Let’s Get Physical: A Look into the Practice of Physical Therapy

Tiffany Rubin

Chief of Happiness

Nurse Next Door Delaware

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In the Beginning

The use of exercise and manual therapy for pain relief dates back as early as 460 B.C., but it was in the early 1920’s when physical therapy (PT) really found its footing. The demand for its skilled work force rose dramatically to address the physical needs of individuals affected by the polio outbreak. In 1921, Mary McMillan, known as the “Mother of Physical Therapy” founded the Women’s Physical Therapeutic Association; today we know it as the American Physical Therapy Association (APTA).

Physical Therapy Today

Since the humble beginnings of PT, the industry has grown in its demand, diversity of skills, and conditions of which it treats. According to the APTA, there are over 204,000 licensed physical therapists in the United States today. Physical therapists have also grown from being under direct supervision of physicians (literally providing care in the same space), to relatively autonomous healthcare professionals who work with physicians. Together they help to ensure recovery from surgery and illness and provide rehabilitation for any number of conditions that affect one’s activities of daily living (ADLs).

Becoming a Physical Therapist

The APTA defines physical therapists to be: “highly-educated, licensed health care professionals who can help patients reduce pain and improve or restore mobility – in many cases without expensive surgery and often reducing the need for long-term use of prescription medications and their side effects.” Physical therapists generally achieve either a Masters or Doctorate Degree in the Science of Physical Therapy. They are required to pass a board licensure exam, complete several internships successfully, and complete 30 hours of continuing education every two years to ensure they are up to date on the latest research-based care. There are also special postgraduate certifications– such as Geriatric Specialist or Lymphedema Specialist –that physical therapists can achieve through extensive continuing education, clinical case work, and board exams.

How Can You Access Physical Therapy?

There are usually two different ways one can initiate physical therapy care. The first way is through a prescription from your physician, which can be your primary care physician (PCP), your cardiologist, or any other medical doctor (MD), nurse practitioner (NP, FNP), or physician assistant (PA). Your physician can fax the prescription or you may take it to any physical therapy company you wish to use. The second way is through self-referral. A self-referral simply means you are the one determining that you would like to receive PT care for a specific condition and you are the one either calling your physician to initiate it or calling the PT company directly to have them initiate care. Either way is acceptable practice.

It is important to note that, as a consumer of healthcare, you have the right to choose any company you prefer to administer PT care. Your physician may make suggestions of which company to use, but ultimately it is up to you. Another thing to remember is if you are unsatisfied with the PT provider you have chosen, you can call your physician and switch providers to another company of your choice. In certain states (of which Delaware is one), there is “Direct Access” to physical therapy services. This means that a patient can be seen by a physical therapist for 30 calendar days before needing a prescription from a physician. Direct Access was instituted to improve access to care even when a person does not have a physician, which may happen, for example, if someone moves to the state and hasn’t gotten in to see a new physician yet but needs PT services immediately.

Insurance Coverage for PT

Physical therapy services are generally covered by insurance, but it is necessary to confirm this with the PT company you choose as your provider. Here are a few guidelines to help you understand what your insurance may cover:

  1. For those on Medicare, by law, physical therapists cannot charge out-of-pocket for services that Medicare would cover unless their Medicare PT benefits have been exhausted for that year.
  2. For outpatient PT practices (Medicare Part B), Medicare will cover 80% of the cost. Secondary insurances (supplemental insurance to Medicare) will cover the remaining 20% of the cost most of the time. Private insurance coverage varies greatly and therefore patients may incur more out-of-pocket costs, such as co-pays and deductibles.
  3. Home Health Care Agencies (Medicare Part A) that administer physical therapy services to those with Medicare do not charge out-of-pocket costs to patients, but they are restricted to seeing patients that are strictly “homebound” (unable to get out of the home without considerable difficulty). Once a patient is no longer homebound, Medicare Part A will not cover these in-home services.
  4. There are some companies that are Medicare Part B (outpatient companies) that can administer PT in the home, and because they are Medicare Part B, are not restricted by homebound status. Medicare Part B Practices are also the common clinics you see in your community. The best way to find out which one you are using or can use is to simply ask your current healthcare provider.

The Benefits of Physical Therapy

Physical therapy has many benefits for people of all ages. Here are a few ways a physical therapist can help you:

Pain relief – Physical therapists are educated in specific manual techniques, modalities (like electrical stimulation and ultrasound), and even more specialized areas such as dry needling, to address pain non-pharmaceutically. As our opioid-addiction epidemic has exploded—and prescriptions for narcotics are becoming fewer—there is going to be a flood of patients who are looking for other methods to relieve pain. Exercise has been found to be an excellent pain reliever, as well, in most cases. Exercise has been clinically proven time and time again to be the most beneficial thing for the human body for every system. Physical therapists are experts in rehabilitative exercise and getting patients back to their prior level of functioning or better.

Maintain mobility and independence as you agePhysical therapists can help clients to maintain flexibility and muscle, keeping daily activities easy and injury-free. And that in turn promotes an independent lifestyle, a goal for many aging adults.

Empowerment – Make sure your physical therapist is communicating to you what a treatment plan is accomplishing in your body and how to maintain the gains made in PT. Through education physical therapists empower their clients to be more in control of their health and wellness; a better quality of life then ensues.

 

Thank you to Kathryn Cieniewicz, from Aging in Place Specialists, LLC for being our guest contributor to this month’s blog topic of physical therapy. Kathryn attended Northeastern University in Boston, Massachusetts, achieving her degree, Masters in Science of Physical Therapy, in 2003. Kathryn gained professional experience at one of the then top rated sub-acute hospitals in the country at Kessler Institute, now called Select Medical, in New Jersey. Since moving to Delaware in 2006, she has become an integral part of the rehabilitation community here in Sussex County. Kathryn is also a Certified Aging in Place Specialist (CAPS) and a Certified Environmental Access Consultant (CEAC), directing her professional ambition in senior care fall prevention and independent living through provision of in-home Physical Therapy and home modification services.  She is the CEO of Aging in Place Specialists, a company with the mission of empowering and equipping senior individuals with the services, knowledge, assistive technology, and home modifications needed to live well at home more safely and independently. Kathryn has been a speaker and discussion panelist at the Annual LIFE Conference in Dover Delaware, in the field of aging in place and accessibility. Kathryn and her company have also been published in “PT in Motion,” a national publication of the American Physical Therapy Association (APTA) in 2016. Kathryn’s goal is to pioneer the pathway to successful aging in place in Delaware—improving quality of life, enabling independent living, and collaborating efforts to decrease the likelihood of the aged entering long term care facilities. Kathryn resides in Lewes Delaware with her husband, Mark, and two sons, Landon and Noah.

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