By David Bertone, P.T., D.P.T., O.C.S.
Imagine a scenario in which a patient learns he needs a dreaded root canal. The dentist’s plan of care requires four visits instead of the standard two and the patient will be on the hook for double the typical out-of-pocket costs. On top of that, the patient will receive a lower quality of care than if he went elsewhere. Should the patient stand for that? Of course not.
When it comes to the physical therapy needed following total knee replacement (TKR) surgery, a study published in the scientific journal Health Services Research says this type of scenario may be more common than you think. Where patients get physical therapy following TKR may affect how much the rehab costs, how many visits they need, and the quality of care they receive.
Led by Jean M. Mitchell, Ph.D., James D. Reschovsky, Ph.D., and Elizabeth Anne Reicherter, P.T., D.P.T., Ph.D., the study examined whether the course of physical therapy treatments received by patients who undergo TKR surgery varies depending on whether the orthopedic surgeon has a financial stake in physical therapy services, often called physician self-referral. In reviewing 3,771 TKR patients, the study investigators concluded that physical therapists not involved with physician-owned clinics saw patients for fewer visits and provided more individualized care at a lower out-of-pocket cost.
it is critical that patients receive continuity of care by seeing the same highly skilled physical therapist throughout their entire course of treatment. This is especially important following joint replacement surgery.
Specifically, the study found that TKR patients who were treated in a clinic owned by their orthopedic surgeon received an average of 8.3 more (or twice as many) PT visits than those who were treated in a clinic in which their orthopedic surgeon had no financial stake.
Rehab professionals would like patients to know they have options and do not automatically need to see a physical therapist who works in the surgeon’s own clinic. Members of the PT profession are urging patients to seek out an evaluation by a physical therapist who specializes in orthopedics, ideally before scheduling a surgery consult. If that’s not possible, the public should consider seeing a PT outside of the physician self-referral clinics in order to receive more individualized care that is task specific to each patient’s deficits and impairments following surgery.
The rehab program in a physician self-referral clinic is often heavily focused on group therapy sessions. In such a setting, the PT may not be able to observe and address each patient’s deficits. Conversely, patients treated in an individualized physical therapy program will be better sooner and receive better care. Higher quality care correlates with more efficient and effective episodes of care.
The study, titled “Use of Physical Therapy Following Total Knee Replacement Surgery: Implications of Orthopedic Surgeons’ Ownership of Physical Therapy Services,” was partially funded by the American Physical Therapy Association’s Private Practice Section.
Founded in 1956, the Private Practice Section of the American Physical Therapy Association champions the success of physical therapist-owned businesses. The members are leaders and innovators in the health care system. The American Physical Therapy Association (APTA) represents more than 85,000 physical therapists, physical therapist assistants and students of physical therapy nationwide.
Dr. Bertone practices at db Orthopedic Physical Therapy, which has offices in Manalapan and Lincroft. For more information, call 732-462-2162 or 732-747-1262.
