Abby Sims

Today’s blog post comes from Abby Sims, MS, PT, a professional blogger and creator of FitScreen™ ( in Seattle, Washington and NYC. Check out Abby’s full bio here. You can also follow her on Twitter @abcsims and subscribe to her blog here.

The evolving healthcare environment continues to challenge the adaptability of provider business models. Not only are physical therapists tasked with staying abreast of new developments in the field and expanding our clinical repertoires, we have also, understandably, been asked to place greater emphasis on functional outcomes. In doing so, we’ve had to embrace new methods of documentation, reporting, and coding, while our governing body develops more avenues for research to provide the necessary insight and further justify the care we provide. In order to acclimate to the limitations placed on therapy reimbursements—the ceilings placed on revenue per visit or visits per patient—therapists have had no choice but to manage care differently. Another option is to innovate and generate entirely new revenue streams—cash-based revenue streams.

The media’s focus on wellness, healthy living, and fitness places a spotlight on prevention, and PTs are perfectly positioned to lead by expanding and better marketing our menu of services. The concept of physical therapists providing primary care isn’t new, though perhaps its appeal or the necessity to get on board has been invigorated. Some specialists have been performing functional capacity evaluations in the workplace for years and provide ergonomic training to minimize the time lost due to injury. Others offer personal training in their therapy clinics, a logical way to increase the bottom line. Programs like the one discussed here—FitScreen—are yet another option.

Way back in 1983 I developed an assessment that physical therapists performed for all new clients at New York’s Sports Training Institute (STI). Though now long since dissolved, STI pioneered the concept of one-to-one fitness in the mid-70s. The Institute personalized clients’ fitness programs addressing any weaknesses or strength imbalances they might have, while taking into consideration any musculoskeletal issues that were identified. FitScreen is a more comprehensive version of this assessment—one that incorporates balance, movement, and functional testing—while continuing to evaluate flexibility, strength, and range of motion as well as perform an expansive number of special tests to detect a predisposition to injury or the presence of a problem.

Curious as to who would constitute your market base? Actually, just about everyone. A program like FitScreen is ideal for the person just embarking on a fitness program, especially one with underlying medical conditions. Those who may be fearful of exercise or are unsure of how to proceed safely are perfect candidates. Working in cooperation with internal medicine physicians and family practitioners to address concerns about blood pressure, cholesterol, diabetes, and other risk factors also enables PTs to benefit from ancillary referrals for traditional treatment. 

A second demographic ripe for intervention is the client who has completed PT (or faces discharge regardless) and is mainstreaming into a broader fitness program. We aren’t always able to progress patients through end-stage care as we did in the old days, restoring or even improving upon their pre-injury level of function. Turning them loose without all the tools to manage their self-care—beyond those specific to the injury treated—may be a precursor to recurrence or to new injuries.

Clients who may be gearing up for an event, particularly one they may not have participated in prior—such as a marathon—form the third group that benefits from comprehensive PT assessments. Preventing the overuse injuries that often occur with dedicated training is crucial to successful performance. Marketing preventive services to runners’ clubs, dancers/performers, or athletes is a natural extension of what we already do. Those whose livelihood, or avenue for serious competition, depends on a body in balance are most appreciative of the effort to achieve and maintain this balance while challenging their limits. 

Lastly, those who fly solo—in the gym or at home—or those who work with personal trainers, comprise the fourth group who will benefit from your expertise. The rudimentary fitness assessments performed in some fitness centers are generally only a minor upgrade from programs that provide no assessment at all. The spectrum of knowledge and ability displayed by personal trainers is also a broad one, and those who work out alone often lack an understanding of what to do or how to do it (just look around any gym—it is cringe-inducing). The best way to ensure that fitness programs will meet clients’ fitness goals and needs rather than cause overuse injuries is to establish each individual’s baseline and provide recommendations for care as well as clarify contraindications. This presents an opportunity to educate our clients as well as other professionals in the process. Establishing cross-referral relationships with trainers can be a welcome addition to your practice while allowing you to handpick those who will provide your clients with a safe fitness experience. Of course this also holds true for professionals instructing other types of exercise programs such as Pilates, yoga, or martial arts. 

So, what does a comprehensive fitness screening entail? As an example, the FitScreen program begins with the completion—pre-exam—of a thorough history form that includes discussion of goals, concerns, lifestyle, and functional demands. The assessment that follows—which takes a minimum of two hours—is the focus of the program. A detailed report is subsequently generated, providing both the client as well as his or her medical/fitness team with all findings and recommendations. A follow-up session is scheduled for the physical therapist to review the results with the client, and if the client chooses, his or her personal trainer can be invited to attend. The purpose of this session is solely educational (with some demonstration), and to stress the importance of safe and personalized exercise progressions. Additional sessions are optional but may be scheduled in order for the PT to provide further guidance, perform selective re-testing, monitor progress or modify exercise progressions should a client desire. 

From a billing perspective, FitScreen is a cash-based service. Bill your clients directly, and encourage those with out-of-network benefits to submit invoices to their carrier for possible reimbursement. It may be advantageous for these clients to attach a prescription for physical therapy that lists any applicable diagnoses as well as instructions to “Evaluate and Treat."

Do you conduct PT assessments as a primary care service in your practice? What are your experiences with cash-based services?

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