Hospital Compliance Manager Brenda Kemling, PT and Assistant Director of Operations Bill Mannewitz, PT attended the APTA Combined Sections Meeting last week in New Orleans. The three-day event is an opportunity to gather for the country’s largest conference on physical therapy. Incidentally, Bill ran into Cory Ash, PT, assistant manager for RehabVisions Outpatient Clinic in Dickinson, North Dakota, in one of his sessions, so RV had more representatives than we even realized.
Themed to play on NOLA (New Orleans), pre-conference material told of Networking Opportunity, Learning and Acceleration. Bill and Brenda agreed the yearly conference did not disappoint with record-breaking attendance of over 17,000.
As for the content of the meetings, both said there were a few themes. “There was an overall push to get back to listening to patients, identifying their individual deficits, and quit trying to apply protocols that aren’t appropriate,” Bill said. Brenda agreed and said this also serves as a reminder to use critical-thinking skills while avoiding overreliance on documentation software and outside structures to limit how you treat.
Another theme that related to listening was remembering your patients have a voice. Brenda said she was going to use some of that information for an upcoming presentation to the Iowa Hospital Association Rehab Managers, “Medical necessity starts with your patient’s voice. I think that’s a really smart way to think of it,” she said.
Treating chronic pain in light of the country’s opioid epidemic was also covered in several sessions. “We discussed retraining the brain (neuroplasticity), patient education on appropriate interpretation of pain, and not ignoring the cardio-pulmonary and respiratory systems,” Brenda said. The message there again was looking at the patient as a whole, she said.
Insurance was another big subject. Bill said there was a lot of talk about insurance and becoming advocates for patients regarding number of visits when necessary. “We must be cognizant of insurance limitations while working with patients on what is appropriate for the individual based on length of time for recovery. At the same time, we need to be advocates for them to seek more visits from insurance when it’s necessary.”
The two were obviously excited about what they learned. Hospital and clinic rehab directors can expect some of these themes to be visited at the upcoming managers meeting in April.
Written by Jennifer Fuentes, PT
As a PT student, I never imagined that wound care would become such a huge part of my future. I had never seen a therapist treat wounds, so it wasn’t something I envisioned in my practice. In my first job, though, it became a necessity. I was working at a skilled nursing facility and over half of the residents had wounds or had experienced some sort of skin breakdown during their stay. I saw the need, had the knowledge through my graduate school training, and figured out the details from there.
I think many therapists think “that’s not my thing,” or “I’m not qualified.” If you have never seen or tried it, you might be surprised at how rewarding wound care can be for both the patient and the therapist. To those who think they aren’t qualified–you don’t have to be certified or specialized to treat wounds (although checking your state practice act for restrictions is always recommended). As therapists, both PT and OT, we receive training in all aspects of anatomy and physiology. We know what unhealthy and healthy tissue looks like, we know where the muscles and bones are, and we should be able to use debridement to help with wound healing. The other variable with wound care is determining what kind of dressing to use on different wounds. There are many different manufacturers that are a great resource for this. Take advantage of the online tools and education they provide, along with appropriate continuing education courses.
In our own hospital, we had a wound nurse who was handling all of the wounds for a time. He was becoming overwhelmed with the caseload, so I started taking his overflow. When he resigned, our department was the natural fit to take over all of the wound care caseload, because we had strategically placed ourselves in that position. When I also got overwhelmed, I was surprised when two of my staff volunteered to help. All I had to do was ask! They were excited to learn a new skill.
If your department is treating lymphedema, you should be treating wounds as well. About one third of my lymphedema patients also have wounds or some sort of skin breakdown problem. Use the whole scope of your skills and treat these wounds yourself rather than letting someone else help your patients or let these wounds go untreated.
The bottom line is if you’re not treating wounds in your community, you need to figure out who is and if it is adequate? I’ve found that oftentimes it can be nursing or even podiatry that are managing wounds. Sometimes patients are traveling out of town to have their wounds treated or trying to handle it at home, which will not usually be as effective. Wound care is also a financially viable program. It reimburses well and is not a financial burden on a facility because the debridement improves and expedites wound healing.
When it comes to treating wounds, therapists can do it and we should.
This country’s opioid crisis is a hot topic in healthcare. Because of the national attention the issue is garnering, physicians are feeling the pressure to reduce prescriptions for these drugs. Fortunately, there is a better avenue.
Physical therapy can be just that—long-term relief from pain without medication.
Rehab Director Skylar Tarbet, PT heads our outpatient clinic in South Bend, Washington. We asked Skylar about the issue.
Are you identifying patients as they come in who have addiction? Or are you just combating it by educating on pain management without the use of opioids?
The majority of people I bring it up with have chronic pain. They typically have some kind of dependency on opioids or have in the past. In Washington, there has been a big push to reduce dependency so people are getting cut back on their meds and doctors are looking for alternate ways to manage their pain.
So, what do you do?
A good chunk of it is education—just trying to tell them a little bit about the anatomy and physiology of pain and why we hurt versus only focusing patient education on the mechanical/structural component or original cause of the pain. For example, only talking about a patient’s spinal disc herniation in relation to pain can actually elevate fear avoidance behaviors.
Pain is much more complex than “I hurt here and I take a pill for that.” Pain is not produced at the tissue or joint level within our body, but rather pain is produced in the brain by perception of threat. When we perceive something to be a threat, our body sends impulses to the brain that is interpreted as pain. In an acute situation, this is a legitimate response and the body will avoid further exposure to this stimulus. Over time, we learn to avoid the threat out of fear of pain, which then creates increased sensitivity of our pain receptors. When this vicious cycle exists longer than six weeks to three months, we consider it chronic pain. With chronic pain, the tissue has had enough time to recover, but the brain has learned a conditioned response to interpret certain movement as “painful,” which leads to long-term disuse. The pain is no longer informative about what’s really occurring in our body. The brain has become hypersensitive. Patients come in and show an x-ray or MRI and say, “Look here I’ve got a bulging disc or structural problem causing pain.” Most of the time it’s no longer a structural issue; the brain has become sensitized to interpreting every signal from that part of the body as pain, even though no further damage is happening.
So, it’s a perception thing?
It’s a body/mind retraining really. We must teach the brain that it’s okay to move. Patients need to understand that first. Normal movement will not cause more tissue damage. We need to re-condition the brain to interpret normal movement patterns while educating the patient on their tolerable pain levels.
I recently had a patient who could barely walk or stand up. He was in excruciating pain. I sent him home with exercises and education. He was proactive in making life changes seeking education regarding his problem, and at his last appointment he was a completely different person. He still has perceived pain with movement, but he is relearning how to move and managing his symptoms.
Our approach to patients with chronic pain has got to be a one-on-one experience. We must assist each in finding the movement/mobility they previously had through quality education and movement training.
Tracy Milius, OT
Almost half of Americans suffer from chronic illness with one in four suffering from multiple chronic conditions. In healthcare costs, that group absorbs 65 percent of total dollars spent; when considering Medicare alone, the number climbs to 95 percent. Those numbers can be shocking, but it’s important to remember that these statistics represent individuals. Individuals that, if given a roadmap for success, may jump at the opportunity to improve their health.
Steve Kinkead, SLP
For National Stroke Awareness Month, we are highlighting a therapy team working at a Level II Stroke Center. Their commitment to running their portion of the stroke program with an organized, comprehensive approach has helped many patients excel in their recovery.
As I read about and hear more stories of young athletes collapsing during sporting events and reflect on February being American Heart Month, I also think about the times I should have done a better job asking medical history questions (those that weren’t already checked on the history form) and taking baseline vitals for my young, healthy athletes and non-retiree patients, not just the retirees.
One of our primary roles as therapists is to thoroughly examine our patients, which includes screening for conditions that may negatively impact their response to their plan of care and interventions. Part of our examination that is commonly overlooked is taking vital signs.
Steve Kinkead, SLP
January is National Mentoring Month and the perfect time to review our stance on the topic. We hire new therapy graduates throughout the year, and mentorship has always been an important point of discussion in both the interview and decision-making process.
Patients with breast cancer whose lymph nodes have been disrupted during surgery have an increased risk of lymphedema. Providing education to pre and post-mastectomy patients is an important service for physical therapists to provide.
Rehab Director and lymphedema specialist Jennifer Fuentes, PT believes there is opportunity for therapists to be more aggressive in establishing relationships with therapy and oncology teams at treatment centers to reach patients earlier in the treatment timeline.
Kayla, age 24, is “one of the most rewarding patients” the therapy team in Oskaloosa, Iowa has ever worked with. She started outpatient rehab with RehabVisions’ therapists this past February, but it’s been more than a year since the initial accident and severe traumatic brain injury (TBI) that began her long rehab journey.
In August of last year, Kayla was involved in a head-on motor vehicle accident (MVA) that left her with multiple life-threatening injuries, including lacerations, broken bones, fractures, cerebral artery injuries
Falls Prevention Awareness Day (FPAD) occurs this year on September 22, the first day of fall. This day is an opportunity for therapists to raise awareness among the older populations in their community about the dangers of fall-related injuries and how to prevent them. The National Council on Aging (NCOA) and national therapy organizations have collected helpful educational resources therapists may provide to patients and caregivers:
Jennifer Flanagan, SLP
Research shows that most short-term rehab patients will benefit from a home safety evaluation (HSE) to increase safety and independence as they return to their prior living arrangement. Director of Operations Tracy Milius, OT emphasizes this, saying, “You can provide therapy all day in a facility, but it is incomplete if you don’t ensure everything you have taught the patient can carry over to their home.” Returning patients to a safe home environment is also important when meeting the new skilled nursing (SNF) facility quality measures, particularly the percentage of short-term stay residents who are re-hospitalized after discharge.
To find your first job in the setting you favor most, with the caseload you prefer, the mentorship you require, and with a company that supports the opportunities you ask for must be something from a dream, right? Not for Brady Martin, PT, a 2015 graduate from the University of Mary in Bismarck, North Dakota. He found all that at RehabVisions Outpatient Clinic located in Dickinson, North Dakota.
As therapists grow in their skill-sets it’s beneficial (for both therapist and patient) to occasionally get “back to the basics.” Mary Cater, PT explains why you should take breaks from equipment, and get back to hands-on exercise.
Many of us therapists can become bored with the same routine at work. We get into the habit of performing the same exercises the same way on each patient. It is no wonder patients become bored and we become frustrated that they don’t seem to be progressing. We can get so involved in using fancy equipment and new treatment techniques that we forget the basic exercise techniques we were trained in. Maybe it is time to return to the basic fundamentals of exercise without the use of all our equipment.
Last month we posted about the importance of educating referral sources and communities on the importance of early lymphedema diagnosis and treatment. Equally important is the actual creation and marketing of a lymphedema program.
Many different kinds of swelling can be treated in the same manner as a lymphedema diagnosis, and the program can also be marketed as swelling management services. There are a few basic elements to consider, according to Rehab Director Jennifer Fuentes, PT:
RehabVisions and our therapists are no strangers to the topic of dementia. Cognitive testing is a great way for disciplines to work together using their expertise in order to provide the highest level of quality care. We asked Regional Clinical Manager Jolene Denn, SLP to share how her team approaches dementia and her PT’s role. Jolene is an expert on dementia and has presented a CEU course on the subject to RehabVisions therapists.
Know the Stage
Lymphedema, a complex medical condition affecting one or more limbs of the body, can present additional challenges for people at risk who live in smaller communities, in that they are likely not surrounded by enough general providers and medical staff who know how to appropriately identify and treat it. This can create an under-served population and situations where patients are identified less quickly and at later stages.
After a year and a half of lead-up, we were so excited to finally participate in APTA’s National Student Conclave this past Friday and Saturday in Omaha. RehabVisions was represented at the trade show as we doled out the world’s best ginger snaps and met bright PT students from all over the country.
As a middle-aged woman, I begrudgingly schedule several annual visits with my doctor for wellness checks and preventative screens. Despite dreading those annual appointments, I realize it is important for my overall health and making certain all is well, so I’m around to see my daughter grow and prosper. The one appointment I actually look forward to is my physical fitness test.
Granted, I don’t schedule a visit with my local therapist since I am already a licensed physical therapist, but I do set aside time every year to reassess my strength, balance, coordination, weight, nutrition, and exercise regimen.
An estimated one million Americans live with Parkinson’s Disease (PD) and around 60,000 new cases are diagnosed each year. There is no cure for the progressive disease. Many physical therapists and occupational therapists are learning a newer exercise-based behavioral treatment technique, called LSVT BIG, that patients with a PD diagnosis can continue to practice after completing the initial program.
There never seems to be a shortage of ACL injury stories in sports news (hear about Stephen Hill earlier this month?). Many professional athletes, like Tom Brady and Tiger Woods, have torn their ACLs and subsequently raised societal awareness of this injury. The American Orthopedic Society for Sports Medicine estimates there may be between 100,000 and 250,000 ACL injuries each year in the United States alone. Physical therapists are uniquely trained, educated and positioned to engage communities in the prevention of a torn ACL.
The diverse regions of our country offer unique opportunities for rehab clinics to develop programs that will most benefit their surrounding communities. In the retirement-friendly resort area of central Missouri, golf is a popular recreational sport. We asked Courtney Hulett, PT about BACKtoGOLF, a leading fitness program recognized by GOLF magazine.
In upcoming decades therapists can expect to treat an increasing number of geriatric patients as the United States experiences the coming “boom” in older populations. One therapy that has proven beneficial for a range of deficits in this population is aquatic therapy.
RehabVisions Certified Hand Therapist (CHT) Brenda Kreuter, PT had been a practicing clinician for a number of years before she happened upon the world of hand therapy.
Patients recovering from stroke and experiencing mobility difficulties are a common diagnosis seen by Steven Nicholson, PT. Neurological patients present some unique challenges in the inpatient environment. We asked Steven how he works with an acute care approach to neuro, and he recommended these three focuses to help short-term patients reach a safe and improved level of stability before discharge.
The initial goal must be education for both the patient and the family/primary caregiver. Because the patient may be experiencing cognitive impairment due to the stroke, it is important to provide comprehensive education for the family.
Over the past decade we have seen an explosion of research on how to become more effective in dealing with patients who are in pain. Global statistics consistently demonstrate 25 percent of the world’s population deal with chronic pain. Looking at current research, one of the overriding treatment strategies is patient education.
It’s the time of year to discuss running safety with patients and communities. Sharing your expertise and advice can help properly prepare a body for running and jogging season–and hopefully prevent injury.
Tracy Milius, OT
According to the National Institute of Diabetes and Digestive and Kidney Diseases, more than 13 million US citizens have incontinence. What many of these people do not realize is that they have viable treatment options within PT or OT to improve their quality of life.
In an effort to promote awareness, we asked Melissa Clarke, OT who has been treating patients with incontinence for three and a half years, a few questions:
What patient demographics do you typically treat and what patient education do you provide?
Evidence-based practice is defined as the “integration of the best research evidence with clinical expertise and patient values.”¹ The demand for and interest in applying evidence to rehabilitation practice has substantially grown in the past decade, in part, by the increase in publication of systematic reviews (over 700 relevant to the practice of physical therapy alone), other articles related to evidence in practice, and transition towards quality value-based reporting and payment models.
Bill Mannewitz, PT
Every business looks for that edge that allows them to have the most qualified and most capable employees. The key to creating this environment is to hire only those who are able to perform the job specific tasks required of them. Rehab departments can help local businesses achieve this goal, decrease the risk of injury, and decrease costs associated with worker’s compensation premiums by offering post-offer employment testing and fit-for-duty testing.
Dry needling is a relatively new treatment option for physical therapists. Although it is not an approved intervention in all 50 states it is within the scope of physical therapist practice issued by the American Physical Therapy Association (APTA) and becoming more common practice in some of our clinics. Dry needling has shown effectiveness for patients with everything from low back pain, neck pain, shoulder pain, elbow pain, hip pain, tension headaches and migraines, to fibromyalgia, plantar fasciitis and tendinitis.
Is your rehab department maximizing its potential? This post is the fifth and final in a series. It’s based on some items RehabVisions focuses on when we manage therapy departments, but it’s also a conversation starter about things you could be doing differently.
#5 Think About Your Image
Remember Andre Agassi in those old Canon camera commercials in which he professed, “Image is everything”? Well, right or wrong, what he said is ultimately true. People base a large portion of their perceptions on what they see. The image your rehab department is showing may be the deciding factor in whether a patient chooses you as their rehab provider.