- Kristin McNealus, DPT, MBA
Want More PT?
I have provided physical therapy in every level of care, and universally, patients want more. I am here to tell you that your therapists want to give you more treatment, but as with everything, it comes down to money…
Acute Care is when you are in the hospital, and are not medically stable. You need 24 hour care and monitoring due to a trauma, illness, injury, or surgery. Not everyone in the hospital gets physical therapy; the physician has to order it. Physical therapy is important to prevent further complications that can occur during a hospitalization. People often feel ill, or have a lot of pain, and the last thing they want to do is move... If this is you or your loved one, push through it! Working with physical therapy will help prevent clots, respiratory illness, skin breakdown, and weakness. Movement will also help get you out of the hospital faster. While PT is beneficial in this setting, the amount is limited. Hospitals get reimbursed at a set rate, so physical therapy is not adding to the charge for your stay. For this reason, hospital management does not allow therapists to spend a lot of time with each patient. You may see your therapist for only a few minutes, and you may not get therapy every day. Even though it is not much, take advantage of what you can get. And if you are not receiving skilled rehabilitation, ask your physician to order it.
Acute Rehabilitation is an intense setting that follow acute care for people who would benefit from a lot of therapy over a few days, and it would make the difference of being able to go home rather than a nursing facility. This is a costly setting for the insurance companies, so the time they will cover has decreased drastically in the last two decades. A person in acute rehab must participate in three hours of therapy per day, six days per week. This is a combination of PT, occupational therapy, and speech therapy. This can help promote great gains in a short period of time, and is a wonderful opportunity if it is available to you. People are disappointed when they learn that the stay is short, and the goal is not to get you back to your prior level of ability. The goal is to get you home as soon as possible, safely. Then your goals can be addressed with home health or outpatient therapy.
Home Health will come to the home to perform an evaluation and determine how many visits you will get before you can go to outpatient. This is for people who are not very mobile, and considered "home bound." Unfortunately, insurance does not cover a PT coming to your home just because it is convenient for you. Home health therapists generally only come out 1-2x per week, and you may get anywhere from 4-12 visits approved. This is a big drop off from the therapy you receive in the hospital, and it is important to work in between therapy sessions in order to progress. While progressing means you can no longer get home health because you are strong enough to go to outpatient, you could also be denied home health benefits if you are not demonstrating improvement! Crazy, right?? And the improvement has to be measurable by a scale that the insurance company recognizes. If your insurance does not reimburse the therapy company, they will discharge you from services.
Outpatient physical therapy is what most people are familiar with - go to a clinic a couple of times per week. Insurance is still looking for those measurable improvements in order for the sessions to be covered. Insurance may have a number of visits they will approve, or an amount of weeks. There may also be an annual limit to the amount of therapy you can receive. Again, it is important to put in work between sessions in order to make improvements. It is difficult for any therapist to address your goals if you can only work together once per week.
Understand that it is more often the system, and not your therapist, that is choosing the amount of therapy you receive. Advocate for yourself with your insurance! They are more likely to listen to the paying customer who complains than the therapist asking for more money. And if that does not get you what you need, look into self pay options, which more therapists are offering. When you pay cash, there are not restrictions imposed by the insurance or management.