Physical Therapist practice in several settings; for instance, physical therapists traditionally practice in outpatient private clinics, acute care in hospitals, sub-acute settings like rehabilitation clinics; furthermore, physical therapists treat work and sports injures. It is hard to find a setting that physical therapist do not practice; including wound care and womens’ health. Basically, the scope of physical therapy practice is to treating across the spectrum of age from pediatric to geriatric patients. Also, by incorporating physical therapy specialty training in musculoskeletal and neuromuscular diseases, physical therapists are the provider of choice to treat and prevent diseases of the joints, muscles and nervous system. Lately, hospitals have begun a new. Hospitals across the United Stated have been placing physical therapists in Emergency Departments to address healthcare costs and improve patient satisfaction.
This website is dedicated to providing information on how placing physical therapists in the ED can can be done and how the pros and cons of this practice.
Like most ideas that present as slightly out-of-the-box or off the beaten path, the very mention of placing physical therapist in the emergency department will almost always be met with “why?”; even physical therapist’s initial reaction is a blank stare that seems to suggest “that seems not to make sense!”. Yet, almost always, the fog of confusion clears when the facts are laid bare.
It is no news that US healthcare is complicated, challenging, frustrating and very expensive. But why? Because the allocation of the most expensive medical resources reside in the emergency department. It makes sense when you think about it, Emergencies should be more expensive than scheduled care. Yet patients will utilize Emergency departments more than they can afford. One, the long times to see primary care doctors; compounded by a staggering number of underinsured and non-insured patients, leaves patients with only option for care – the emergency department! It is the only place where the law requires all patients regardless of ability to pay for services must be cared for. Let’s consider the breakdown of conditions that are treated in the emergency department.
The CDC reported that of the 145 million emergency department visits in 2016, 7.4% were of musculoskeletal system and connective tissue origin, 3.8% were injuries to the neck, 6.4% shoulder and upper arm injuries, 5.2% elbow and forearm injuries, 14.4% hand and fingers injuries, 2.3% hip and thigh injuries, 7.8% knee and lower leg injuries, 10.7% ankle and foot injuries and, 2.2% nervous system diseases.
Adding these numbers, 50% of patients seeking care in the emergency department could benefit from physical therapy. Herein lies the opportunity and primary reason for physical therapist to be in the Emergency Department. Clearly, physical therapists are qualified to treat a great deal of the non-emergent conditions that end up in the Emergency Department.. For instance, patients with simple sprains and strains, who walk into the ED unarguably will benefit from PT and pain management alone. A strong argument can be made against imaging these patients. In fact, physical therapists traditionally treat these conditions successfully using therapeutic exercise, manual therapy and good ‘ol education.
Why are emergency department visits expensive? let consider that Emergency departments are housed in hospitals. Hospitals are high overhead businesses. consider the cost of maintaining the facilities, the cost of staff (nurses, doctors, respiratory therapists, lab staff janitorial staff..the list goes on). Comparing the cost to a primary care doctors office, one can begin to appreciate that hospital overhead is incredibly higher than outpatient facilities. The second reason emergency department visits are very high is because every emergency department in the united states is required by the law call EMTALA to treat everyone who walks through their doors regardless of payment status. You don’t have to be in the hospital for too long to realize that hospitals are refuge of choice for the homeless, and anyone who is uninsured. In fact, hospitals are the only medical facilities where free healthcare is backed by the law. The flip side of that coin is that, to offset the costs incurred by patients who receive “free” care, the patients who can pay must pay more to keep hospitals in business; In fact they must pay above and beyond to cover the cost for those who cannot pay. Lastly, I argue that the cost of medicine in general is the victim of litigious culture in America. The cost of insuring hospitals, physicians, diagnostic equipment; everyone and everything that touches a patient to hedge against law suits is huge. The risk is so significant that most hospital have employees dedicated to manage the risk of lawsuits.
What we do know is that physical therapy service is cost effective; especially when utilized to treat conditions physical therapists are specialists to treat. For reasons mentioned already; the overhead of providing physical therapy is significantly lower than traditional medicine; because no expensive diagnostic equipment is necessary. Also, the risk of serious injury or death resulting from receiving physical therapy is significantly lower compared to services provided by physicians; point in case, the risk of litigation is significantly lower for physical therapist than physicians. When appropriate, it’s is prudent for hospitals to utilize physical therapist to manage patient care; especially when outcomes are comparable or better than care provided by other providers. In summary, the cost of healthcare is decreased significantly when physical therapist are incorporated into emergency departments.
Ephraim Makuve, PT, DPT, MBA