist to client session is different than if the therapist is supervising multiple cases at once.

For example, for a given amount of time, if (covered under Medicare) you're seen by the PT for the entire duration of the appointment, with no overlap by other clients, then there is no issue with standard billing codes for therapeutic exercise, activity, manual therapy, or neuromuscular re-education.

The second the therapist is supervising a second person (or more) at the same time as a Medicare patient, the Medicare patient must only be billed for "Group Therapy."

Guess which situation reimburses at a higher rate. Guess what gets practiced in the shadows when billing.

I really hope this practice is not as rampant as I imagine but I have had clever people (covered by Medicare) bring me their past physical therapy notes from previous organizations. What do you think was on their billing report vs what they reported their care to be?

Also to clarify - 1:1 care does not equal one patient to one unspecified supervising person. The 1 must be a PT or PTA. A technician or office assistant supervising exercises or other forms of treatment is not an equal substitute for the eyes of a PT or PTA. Neither should they be in yours. I think the example Medicare requirements set should be the standard for everyone.

*For all others with private insurances - are you okay paying the same rate for your therapy service whether your the only one, or one of multiple being supervised by the therapist at the same time? Because believe me, you're being billed the same. I know which situation I would pick. Some food for thought. In the long run, I think it's only a matter of time before private insurances follow Medicare's billing requirements.

To summarize, stay informed when shopping around for a physical therapist, as well as all your other healthcare needs. The more information you have, the sounder your decision making will be. Call the clinic ahead of time, before your first appointment, to se if its a good fit. The situation you end up in can have a significant impact on the outcome of your rehab process, but also your finances.

Choose wisely.

Address: 1942 Raymond Dr, Northbrook, IL

Phone: 630-447-9746

Fax: 630-385-0124

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