When I woke up after a night of boot-scootin’ my way down Lower Broadway—Nashville’s famous honky-tonk alley—my head wasn’t the only thing that hurt. In fact, the moment I stepped out of bed, I knew I was in serious trouble, even if I wasn’t quite ready to admit it to myself. Part of me was in denial that I could actually injure myself from swinging through one too many do-si-dos. But, the shooting pain I felt on the back of my heel was all too familiar. As a former collegiate track athlete, I’ve experienced more than my fair share of lower-extremity injuries—Achilles tendinitis included. I’m well aware of what this particular ailment feels like, and as the old saying goes, if the cowboy boot fits…

Of course, as any sports PT knows, distance runners are notoriously stubborn. We don’t like taking time away from our running routines, even when we know we should (i.e., when we’re hurt). So, when I returned home to Phoenix, I continued to slog through my almost-daily runs, supplementing with cross-training when the pain became too intense. I massaged. I iced. I dug into my library of strengthening exercises from my college training room days.

And then one day, my heel hurt so bad that I had to stop in the middle of a run. As I hobbled home, barely able to walk, the irony of my situation was not lost on me. After all, I’ve spent the last five-plus years of my career promoting the unique value physical therapists offer as first-line providers for patients with musculoskeletal injuries—especially when those injuries are addressed early. And yet, I had avoided seeing a PT—or any other healthcare provider for that matter—for months.

I decided it was time to walk the walk (or, in my case, limp the limp). So, I did a little research (a.k.a. scrolled through a few pages of reviews), and picked a highly rated clinic near my house that specializes in treating endurance athletes.

I thought I knew what to expect. I mean, I could explain the elements of a high-quality patient experience in my sleep—and I figured any clinic worth its salt surely would embody those elements. What I soon realized, though, is that it’s one thing to talk about what makes patients satisfied and loyal; it’s another to actually deliver a therapy experience that patients will rave about. With that in mind, here’s a breakdown of the reasons why—spoiler alert!—I stuck it out ’til the end, and continued ponying up about $75 per visit, twice a week, for a little over two months:

The State of Rehab Therapy in 2018 Guide - Regular BannerThe State of Rehab Therapy in 2018 Guide - Small Banner

1. I understand why my out-of-pocket cost is so high.

At the time I began my therapy plan of care, I had a high-deductible health plan—you know, the exact kind of insurance coverage many PT clinics blame for their high patient dropout rates. Essentially, I was responsible for the full cost of each visit—an amount similar to the cost of physical therapy without insurance—and even after putting together tons of resources aimed at helping therapy practices retain patients despite the high patient cost burden, I still found myself questioning whether it was worth it. But while I understand why my coverage is so limited—and thus, never held it against my provider—that is not the case for all patients. And no one at the clinic ever attempted to explain all of this to me; at the beginning of each appointment, the front desk staff simply announced the amount due, swiped my credit card, and asked me to sign on the dotted line. Some days, they barely even said, “Thank you.” (Let alone, “Have a great visit!” Or, “See you next time!”)    

2. I know how slim PT practice profit margins are.

The average patient might assume that at $75 a pop, the clinic must be making out like a bandit. If it weren’t for my background, I know I would—and I’d probably feel a bit taken advantage of, too. The reality, though, is that most PT clinics are running on very slim margins. On top of that, many staff therapists are dealing with mountains of student loan debt while making comparatively modest salaries. A lot of this stems from continually falling payer reimbursement rates for PT services—but again, most patients aren’t remotely aware of the PT community’s struggle to negotiate payer contracts that are truly commensurate with the value PTs provide.

3. I know that because of those margins, therapists often see multiple patients at once.

When you’re paying $75 for roughly an hour of treatment, you expect to receive one-on-one attention the entire time. I mean, I’ve paid less than that for a 60-minute, full-body massage. In many PT clinics, though, the reality is that in order to achieve the patient volume necessary to maintain financial health, therapists must see multiple patients over the course of an hour. So, I usually ended up spending a total of 15 to 20 minutes with my therapist, right at the beginning of the appointment. After that, a therapy tech would take me through my exercises—many of which I was totally capable of doing on my own, unsupervised. In fact, when the clinic was really busy—or when they were short-staffed—I often completed my exercises by myself. And I’d be lying if I didn’t admit to thinking, “Why am I paying for this?” at least a time or two. But, I get it—my PT couldn’t spend the full hour with me, even if he wanted to. Instead, he juggled providing manual treatment to other patients with periodically observing and critiquing my exercise form, and I cut him some slack despite feeling like I wasn’t always getting my money’s worth of skilled therapy.  

4. I realize that progress can be slow—and that it’s not always linear.

During my initial evaluation, my therapist was completely upfront regarding my rehab potential. He told me that although the chances were slim, it was possible that my Achilles issues stemmed from a structural deformity that could only be corrected through surgery—and that the only way to know for sure would be to undergo expensive imaging. He also told me it could take several weeks—possibly even several months—to get me back to a point where I could run pain-free. Most importantly, though, he expressed confidence in our ability to achieve the desired outcome together—even if it took a while. With all of that in mind, I made a conscious, informed decision to move forward. And in doing so, I took ownership of my treatment plan and committed myself to upholding my end of the bargain.

Furthermore, thanks to my history with rehabbing similar injuries, I knew it wasn’t going to happen overnight—and that I very well might actually regress before I started to see positive results. Of course, not every patient goes into therapy treatment with that perspective, which is why so many—about 70%, according to our estimates—never make it past the third visit. It’s crucial that patients embark on their therapy journeys with the intention of making it to their destinations—rather than going in with the mindset, “I guess I’ll pay for a few visits and see how things shake out.”

5. I’m aware that staff therapists are beholden to the limitations of their clinic’s technology.

When I began my search for a therapist, I went about it like any other patient—which means I didn’t limit my options to WebPT Members. I simply wanted to find the provider I felt was best equipped to treat my specific injury, and that provider ended up not being a WebPT clinic. Now, technology is no substitute for top-notch therapists, but what I found is that it can certainly add to—or take away from—a patient’s overall experience. But while some patients might inadvertently let sub-par technology influence their opinions of their providers, I understood that my PT likely had very little say in the clinic’s chosen software vendor. So, I didn’t let illegible flowsheets (like, so illegible that the techs had no idea what exercises I was supposed to be doing), inconsistent appointment reminders, and a less-than-intuitive HEP platform affect how I felt about my therapist, specifically. But, I was very aware that my overall experience could have been better if the clinic had a better tech stack.

6. I am determined not to be a statistic.

According to our most recent State of Rehab Therapy report, only about one in ten patients actually complete their entire course of care—which means about 90% end up bailing early. I know that course of care completion is essential to achieving optimal outcomes—and thus, I was bound and determined not to be a quitter. I considered making it through my entire treatment plan to be akin to winning, and while I’ve long been retired from competitive track and field, I have not lost my competitive spirit. So, I set out to win. Most patients, though, aren’t even aware of this stat—let alone dead-set on beating it.

In the end, I reached my therapy goals and earned an official discharge. But, that doesn’t mean I walked out of the clinic on my last day feeling good as new. Instead, my PT gave me a continuation plan that I have (mostly diligently) followed for the last several months. And while I am still not 100% pain free, I feel stronger than I have in years. So, in retrospect, my PT experience was absolutely worth the relatively steep per-visit price—even if I wasn’t recognizing that value in real time. And therein lies the rub: selling the future value of a service that doesn’t always seem valuable in the present. It’s a challenging—though not insurmountable—conundrum, and it’s one all rehab therapy providers must be aware of if they want to be successful in an increasingly consumer-focused healthcare environment. Otherwise, they’re going to see a whole lot of would-be patient success stories boot-scoot their way out of PT—and into riskier, more invasive treatment options.

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