MHA 506: Health Care System Organization

Module 2

Case Study II: Outpatient Services; Physical Therapy

Dr. Ohlson, Edward

10 June 2013
 Abstract

Outpatient services are medical procedures or tests that can be done in a medical center without

an overnight stay. Many procedures and tests can be done in a few hours. Outpatient services

include: Wellness and prevention programs such, as counseling and weight-loss programs.

Diagnosis treatment that include but is not limited to lab tests and MRI scans. Outpatient

treatments also include some same day surgeries and chemotherapy treatment. Many outpatient

clinics and hospitals include rehabilitation services, such as drug or alcohol rehab and physical

therapy.
Outpatient physical therapy services means; the physical therapy services provided by the clinic

and other health agencies to patients on the pretense that they will be there for a few hours and

then leave the facility. This falls in line with the definition of outpatient clinics that all outpatient

facilities are alike in having no overnight patients. (Carr, 2010) The main aim of outpatient

physical therapy services is to help people to restore movement and function, relieve pain, and

prevent further injury. (Gibson, 2005) It provides evaluation and treatment of numerous physical

conditions for all age groups. Outpatient physical therapy services is provided to people with

musculoskeletal disorders such as back and neck strains or knee injuries, neurological deficits

such as stroke or cerebral palsy, and skin disorders such as wounds, burns or diabetic foot ulcers.

(Cup, Pieterse, Munneke, Marten; van Engelen, ; Hendricks; van der Wilt, Gert J; Oostendorp,

2007)

According to the medical dictionary "outpatient physical therapy services" means physical

therapy services furnished by a provider of services, a clinic, rehabilitation agency, or a public

health agency, or by others under an arrangement with, and under the supervision of, such

provider, clinic, rehabilitation agency, or public health agency to an individual as an outpatient

who is under the care of a physician and with respect to whom a plan prescribing the type,

amount, and duration of physical therapy services that are to be furnished has been established

by a physician or by a qualified physical therapist and is periodically reviewed by a physician.

(medical.dictionary.com)

Physical therapy covers a vast area of services and those areas can vary according to geological

location, and size of the hospital, clinics providing the services. There are however some services

that are common and can be seen throughout the industry. Physical therapy can have specialized
treatments of non-operative and operative conditions. (Cup, Pieterse, Munneke, Marten; van

Engelen, ; Hendricks; van der Wilt, Gert J; Oostendorp, 2007) Providers in physical therapy

often evaluate and set treatment programs designed to return their patient to a prior level of

functional mobility. The therapists and techs in the physical therapy arena provide often use

cutting edge treatments for all types of musculoskeletal conditions of the entire spine and

extremities. Some of the reason that a physician or surgeon may refer a patient to physical

therapy include: osteoarthritis, degenerative disc disease, sports and job related injuries,

tendonitis, bursitis, and pain syndromes. Physical therapy can provide pre- and post-operative

surgical care. (Rodriguez, 2002) This is usually the type of therapy that is handled on an

outpatient basis, though it may also be provided by the hospital while patients are recovering

from surgery.

One of the most well known types of outpatient physical therapies and most commonly known to

the general public is orthopedic physical therapy. Orthopedic physical therapy usually takes

place in the hospital directly following surgery or in an outpatient clinic where customers visit on

a daily or weekly basis. (Richardson 1994) This type of therapy focuses on the musculoskeletal

system, including joints, tendons, ligaments, and bones. Sports injuries fall into this category as

do patients who have just undergone orthopedic surgery and those who have been involved in

other accidents. A variety of methods are used in orthopedic therapy, and joint mobilization is a

major concern. Therapists may use massage, whirlpools, flexibility exercises, hot and cold packs

and electrical stimulation in this area.

Another service that is provided as an outpatient physical therapy is geared toward people of

older generations as well as toward people who have trouble with the aging process. This type of
physical therapy is known as Geriatric Physical Therapy. (Childers, 2001) These patients are

often victims of osteoporosis often see a geriatric physical therapist as do senior citizens who

undergo extensive surgery. Balance disorders and various forms of arthritis are also treated by

these therapists.

Neurological physical therapy is a different type of outpatient physical therapy service that is

particularly specialized and requires a great deal of training as well as knowledge of neurological

diseases and disorders. Patients who have suffered strokes, brain injuries, and damage to the

spinal cord may be recommended to a neurological physical therapist, as are those who suffer

from Alzheimer's, Parkinson's, cerebral palsy and MS. The focus will be on restoring function to

the limbs as well as dealing with paralysis and vision problems. Often, this type of therapy will

be ongoing on either an inpatient or outpatient basis. (Cup, Pieterse, Munneke, Marten; van

Engelen, ; Hendricks; van der Wilt, Gert J; Oostendorp, 2007)

Two other types of physical therapies that are not as well known are cardiac and pediatric

outpatient physical therapies. Cardiovascular physical therapy patients who have suffered

problems with their heart and circulatory system will often see a cardiovascular physical

therapist. It is usually focused on increasing range of motion and endurance in patients who have

recently had surgery or been diagnosed with a heart condition. Patients with lung cancer, cystic

fibrosis and other lung diseases may also need a cardiovascular physical therapist. (Brooks, G.

2008). In an outpatient pediatric physical therapy setting the focus is on the physical therapy of

pediatrics. This is provided to children under the age of eighteen. They could have suffered an

orthopedic injury or they could be suffering from childhood diseases which require therapy, such

as development delays and spinal bifida. (Dunford and colleagues, 2012) Therapists that engage
in this type of outpatient physical therapy must be good with children and must work not only as

therapists, but also sometimes as diagnosticians.

There are several key players in the world of outpatient physical therapy. Among them are

doctors/medical providers, physical therapists, and physical therapists aides/assistants. The

primary physical therapy practitioner is the Physical Therapist who is trained and licensed to

examine, evaluate, diagnose, and treat impairments, functional limitations, and disabilities in

patients or clients. Currently, most Physical Therapist education curricula in the United States

culminate in a Doctor of Physical Therapy degree, but many currently practicing PTs hold a 2

year Master of Physical Therapy degree and some hold a Bachelor's degree. (Newman 2010)

Physical therapist assistants may deliver treatments and physical interventions for patients and

clients under a care plan established by and under the supervision of a physical therapist.

Physical therapist assistants in the United States are currently trained under associate of applied

sciences curricula specific to the profession (Newman 2010). In most cases, and states a referral

is needed by a medical provider or surgeon in order to start physical therapy.

There are many hospital departments, staffed by a wide variety of healthcare professionals, with

some crossover between departments. For example, physical therapists often work in different

departments and doctors often do the same, working on a general medical ward as well as an

intensive or coronary care unit. Some of these units work very closely together, and may even be

combined into one larger department. Each department tends to be overseen by consultants in

that specialty with a team of junior medical staff under them who are also interested in that

specialty. Healthcare workers know that no single department within a healthcare system can

stand alone and function well independently. This is especially true for the surgical department

and outpatient physical therapy departments after visiting the surgical department, many patients
require some amount of physical therapy post operation. This relationship is paramount to

successful patient outcomes. Another department that works well with physical therapy is the

occupational therapy department they are connected in that both departments determine a

patient’s current physical limitation and condition. This collaboration in turns gives an outpatient

physical department a chance to work in conjunction with occupational therapy.

There are several trends in the US that are affect the number of patients that are being seen in

physical therapy, one trend is that people are live longer, another trend is a more active lifestyle,

for example sports and fitness. These trends are causing more and more referrals to outpatient

physical therapy.

Balance disorders commonly affect the elderly. (Childers, 2001) These disorders are caused by a

number of factors, including medications, disease, poor muscle tone, and lack of activity.

(Childers, 2001) Outpatient physical therapy and exercise instructions help seniors enjoy fuller

and more active lifestyles. Whether balance issues are caused by physical conditions or sedentary

lifestyles physical therapy can help increase balance, coordination, strength, and stability. The

benefit of outpatient physical therapy for patient in this demographic group is that physical

therapy visits can help with balance and stability. Over time there is a general decline of muscle

strength and neuromuscular disorders in some patient such as Parkinson's disease, multiple

sclerosis or amyotrophic lateral sclerosis and Lou Gehrig's disease they severely limit elderly

patient’s independence and ability to perform daily living activities without proper physical

therapy. (Childers, 2001)

Exercise and physical activity are very important to maintain a healthy lifestyle but it is a fact

that strenuous physical activity greatly increases the risk of soft tissue damage (ligaments,
muscles, and tendon) and bone in traumatic injuries, a more intensive surgical or medical therapy

is needed. Some common sports injuries for which outpatient physical therapy can be very

helpful include abrasions, perhaps the most superficial and common forms of injuries. (Troute,

2011) Ankle sprain is also another common and apparently simple form of sport injury that can

occur when athletes perform vigorous activity without performing warm up exercises. Tearing of

ligaments (ACL being the most common) ((Troute, 2011) is another injury that may limit the

degree of movement across the knee joint and can affect athletes. Regular outpatient physical

therapy in active adults, who are injured, improves range of motion across the joints, flexibility

of muscles and promotes overall fitness as a whole by warming up muscles and reconditioning

the body to perform at peak performance levels.

From a healthcare administrator prospective these trends offer a chance to increase patient

volume. Hospitals will benefit from increasing demand for healthcare among a growing

customer base. Furthermore, in healthcare keeping up with these current trends will pave the way

for revenue growth as more individuals grow older and exercise more the need for more physical

therapy .Conversely, a healthcare administrator has to remember that with greater patient loads

in the physical therapy department there may be high labor costs as a result of hiring more

medical professionals and assistants. Thus to capitalize on these trends they need to make the

departments completive, and relevant for both demographic groups.

With the new healthcare reform bill in place, administrators do not have to worry as much about

uninsured elderly and payment for services render, this is a double edge sword because the once

uninsured that did not seek prevention services frequently now can however Medicaid and

Medicare do not always pay the asking prices compared to those who have insurance.

Ultimately, this makes the cost higher for the medical facility. Administrators should avoid over
hiring, and staffing. They would also need to avoid by supplies to over compensate for any

specific reason.

Outpatient physical therapy department specializes in the treatment and rehabilitation of

orthopedic and sports related injuries, surgeries, and conditions. The services offered at different

medical treatment facilities may differ from physical therapy department to physical therapy

department and how it is delivered through the facilities. The staff often provides consultation,

direct treatment. Delivery of these services may be provided in small group or individual

treatment in a variety of settings.

 References

Carr, R.(2010,December30)Outpatient clinic Retrieved from

http://www.wbdg.org/design/outpatient.php

Gibson, K. (2005). Creating advocates for physical therapy. PT, 13(7), 28-32. Retrieved
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Cup, Edith H; Pieterse, Allan J; ten Broek-Pastoor, Jessica M; Munneke, Marten; van
Engelen, Baziel G; Hendricks, Henk T; van der Wilt, Gert J; Oostendorp, Rob A (2007)
Exercise Therapy and Other Types of Physical Therapy for Patients With Neuromuscular
Diseases: A Systematic Review

Rodriguez, M. C. (2002). Acute post-operative physical therapy following total knee

revision surgery MGH Institute of Health Professions) ProQuest Dissertations and Theses, ,
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Richardson, J. K. (1994). Clinical orthopedic physical therapy Philadelphia: W.B. Saunders

Co.

Brooks, G. (2008). Cardiovascular/Pulmonary essentials: Applying the preferred physical

therapist practice patterns. Physical Therapy, 88(10), 1233-1234. Retrieved from
http://search.proquest.com/docview/223117806?accountid=28844

Pediatric physical therapy; reports outline pediatric physical therapy study findings from C.
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Byron Y. Newman, Physical therapy, Optometry - Journal of the American Optometric

Association, Volume 81, Issue 2, February 2010, Page 57, ISSN 1529-1839,
10.1016/j.optm.2009.12.006.
(http://www.sciencedirect.com/science/article/pii/S1529183909006605)

Childers, C. (2001) Geriatric physical therapy, ed 2. Physical Therapy, 81(11), 1847-1848.

Retrieved from http://search.proquest.com/docview/223117539?accountid=28844

Troute, R. L. (2011, Sep 25). Therapy, fitness is universal's goal. McClatchy - Tribune
Business News Retrieved from http://search.proquest.com/docview/893944271?accountid=28844

http://medical-dictionary.thefreedictionary.com/physical+therapy