THE FUTURE OF PHYSICAL THERAPY

COVID-19 has affected this country on a level like nothing else has. And while it would be easy to point to the obvious downsides that this pandemic has brought, there are important lessons to be learned moving forward and how those should influence the future of healthcare and physical therapy in particular. 

Knowledge is power 

It’s normal for people to react in times of stress and fear. Whether that means stocking up on home goods, emptying out their investment accounts to hold on to cash, or indulging in unhealthy vices, we all have temptations that seem to speak louder when uncertainty is apparent. Unfortunately, for as many people who seek to help others during those times there are just as many if not more people who look to profit off of the worries of others. Perhaps you’ve even seen some of the advertisements about diets or spinal manipulations that improve immunity against Coronavirus. Even if you tried some of these strategies you are not to blame. But that doesn’t mean you have to be a victim of it either. Now, more than ever, we are finding that a healthy dose of skepticism, a quest for truth, and an unwillingness to accept “fluff” as medical treatment are essential not only for the provider but the consumer as well. 

Physical therapy is no stranger to this problem. For far too long many physical therapists have pushed treatments that are band-aids at best: passive modalities, dry needling, activity avoidance, and the like simply to help the patient feel a certain way while not actually inching them towards higher levels of function and self-sustainability. 

This is not to say that patients should be able to recite the latest volume of the New England Journal of Medicine in order to feel confident in the treatment plan they consult with their physical therapist on, but it is an encouragement to continually question the “why” and the “how” of the treatment they receive. And physical therapists should feel the weight of this responsibility to continually evolve their practice to the best available evidence. 

If providers and patients both acknowledge the need for this progression what we will soon find is that a lot of “fluff” is tossed out the window, outcomes will be improved, and the health of the American public will benefit while the healthcare spending in this country will be reduced. 

Physical therapy is about more than eliminating pain

Please note that this is not to say that pain is not an important consideration in the benefits of physical therapy. In fact, pain is the main reason the majority of people seek therapy in the first place and is one of the more complex issues that we deal with on a daily basis. However, the benefits of a qualified physical therapist can improve one’s life well beyond just reducing pain symptoms. We’ve seen this over the past few weeks from both physical therapists on the frontlines of inpatient care as well as those of us in outpatient doing telehealth and remote consultations. Our colleagues in inpatient care have used movement and exercise to improve post-treatment outcomes and reduce hospitalization times. They are also critical in adjusting patient positioning to prevent Acute Respiratory Distress Syndrome (ARDS) in those suffering from COVID-19 complications. As outpatient physical therapists we have been called upon to rely on our communication skills and patient education tools to consult patients on exercise programs for not only physical wellbeing but mental health as well.

So while insurance companies want to stop your physical therapy journey once pain is reduced (note: they are not concerned about pain being eliminated, just simply reduced enough to justify a stop in payment), we want to step in and be part of the health journey until you feel ready and able to carry the torch by yourself. 

This is also why we made the decision to bring a registered dietitian on board. To us, physical therapy extends beyond the exercise and movement component of a person’s health outcomes. Proper nutrition needs to run parallel to an intelligent exercise program. 

The future of physical therapy needs to be about more than exercise and pain. The concept of therapy needs to be reconsidered and broadened (within our legal scope of practice, of course). And truthfully, the archaic belief that physical therapy is about “fixing” people must be abolished. For our society to truly benefit from our profession in a post-COVID world we must understand that we have more to offer to the recovery of our communities than soft tissue massage and underdosed exercises all in the name of creating comfort. 

You are your greatest asset to not becoming a statistic

The debate(s) surrounding the pandemic are never ending. And although there is still a lot left to be learned about this virus we are learning one very important lesson: there is more you can do for your own health than you think. Just look at the most effective methods for reducing the spread of disease and you will see that all of the recommendations are behavioral: 

Wash your hands

Cover your cough/sneeze

Don’t be around people if you are sick

Sure, one could make the case that some of these things are harder to control for some than others. But by and large, these are things that are reliant on human behavior. 

Now let’s take a look at the list of risk factors for having complications related to COVID-19 infection: 

Asthma

Obesity

Chronic lung disease

Age 65 and older

Diabetes

Nursing home or Long-term care facility resident

Heart conditions

Immunocompromised

Chronic kidney disease 

Liver disease

Similar to the prevention of disease spread, most of the factors on this list are preventable by human behavior. Taken further, every item on this list can be impacted positively by participating in regular exercise and proper nutrition. It’s clear that the data strongly suggest that regular participation in exercise improves immune function and reduces recovery times to illness. Please note that we are not saying exercise can prevent you from catching the coronavirus, but rather that complications from an infection as well as recovery rates can be improved by having a more robust immune system that has been improved by regular exercise and proper nutrition. 

Healthcare should be about optimized outcomes and minimizing reliance on the system rather than generating profit through a billing menu and codependency

Right now, as it stands, healthcare is paid for by billing menus. You seek help from a medical provider, the provider goes down a list of interventions (sometimes mandated in order to “unlock” access to other interventions and other times just as a laundry list that has been passed down by tradition and routine), and each service is tallied on your medical bill. This is largely due to insurance company reimbursement rules but is also driven by tradition. Medical providers are paid to exercise their particular expertise and that expertise is often displayed by what interventions are chosen (or not chosen in some cases). This occurs not only in medical specialties but also in physical therapy clinics. These billing methods are calculated by hospital administrators and in-network physical therapy corporations to maximize revenue. While we believe that the majority of healthcare providers are in their professions for truly altruistic reasons, the reality is that many times these organizations do not give providers much of a choice but to continue these billing practices and will even incentivize providers to do so. 

After a while, it’s easy to see that the undercurrent of our healthcare system relies on focusing on sickness. For example, if a patient goes to their physician with back pain they are likely to be ordered to have a set of x-rays and prescribed pain medications. Given that x-rays are unlikely to show anything remarkable in the spines of low back pain patients the next step is ordering an MRI and maybe a referral to physical therapy. And if it’s a physical therapy clinic that the physician has a financial stake in that patient is statistically likely to show less improvement while having higher medical costs. At this point one of two things will happen: 1) the patient will continue receiving treatment at that POPTS (Physician Owned Physical Therapy Services) not knowing that they are overpaying for sub-par treatment, or 2) the patient will return to their physician and be referred to an orthopedic specialist to begin the process of exploring surgical options, none of which are shown to be as effective as they are touted to be. From here the patient is likely to remain in the medical system for much longer than necessary and continue to contribute to the financial burden that back pain is to our society. 

There are reports that patients experiencing COVID-19 complications will see medical bills around the $30,000 mark. In fact, USA Today reports that hospitals are paid more for patients listed with COVID-19. This is not to say that doctors and hospitals are gaming the current pandemic for higher profit margins, but with multiple reports from hospitals around the country showing significant financial loss during the pandemic as elective procedures have been halted it’s easy to see that keeping patients in the loop pays the bills. 

The future of healthcare should really focus on maximizing health outcomes and reducing dependency on the system. So while it seems unreasonable from a financial perspective, we feel that it is our responsibility as leaders in the physical therapy industry to encourage holistic health in our patients and to drive self-efficacy and independence as soon as possible. We may not see this transformation in the system in our lifetimes, but we are more than willing to take the first steps on that journey and we hope you will take that journey with us.