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Posted 9/27/2013 3:52 PM (GMT 0)
I just came back from "one hour" of PT.

What was included:  Me walking on the treadmill for 15 minutes.  Me stretching out my hamstrings.  Me doing pelvic tilts and bridges.  Then the PT came over and did three bouts of trigger point release on my hip flexors, and three supported hip flexor stretches.

Then it was me doing adductor exercises.  Me doing lumbar mobility exercises.  Me doing IT band and quad stretching on the foam roller.  With an ankle weight, me doing standing abductions, and standing hip extensions, and lateral walking for a total of 80 steps.

That was it.

For the whole "hour" I was there, he was with me maybe 10 minutes.  Everything else I did myself, on my own, and frustrated, I did ask if I could join a gym...and not yet.  He doesn't feel I'm ready.

For THIS, my insurance company gets billed.

There are two PT's there (no PTA's) and they're so busy with two other clients each at the same time.

So big deal I get the "luxury" of knowing this facility only employs PT's.  Frankly, my facility in MA where I had one PT and one PTA, I got a whole lot more attention, even when they were juggling two patients each.  They never just passed you off.

I'm livid.

I'm sore too, and good or bad it was all my own doing.

I am less than happy.

Merrida (the grouch)

Posted 9/27/2013 5:21 PM (GMT 0)
That is very typical for facilities to double and triple book people. Its one thing for the PT/PTA to rotate thru the clients, monitoring what they are doing, but having you to go about your exercises and let them know when you are done is unacceptable. I also felt the same way when I was there for a work injury to my shoulder. If I was going to be ignored and not monitored I could do the exact same thing at home. It got the point that I would wait after I was done with each exercise to make sure they had to come to me to review the next and make sure I was doing it correctly and I could ask questions.

I have thought about asking them how they separate their billing of 1-1 therapy verses self intitiated therapy with 10% therapist assistance. I am a COTA (not working in rehab right now) and I know at times I have set someone up with a task, but I demonstrate and observe them starting it them keep checking on them. Then the same thing happens with the next task.

Maybe you can ask for a time that they arent so busy for your therapy session, not sure what the answer is. There has got to be a cap of some sorts for how many pts a therapist can oversee/bill for at one time. For me I can only bill for 3 medical assistance clients at one time, and then it needs to be billed as group theapy verses individual therapy. You may want to check what they are billing for exactly, there is a difference! Some insurances dont allow for group therapy only individual. Of course individual is more expensive than group, it may not affect how many sessions you can get in a year but it will affect how much they get paid. Of course all insurance and billing is different just what I have learned over the years between mine and working in therapy.
Posted 9/27/2013 6:23 PM (GMT 0)
Angel,

My previous PT's were great. Sure there were 4 patients to 2 therapists, but as you mentioned, they would rotate and cycle. I never felt ignored.

I'm doing the same exercises now as day #1 so yes, of course I know them. But frankly, I can do this at a gym, and probably make more progress. They are adamant about treating only one area (but he explained, he gets paid the same whether he treats one or two areas,....well la-tee-da, but I have three doctors who sent Rx's for PT because of my hip, my spine, and the foot drop,...and I also have a referral because I the cortisone injections for my shoulder aren't holding up and that doctor, who does the injections, said to r/o his suspicions of a tear, I have to be aggressive at PT with my shoulder).

They don't address the shoulder. They don't address the foot drop. The only thing they do for my back is put a STIM and ice on it (same thing I do at home, throughout the whole day). The only "core" work (can't even call it that) is 20 pelvic tilts and 20 bridges.

Nothing for balance, nothing for stability and strength, nothing for posture, nothing for gait training.

Granted I have made great strides (no pun) in my hip flexibility...but add that into how my pain meds just got cut in half, and the things I do on my own, such as laundry, grocery shopping, the stairs inside and outside the house, or just taking a walk,...I'm down for the count.

In fact, as of right now, it's 2:20pm EST, and my back hurts, a lot. And I just had PT this morning (for the hip).

I asked for 3 x week BECAUSE I have such complex issues...not so they can toss me into their schedule, knowing I know all the exercises and then some, while they do modalities on other patients.

If it's all about the pay, why can't he spend the same 60 minutes on me and work on both my hip and back since they're both related? Because he can't BILL for two body parts, that's why.

It will be one month that I've been going to them so far.....

I'm getting ready to hulk out because I feel angry....I do not feel supported in what I am trying to do.

And at 3 x week, why can't even 1 day of those 3 be for my shoulder and back? Especially since they're not giving me clearance to work out at a gym (and I have to play by the rules).


Greener and greener!

Merrida
Posted 9/27/2013 7:07 PM (GMT 0)
You need to let your Dr know they're not addressing the shoulder especially if he's depending on therapy to rule out a tear.

Also find out what exactly is getting billed like Angel said.

I had a therapist office that use to do that! Stick me in the pool and I never saw them again for 30 minutes. One day to test my theory,thought maybe they had cameras in the pool room or something, I never got in at all, not one toe. When she asked as I was leaving if I felt I had a good session in the pool today I waved on my way out and said "great! Real work out! " She said "see you next week " No she never saw me again.

Its probably astounding to see what they charge for that? My 30 minutes in or not in the hydropool!

I told my Dr that I wasn't going back to them and why. He sent me to a different one and they get in the pool with me or us as there are. 2-3.

Take a deep breath, scream if no one can hear you and start on fixing it.
Posted 9/27/2013 7:33 PM (GMT 0)
In my Oncology Rehab program, I don't have any of those problems you describe. They have one full-time therapist for each patient. I am allotted an hour per session, how long I stay depends on me and how I am feeling and doing on a particular day.

I have had the same therapist my entire going on 28 months. Only time I had a substitute (and she was of equal quality to my regular, was when she went out on maternity leave under the FLMA. And when she was out then, she would either call me or e-mail me weekly, to make sure I was being treated right.

After each routine or exercise, my BP and oxygen levels are checked. Makes me feel very safe to be that closely monitored.

So far, under Medicare only, I have never been charged or billed a single cent.

This coming Monday, I will have my free massage session for the month. If I want any additional ones during the month, they only charge $28 per session, and they even bill for that.

PT can vary so much, whether it be private sessions, or if it's part of a major hospital group. I have been to some in the past, where they were doing as many as six people per therapist, and you would be lucky to have even 5 minutes of quality one on one time. Plus, in my case, they appeared clueless as how to deal with an oncology patient having special issues.

Sorry you are upset, but from what you wrote, I would be too. Do you have any alternative in your area, other than the facility you are currently using?

Hope you can find a better solution, as I am a big believer in long term PT.

David
Posted 9/27/2013 8:09 PM (GMT 0)
Thank you Vickie and David for your replies.

I know my already HBP is even higher because I am so angry. They spend more time making sure I've scheduled appointments for the following week.

For a patient coming 3 x week, I actually expect them to be even more involved, knowing they have someone who's that determined. I left the office today so angry, I cried when I got to my car.

While I want them to respect the fact that I've been in PT long enough, and have a working history involved enough, to be quite familiar with the exercises,...that does not mean I expect them to just hand me belts and balls and strap on an ankle weight and walk away.

I called my shoulder doc and told them what was going on and asked if they'll fax my new PT a letter.

The extent of their conversation with me was to comment on how I seem to be walking better. Yes, yes, I am. I told them that's why I like the treadmill,....support. On my own, I bang into things and have the bruises to show for it. (Nothing,...no response).

Between the patients and the therapists, I hear more gossip than I do education or information.

I see them M, W, F. Yeah well, especially after I've had time to stew (and I'm still stewing in my own crock pot of frustration and angry juices), and reading what you guys wrote,...you're right. Not only do I not deserve this treatment (or lack of), but I cannot afford it, (financially as well as physically).

I expressed to them how I understand I'm on a tight time frame with regards to nerve regeneration and recovery, (again, that's why I schedule 3 x week)....I can't afford to dilly-dally and do inefficient and mundane, downright non-therapeutic exercises. They haven't advanced me at all from where I was when I started. Yes, absolutely I have more ROM in that right hip, but the massive swelling in that thigh and hip interferes with my gait, and nothing's being done to work with all this new hardware.

To them, I feel like I am just a hip. Not the sum of all the new parts, the neurological deficits and the compensations my body's making to accommodate all this. They're not teaching me anything I didn't know walking in.

My previous PT's were always educating me.

I'm so angry that I feel nauseous right now. The most crying I've done was after my surgeries, brief periods, when the pain was so intense. Well currently, I'm crying again, in part because of anger and frustration, but also because of pain that wasn't there before (ie: what was managed with previous PT's, such as whole back, core, shoulder).

I won't yammer more, it'd be redundant. Thanks for letting me vent. Maybe by Monday I'll calm down a bit. Right now, if I were to talk to them, I am not sure I would be civil. I am more upset now at 4pm than I was when I was having PT at 10:30. I'm not "getting a grip" on this,...I'm just sinking deeper into this pit.


Merrida
Posted 9/27/2013 9:14 PM (GMT 0)
That is exactly how I got half my clients. Many of my clients first went into PT, got ignored and had no progress, so they came to me( personal trainer) and got 1 on 1 attention. With the prices they charge for PT, that is ridiculous. My aunt just got prescribed PT and she had the same experience. She was very disappointed.
Posted 9/27/2013 10:11 PM (GMT 0)
Boxer,

Among my other previous career paths, working as a CPT has been my passion and love for decades. And I'm good.

I, too, would often get the patients that PT's screwed up, ignored or even injured on occasion.

And to hear PT's bad mouth CPT's is really sad. There are good and bad in every field, and ours is no different.

That's my concern with disability,....being able to return to training? I would love to, but to do so, I need to be able to work harder than I am now, yet I'm not getting the support to do that. And, because I've filed for disability, like it or not, I must go to PT even though I know I can do what they're doing and probably more, on my own in a gym. But I do not have "clearance" yet to join a gym, so I cannot overstep their guidelines.


Merrida
Posted 9/27/2013 10:31 PM (GMT 0)
I am going to reduce my PT's to 2 x week because I'm not losing my sessions because they don't feel like focusing on me.

If they did modalities with me, soft tissue work, facilitated stretching,...things I cannot do on my own,...AND gave me clearance to do a real workout at a gym, I'd be fine.

As a trainer, most of my clients were the "difficult" cases other trainers didn't want: Neurological impairment, mental impairments, I was the go-to person for any client with back problems or joint replacements, neurological deficits,....I worked with a teen who had hypertonia when the other trainers would rather not,...stroke victims,...brain cancer patients (and the multitude of complications that presents). Most trainers want the athletes who are "easy" to train that look good in their portfolio.

I had those as well, but my intense passion and interest revolved around the more challenging, the clients other trainers were afraid to take on.

My "element" has always been working with, and thriving in, the environment of challenging situations. My forte. So I'm not naïve.

Regardless, my past, my history, my career, should have no baring on how they treat me. It may be part of the reason I am so livid right now. Because I know better. Because as a trainer, I've provided better care and treatment to my own clients than I've received.

I'm trying very hard to emphasize that they've made great progress in one area, .... the problem is that I am not "one area," and in fact the whole kinetic chain is out of whack, despite that progress, and they won't address the other areas because,.......they cannot bill for them.

I'm still seething.


Merrida
Posted 9/28/2013 1:01 AM (GMT 0)
Wow, that sounds like an awful experience, and I too have had experiences that varied a great deal from one PT office to another.

All that said -- the one time when my PT guy had 2-3 other patients at the same time I asked about it. They claimed the problem was that everyone wanted the 10am appointments, but nobody wanted the 9am ones. I moved to 9am and got lots more done.

I'm not saying that the poor attention you're getting is right, believe me, it isn't. Actually, overall I don't think PT did anything except keep me from going too fast. Next time I'm trying another office!

Post Edited (Lynnwood) : 9/27/2013 7:04:26 PM (GMT-6)

Posted 9/28/2013 2:09 AM (GMT 0)
Other than PT for immediately after surgery, I think, for me at least, personally, it's a waste. Most of the time. My general feeling is that I'm familiar enough, that I can do it on my own (in the facility of a gym).

BUT,...for me to prove that I'm maintaining continuity of care, (even if it's sub-par and lazy, such as what I feel I'm getting currently),...and that's the key word, "prove," my insurance company will accept nothing less than physical therapy notes as evidence.

I feel it's a waste of my time and their money, just for red tape. I sincerely feel I would make more progress on my own.

If I didn't have such an outstanding experience with my previous PT group (with whom I worked for well over a year), I still would believe they are all pointless and purely academic.

Right after my first hip I had a lousy PT experience as well. They ignored everything, and I had to correct them several times (because they were trying to get me to do exercises contraindicated for total hip replacement patients,....they kept forgetting).

Then I found,...my "happy place." I miss them so much, it's incredible. They proved to me there ARE good PT's out there.

If I could, I would drive back down to MA to stay with my regular guys.

The more I think about it, the more I am certain I'm going to have a sit-down with them come Monday. Insurance or no, it's still "my money," and I no longer want to pay for this kind of non-treatment. My biggest concern is,--for the area,--I still don't know whose reputation is what, and I'd hate to burn bridges and create a difficult situation for myself down the road.


Merrida
Posted 9/28/2013 2:29 AM (GMT 0)
I did not read every single post.. too.sleepy.

You are correct to be angry about the lack of attention & instruction. An inattentive PT can cause damage. If you have not already done so, please go to another PT & continue looking until you are satisfied !!

Took me about a year & hmm 3 different offices to find the right group for me.. I had a favorite that I followed to two other locations.. that PT made a career change but there are several other PTs who treat us patients very well.
Posted 9/29/2013 2:20 AM (GMT 0)
My concern revolves around what to say to my PT when I see him on Monday.

Conventional wisdom says not to cut those ties until I have someone else lined up.

Also,...I don't know how or what to SAY to this PT to explain my dissatisfaction. I don't want to make him mad (to give him the benefit of the doubt, maybe there are several misunderstandings,....I know for darn sure there are more than one).

I don't want to come off as arrogant, demanding, and uncooperative, -- all of which he can choose to reflect in his reports that will be reviewed by Disability and the next PT.

I am going to search for other PT's, there's no question about it. I just want to do it in a way that "saves face," if that's possible, without pissing off practitioners I may someday need some type of reference or letters from.

I'm (still) so angry, (I have not been able to let this go yet), that I fully confess I am worried about seeing him and speaking to him Monday for fear of what I'll say, especially without another PT lined up....and even when I DO get another PT,.....how much you want to bet the new ones will want to hear what these guys have to say about me.

I'm tightly grasping this anger and not letting go because there is no closure, so my imagination is running wild. And until I speak face to face with him Monday, that anger will thrive.

The problem is: I do not know "what" to say to him, "how" to say it, how to say it without burning bridges, and how to relay all the things I am downright irate about without being written up as a difficult patient. It's not one or two things, it is SEVERAL things they're neglecting, all of which my doctors and surgeons AGREED must be dealt with, "me as a whole body" with these "new parts" if I don't want to premature compromise the adjacent regions.

I swear they don't read the notes, they don't read the previous PT notes or MD notes, they go ONLY on "their own assessment" and pick and choose what (single) area they'll work on.

Forgive my rambling, but I am so upset and angry that it's making me physically sick. I didn't realize how bad this bothered me until....since my Friday appointment, I've been feeling worse and worse, here we are Saturday night,...than I did at the time of my Friday morning "session." It's eating me up inside.


Merrida

Merrida I had to do a little editing, please remember HW has rules concerning language as it is a family oriented site, thanks....Susie

Post Edited By Moderator (straydog) : 9/29/2013 3:03:10 AM (GMT-6)

Posted 9/29/2013 10:51 AM (GMT 0)
Merrida,

Once you have calmed down, which you should be able to do by getting busy doing something else. Distract yourself. Read a book, go for a drive or a short walk. Talk to a friend on the phone, NOT about your P/T.

Once you are calm, write down the points that you feel have to be made to your physical therapist. When you put it in writing, you won't forget anything that you want to address and having notes in front of you will keep you calmer (hopefully anyway, it has always helped me!).

I understand that you don't want to burn bridges, and no one says that you should. But if they refuse to treat more than the one area at a time, they are doing you a disservice and you are just wasting your money.

I have gone to P/T over the years, there is no reason that one has to communicate with the other. They don't even have to know you were ever seen at that office, that is up to you to tell them if you want to.

Trudy
Posted 10/2/2013 12:18 PM (GMT 0)
I've experienced exactly the same treatment as Merrida and can totally relate. One therapist is juggling 3 clients and when I see the bill I am livid! $200 billed, with $75 of it for the 5-10 minute stretching session at the end. Between the warm up and the icing at the end, they spend roughly 20 minutes with me, while running back and forth between clients. And have the nerve to charge $200??
I just cancelled my appointments for the week and will stretch on my own at home. thank you very much.
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