Why I stepped out of “traditional” physical therapy care


How many times have you called to see a physical therapist of your choosing only to find out you need to take extra steps to see that person? Declining reimbursement from third party payers has forced therapy practitioners to see multiple patients an hour, possibly half hour, leaving very little time spent with each patient. Due to lack of time, most clinicians are only able to address one complaint per visit, sometimes one complaint per entire episode of care.

To compound this, many agencies raise prices exponentially to receive higher reimbursement from third party payers based on a percentage paid or negotiated rate. This increased cost often flows to the patients as well. In addition, patients often receive interventions and tests that will be paid for by a third party payer, which are not necessarily the most effective interventions for their diagnosis. These are common barriers to treatment in our healthcare system and physical therapy is no exception.

Stepping Out

As a doctor of physical therapy working in mainstream insurance based clinics, I am familiar with the above scenarios. While I continued to pursue a higher level of clinical education to improve my outcomes, there were many barriers to implementing these interventions.

In order to provide the highest level of care without barriers, I took the third party payer out of the relationship. I was able to lower overall costs and provide one-on-one care with the patient always seeing the highest level practitioner (doctorate level). Patients now have direct access to me and can utilize me as their practitioner of choice for musculoskeletal and neuromuscular dysfunction. This also provided the flexibility to provide care in the person’s home, as well as in a clinic setting.

Many patients I see spend up to 60 visits in traditional physical therapy clinics, only to get very little accomplished with no supervision and direction. At the conclusion of their treatment, they are still in pain. Three months later they receive a large bill for this. They often wonder if the level of care received was worth it. My practice has a heavy emphasis on manual interventions and dry needling to correct somatic dysfunction with little to no passive time. This has much higher outcomes, with less overall time and money spent achieving goals. My average number of sessions to achieve a patient’s goals is around five. If I am unable to aid the patient, the patient will get a referral to another practitioner.

-Patrick Bray PT, DPT, is CEO of Bluegrass Doctors of Physical Therapy in Louisville, Kentucky.