Insurers

By law physical therapists are required to perform evaluations on all patients despite the fact that they may have previously been evaluated by a physician or another physical therapist. This law is appropriate because without the evaluation, it is impossible for the physical therapist to set up a specific program that would resolve the patient’s problem. Therefore, the patient would be on a more generic program which would be ineffective and more costly.

Physical therapists are extensively trained in evaluative procedures which lead to a physical therapy diagnosis and appropriate intervention. It is incumbent for the physical therapist to set up a program that will effectuate a rapid resolution. No two patients’ programs are the same.  Each program is set up to address specific issues as identified in the evaluation and therefore leads to a quicker recovery. This also would include patient education to prevent recurrence. Physical therapists are not required to have a physician’s prescription in the state of NJ and must develop their own treatment plan based on their evaluative findings.

When a patient is first evaluated, their job duties are extensively discussed with the patient as well as anticipated return to work goals. Right from the very first day we are directing our care at return to full function or modifying the work environment so that the patient can return to work as soon as possible. To that end, we work extensively with work simulation and conditioning activities in order to prepare the patient for his or her return to work.  Additionally, we work closely coordinating with any case managers assigned to the patient’s case to be sure all aspects of the patient’s care are covered.

Although work related goals and work simulation are always included in the care of our patients, for those needing more extensive preparation for return to work, Work Hardening is available. In these programs patients spend longer periods in therapy working on higher repetitions of various work related tasks in order to transition to their previous job duties.

Wayne Physical Therapy & Spine Center offers FCE’s for those patients requiring it. Our therapists are certified in the California Functional Capacity Evaluation system to determine the patient’s ability to return to their previous job duties. These evaluations involve approximately a 4 hour testing system designed to determine the patient’s ability to return to previous job duties. Because FCE’s are already valid and reliable, this is important information for the insurance company to have.

In addition we also provide Post Offer Screening and Independent Physical Therapy Evaluations.

As mentioned previously, a complete evaluation is extremely important in determining the problems that exist. Goals are developed so the patient can return to their normal daily activities as soon as possible. Most importantly, at any physical therapy facility, the insurance company should be sure that patients are being re-evaluated and treatment programs are being progressed as appropriate to ensure attainment of goals. If a re-evaluation is not performed, and specific progress is not documented, the insurance company should not be required to pay for care. It is incumbent upon the physical therapist to show progress. If you suspect a patient is not being treated or progressed appropriately peer reviews done by a physical therapist can help. Please see our question regarding peer reviewson this website.

Because of the level of expertise in our clinic, our physical therapists, in addition to collecting subjective information and performing objective testing, work diligently to document any inconsistencies that may manifest themselves as a behavioral component. To this end, we also perform specific testing using valid and reliable testing tools to determine if there is a behavioral component. Therefore, we are able to identify these patients, coordinate with the physician and/or case worker, in order to move the patient on to appropriate services, not keeping them in physical therapy unnecessarily.

An Insurance company has to be careful about sending patients to facilities that utilize a variety of equipment generically. Although equipment has its place in rehabilitation, the most important aspect of care is the therapists’ expertise and ability to evaluate and set up a treatment program designed to resolving the patient’s problems. Treating patients generically in a “gym” type setting, whereby patients go from equipment to equipment without specific needs addressed is inappropriate. These facilities will have very poor outcomes since their care is not directed to the specific problem at hand. At our facility, we keep the claims managers and claims adjustors updated through periodic reports, if requested. We also invite them to visit our facility and actually observe treatment of that patient. Additionally, our staff have extensive continuing and specialized education which others may not.

Peer reviews are extremely important in containing costs in physical therapy. Unfortunately, many insurance companies utilize un-like professionals instead of physical therapists to evaluate physical therapy notes in order to determine if care and/or charges are appropriate. This puts the insurance company at a large disadvantage because these personnel are not trained to pick up inappropriate treatment, excessive treatment, or inappropriate charges. We offer a service of peer review through our cost containment companies and Mailly/ Inglett Consulting.