Cover Letter

Greetings Professor Fisher,

I present here my data report, Money IN Your Pocket: Saving Money and Time by getting to
Physical Therapy Faster, as assigned on February 24, 2021.
The three data figures in this report were chosen to show the reader how a person dealing with
musculoskeletal injuries could: 1) see the cost saving benefit of choosing physical therapy over
other possible treatments, 2) Understand some of the obstacles that patients deal with before
and after engaging in treatment and 3) Show the reader how “direct access” to treatment can
eliminate some of those obstacles and help a patient get to physical therapy faster.

The data figures used in this report were taken from several different sources all geared toward
the healthcare field of physical therapy. If any follow-up is needed these sources are all cited
throughout this paper and can help you, the reader, expand upon the narrow scope of this
report. An understanding of the physical therapy industry is not needed to understand the data
presented here, as the information shown is intended for the patient for their consideration.
I hope you find this report satisfactory in fulfilling the requirements for this “Data Report”
assignment.
Sincerely,

Marissa Lowman

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 Money IN Your Pocket:
Saving Money & Time by Getting to Physical
Therapy Faster

By Marissa Lowman
Student San Juan College
3/24/2021

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 Money IN Your Pocket: Saving Money &
Time by Getting to Physical Therapy Faster

Submitted to
Professor Johnathan Fisher
Spring Term 2021 G-Professional and Technical Communication
ENGL-2210-101H, ENGL-2210-1010

3/24/2021

By
Marissa Lowman

This report is meant to highlight how choosing physical therapy can be a cheaper, more cost-
effective means of treatment for musculoskeletal injuries. The data figures given for this report
are designed to show three things: 1) a comparison of cost for physical therapy vs other
treatment options, 2) obstacles for care both in seeking treatment and maintaining a course of
treatment, and 3) how utilizing “direct access” for a patient to seek immediate care from a
physical therapist can remove some of the treatment obstacles as stated in #2 and
streamline/reduce patient costs as stated in #1.
This report is not intended to dissuade a patient from seeking other forms of medical treatment
for musculoskeletal issues. Section 2.0 shows that physical therapy is generally a cheaper
course of treatment. The decision to use a different form of therapy or even surgery is open for
the patient and other medical professionals to make, such as with a family doctor or an
orthopedic specialist. Section 3.0 talks about finding the most effective treatment, with
noticeable results, to help keep a patient invested in achieving long lasting recovery. Section
4.0 shows how a physical therapist is qualified to help a patient choose a course of treatment
with a thorough evaluation of their musculoskeletal health.

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 TABLE OF CONTENTS
TITLE AND ABSTRACT……………………………………………………………………………………………………… 3
LIST OF FIGURES…………………………………………………………………………………………………………….. 5

1.0 INTRODUCTION………………………………………………………………………………………………………… 6
1.1 Purpose of the Report………….………………………………………………………………………. 6
1.2 Background of the Report…………………………………………………….………………………. 6
1.3 Scope of the Report……………………………………………………………………………………... 6

2.0 PHYSICAL THERAPY COSTS VS. OTHER TREATMENTS………………………………………………… 7

2.1 Summary………………………………………………………………………………………………………. 7
2.2 Interpretation……………………………………………………………………………………………….. 8

3.0 OBSTACLES TO TREATMENT AND RECOVERY……………………………………………………………. 9

3.1 Summary………………………………………………………………………………………………………. 9
3.2 Interpretation……………………………………………………………………………………………….. 10

4.0 EMPOWERING PATIENTS WITH “DIRECT ACCESS”…………………………………………………….. 12

4.1 Summary……………………………………………………………………………………………………….. 12
4.2 Interpretation………………………………………………………………………………………………… 13

5.0 CONCLUSION……………………………………………………………………………………………………………… 15
REFERENCES..………………………………………………………………………………………………………………….. 16

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 LIST OF FIGURES

FIGURE 1. The Cost of Physical Therapy…………………………………………………………………………………………. 7

FIGURE 2. Why Don’t Patients do Their Exercises………………………………………………………………………….. 9

FIGURE 3. What Is Direct Access?....................................................................................................... 12

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1.0 Introduction
1.1 Purpose of the Report
The information given in this report is designed for the patient/consumer to consider when
choosing a course of care for musculoskeletal injuries. In section 2.0, the data will show how 10
sessions (the standard number of initial sessions suggested) of physical therapy can cost
significantly less when compared to other treatments, such as surgery. In section 3.0, the data
chart will show the many obstacles that a person may face when seeking therapy and in trying
to fit sessions into their daily schedules. It also addresses how physical therapists can optimize
treatment for better patient compliance. Finally, in section 4.0, the data will acquaint the
reader with the concept of “direct access.” This method of care can help a patient streamline
both the initial diagnosis, by allowing a physical therapist to make an assessment without a
doctor’s referral, and to help the patient get started with treatment faster.

1.2 Background of the Report

Healthcare access and costs are a hot button issue for all parties involved. Politicians, insurance
companies, and practitioners all have suggestions for improving the industry. The consumer
themselves generally has little input into their own course of treatment and yet everyone can
agree that time and money are the guiding factors in determining how that care is handled.
This report addresses both the issues of comparative costs and time constraints for the patient
and the issue of giving the patient more control over how they seek treatment.

1.3 Scope of the Report

This report is directed specifically at using physical therapy as the first form of treatment for a
patient with musculoskeletal injuries. It does not attempt to dissuade anyone from pursuing
other treatments first or at all. It does show how a physical therapist is qualified to diagnose
and refer a patient to other specialized practitioners if care is needed beyond the therapist’s
abilities.

Note: An understanding of physical therapy treatments is not needed to appreciate the

material provided in this report.

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2.0 Introduction-Physical Therapy Costs vs. Other Treatments
This first data chart comes from Orthopedic & Sports Physical Therapy (osptky.com) (fig. 1)
O&SPT is a physical therapy business serving eastern Kentucky in multiple communities. As
stated on their website:
At Orthopedic & Sports Physical Therapy, our goal is to provide the highest level of care
using both the science and art of physical therapy. Our service is at the core of how we
treat patients and their families. We will always work to make a difference in the lives
of our patients and the communities which we live and work. (“About Us”)

This data specifies the cost range of various medical treatments, listing these treatments from
least to most expensive.

Figure 1: Orthopedic & Sports Physical Therapy. (2019, May 29). The cost of physical therapy.
Retrieved March 04, 2021, from http://www.osptky.com/2018/01/cost-physical-therapy

2.1 Summary
The information in this chart is designed to show the varying costs of different treatment
options for musculoskeletal issues. The cost of each subsequent treatments listed above grows
exponentially, showing the benefit for a patient to use physical therapy as a lower cost option
of treatment. As shown above, the cost of 10 sessions of physical therapy is close to $1600
cheaper than one MRI diagnostic test and over $30,000 cheaper than having back surgery.
This chart does not specify that a patient should prefer one treatment over another, but if the
cost of a treatment is used as a deciding factor then physical therapy is the cheapest option.

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2.2 Interpretation
The biggest takeaway from this chart is that physical therapy is a money saving medical
treatment. In the article, “The Cost of Physical Therapy,” from osptky.com (2019), the team at
Orthopedic & Sports Physical Therapy reveal that:
…though the exact answer will vary based on your specific needs, the total cost for the
average episode of care, or 10 visits, is $1000. Physical therapy is a cost-effective
treatment designed to get you back on your feet quickly, and with lasting results. Not
only do most insurance providers cover physical therapy, it has been proven to reduce
medical costs by diminishing the need for unnecessary medication, imaging scans, or
surgeries. (“Health News You Can Use”)

Therefore, this information can be used by a patient when weighing the cost/benefit of utilizing
physical therapy as an option for pain relief and other musculoskeletal issues before seeking a
referral to a decidedly more expensive diagnostic specialist.

Low costs for treatments is perhaps the best way for members of the medical community to
“…work to make a difference in the lives of our patients...” (osptky.com, “About Us”).

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3.0 Introduction-Obstacles to Treatment & Recovery
This second data chart comes from a website titled, “Journal of Epidemiology & Community
Health” (jech.bmj.com) (fig. 2). JECH is a web based medical journal published monthly and
owned by BMJ. According to the website:
The Journal of Epidemiology and Community Health is a truly international journal that
encompasses all aspects of epidemiology and public health. It publishes original
research, opinions and materials concerned with the study and improvement of
communities worldwide. (“About”)

This data chart shows the many possible reasons that a person may delay treatment for
osteoarthritis of the knee and why they may have trouble following and sticking to a set course
of treatment.

Figure 2: Campbell, R., Evans, M., Tucker, M., Quilty, B., Dieppe, P., & Donovan, J. (2001,
February 01). Why don't patients do their exercises? Understanding non-compliance with
physiotherapy in patients with osteoarthritis of the knee. Retrieved April 03, 2021, from
http://www.jech.bmj.com/content/55/2/132

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3.1 Summary
This chart was produced from a study about patients with osteoarthritis of the knee, yet it
easily correlates to other therapies for musculoskeletal issues. So many of the obstacles that
this chart shows, about why a person may delay care or become noncompliant with their
treatment, have to do with everyday life. In the bubble, “accommodation of intervention in
everyday life,” a person needs to find a way to add treatment into a possibly already hectic
daily routine. Can they afford to take off work for physical therapy or do they need to squeeze
a session into their lunch hour? With “comorbidities or comparison with others,” are they
overweight and already dealing with societal prejudices, like shame and ridicule? Moms and
dads, who strive to care for their children first, have little energy left to care for themselves.
They don’t want to feel “guilty” for taking time away from their families.
As seen in the chart, “motivation” for an individual is key in getting that person to seek
intervention.

3.2 Interpretation
In the article, “Why don’t patients do their exercises? Understanding non-compliance with
physiotherapy in patients with osteoarthritis of the knee,” (Campbell et al., 2001) the authors
state:
The aim of physiotherapy is to improve muscle strength and joint mobility, often
requiring considerable commitment by patients over long periods of time….Non-
compliance is traditionally defined as a failure by patients to follow advice.(para. 1)
So, best case scenario:
1) a patient is referred for physical therapy by their primary care doctor.
2) They easily schedule the recommended 10 sessions, spreading them out over the next
few weeks.
3) No conflicts arise with the established schedule. Even though the patient feels better
after 4 sessions they keep attending for the rest of their treatment.

This is not a realistic portrayal, as evidenced in Figure 2. Dr. Ryan Klepps, in his blogpost on
Webpt.com, “7 Thought Provoking Facts About Physical Therapy You Can’t Ignore,” (2018) his
fact #4 states, “Only 30% of patients who receive outpatient physical therapy services attend all
the visits their insurance company authorizes.” Dr. Klepps thinks this problem may be due to
therapists “not effectively communicating the value of doing so.”
But the physical therapist has no control over the added stresses of their patients’ lives. The
same stresses the caused the injury, delayed the treatment and make the therapy sessions hard
to attend over a long period of time. Telling the patient that a course of treatment is most

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effective if all sessions are attended, while factual, does little to remove many of the other
obstacles that affects a patient’s motivation.
The authors, Campbell et al., (2001), make a different argument for helping patients maintain
motivation. They state:
A number of the factors found to contribute to non-compliance with physiotherapy in
this study… in particular that symptoms need to be perceived to interfere with life
sufficiently to require treatment, and that an intervention needs to be perceived to be
effective and to be suitable for incorporation into everyday life. 7 20 22 24 This study
provides further evidence that patient's decisions to modify or discontinue therapy
(physical or drug) are reasoned and rational when examined from the patient's
perspective. (Discussion, para. 2)

Physical Therapists need to have treatments that produce effective results first. Then the work
of convincing the patient to comply with the standard course of 10 sessions will be more likely
to succeed.

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4.0 Introduction-Empowering Patients with “Direct Access”
This third piece of data is provided by Symmetry Physical Therapy out of Pelham, NY.
(symmetrypt.com) (fig. 3) In their article titled, “What is “Direct Access” and how it relates to
Physical Therapy care,” it states, “Direct access to physical therapy is your opportunity to be
evaluated and treated by a licensed Physical Therapist without first seeing your physician for a
prescription/referral.” (blog 2015)
This chart shows the traditional approach to treatment vs. using the “Direct Access” approach.

Figure 3: Symmetry Physical Therapy. (2015, January 06). What is "direct access" and how it
relates to physical therapy care. Retrieved March 03, 2021, from
http://www.symmetrypt.wordpress.com/2015/01/06/what-is-direct-access-and-how-it-
relates-to-physical-therapy-care

4.1 Summary
With a traditional approach to care for a patient presenting with musculoskeletal issues, it can
be a long road to physical therapy. The patient will have deal with multiple appointments, from

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doctor to specialist, specialist to diagnostic, diagnostic back to doctor and then finally on to
physical therapy. Each step presents new costs for the patient, along with the time needed to
schedule and attend the appointments. Utilizing direct access, the individual can seek out care
that best addresses their symptoms (back pain, hip pain, neck pain, etc.) first, to help begin
treatment faster.

4.2 Interpretation
As stated in section 2.0 (fig. 1) and in section 4.0 (fig.3), physical therapy has been shown to be
a cost saving treatment for patients with musculoskeletal issues. In the blog, “What is “Direct
Access…” (2015) it says, “Physical Therapists are qualified to recognize when a patient presents
with signs and symptoms outside the scope and expertise of the physical therapist and when
the patient should be referred to a physician.” Direct access to a physical therapist will save a
patient time and money up front and allows for a more in-depth analysis for musculoskeletal
aches and pains from a qualified professional.
Unfortunately, direct access is not always allowed as a choice for patients. On the website,
Getpt.org, a breakdown of each states direct access laws shows for New Mexico that:

A physical therapist can treat direct access patients when:

• The patient has an existing diagnosis from a licensed primary care provider
and that’s the reason the patient is seeking therapy.
• The patient is in a special education program or in acute care (as long as the
care is within the PT’s scope of practice).
• The therapist notifies the patient’s primary care provider of the physical
therapy diagnosis and plan of care every 60 days. (blog 2015)

It is still required for a patient to get a referral from a primary care doctor or for the physical
therapists to have a primary care provider notified of treatment. These two obstacles, while
small, still add time and money to the patient’s course of treatment. They do not provide for
full “direct access,” which benefits patients most.

According to the American Physical Therapy Association (apta.org) in the article, “Improving
Direct Access at the State Level,” they state that:

These restrictions do not recognize the professional training and expertise of the
licensed physical therapist nor do they serve the needs of those patients who
require physical therapy but whose care is unnecessarily interrupted by these
restrictions.” (2020)

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Direct access is not a danger to patient care, nor does it completely eliminate the pos sible
need for other treatments, like surgery, or diagnostic procedures, like an MRI. It gives the
individual more control over their bodies and can save them time and money by getting
them to treatment faster.

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5.0 Conclusion
Settling on the right course of treatment for any one person is complicated. No two people are
alike and everyone should be given the opportunity to seek their own form of healing. People
want to know that they are receiving the correct treatment and that their out-of-pocket costs
will be reasonable. Musculoskeletal issues, when dealt with early, can keep an acute injury
from becoming a chronic pain that further hinders the mobility and quality of life for the
patient.
When a patient is allowed “direct access” to seek out care without the need for referrals,
navigating the healthcare industry can suddenly become a lot less intimidating. In removing as
many obstacles to starting and maintaining treatment as possible, the patient will optimize
their time and money and are more likely to complete a given course of treatment. The low
cost and immediate benefit of physical therapy as an initial treatment for musculoskeletal
injuries can be a great way to alleviate the burden of busy, over worked primary care doctors
and to allow for other orthopedic specialists to focus on patients with more severe injuries that
cannot be helped with physical therapy alone.

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 REFERENCES
Campbell, R., Evans, M., Tucker, M., Quilty, B., Dieppe, P., & Donovan, J. (2001, February 01).
Why don't patients do their exercises? Understanding non-compliance with physiotherapy
in patients with osteoarthritis of the knee. Retrieved April 03, 2021, from
http://www.jech.bmj.com/content/55/2/132

Improving direct access at the state level. (2020, February 12). Retrieved April 03, 2021, from
http://www.apta.org/advocacy/issues/direct-access-advocacy/improve-direct-access-state-
level

Klepps, D., & Collins, M. (2020, December 04). 7 facts about physical therapy you can't ignore.
Retrieved April 03, 2021, from http://www.webpt.com/blog/7-thought-provoking-facts-
about-physical-therapy-you-cant-ignore

Orthopedic & Sports Physical Therapy. (2019, May 29). The cost of physical therapy. Retrieved
March 04, 2021, from http://www.osptky.com/2018/01/cost-physical-therapy

Physical therapy direct access laws by state. (2015). Retrieved April 03, 2021, from
http://www.getpt.org/physical-therapy-direct-access-laws-state

Symmetry Physical Therapy. (2015, January 06). What is "direct access" and how it relates to
physical therapy care. Retrieved March 03, 2021, from
http://www.symmetrypt.wordpress.com/2015/01/06/what-is-direct-access-and-how-it-
relates-to-physical-therapy-care

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