Physical Therapy to Reduce MSK Spend

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Over the past several years, MSK spend has been on the rise and in many employers’ health plans, it is the number one expense. It is our mission at Tx:Team to alter this trend by recommending the addition of physical therapy solutions. Physical therapy has been shown to reduce the need for imaging, medications, and unnecessary primary care and specialist visits, all of which have a massive impact on MSK spend.

Tx:Team’s outcomes are consistently in the top 10% in the U.S; we average a Net Promoter Score of 97; and our costs are 25-40% less than retail. If you’re interested in using physical therapy as a way to reduce MSK spend for not only your health plan, but for your employees and their family members as well, contact Tx:Team today using the form below.

 

    Please provide your email below to continue the conversation with Tx:Team.

    Patients Love Us and We Know Why

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    Since 1983, Tx:Team has focused on providing our partners and our patients the best in quality services. 

    “We believe that everyone should have the opportunity to live the healthiest life possible. By harnessing the collective power of our therapists’ hands and minds to heal, we create an environment of health, wellness, and vitality for our patients, our associates, our partners, and our communities.”

    It is easy to assume or make statements that we give great care. Without the data, how do we know? Tx:Team takes great pride in the fact that our therapists deliver the highest in quality rehabilitation services. So, how do we know? We can prove it.

    Tx:Team uses numerous systems to measure patient satisfaction and patient outcomes. These systems include Focus on Therapeutic Outcomes (FOTO), CMS Merit-based Incentive Payment System (MIPS), patient satisfaction scores, goal attainment, and net promoter scores. The information we collect helps us to measure how we are doing and if necessary, where we can make improvements.

    Why do we do this? We want to be sure we are continually providing the best clinical services with the highest form of customer service.

    FOTO – Focus On Therapeutic Outcomes is an outcomes tracking platform used by our Employer Based Clinics, Frederick Health outpatient clinics, and our team at Putnam County Hospital. Similar to standardized outcome measures like the DASH and the Oswestry, FOTO looks at the change in score on surveys completed by patients throughout the episode of care. FOTO is unique in that they use their database of over 7 million episodes to provide a risk adjusted comparison of outcomes. Our results are compared to the average change and number of visits of patients who are similar based on 13 risk adjustment criteria. FOTO also collects patient satisfaction and net promoter scores as well as any comments patients want to submit. Results are ranked by clinic and therapist against all other 23,500 therapists using their platform.

    MIPS – Merit-based Incentive Payment System. A “gift” from CMS, MIPS measures functional outcomes. The patient is given a survey to measure what their current function is and then fills out the same survey when  progress reports are due and at discharge. Our final score is based on the percentage of cases that fail to progress above the minimum threshold for each measure. MIPS also measures change in pain from start to finish with an expected 2 point decrease. In place of automatic increases to the MPFS for all providers, CMS implemented MIPS as the only way providers can receive an increase. However, participation doesn’t guarantee a positive adjustment. MIPS is a budget neutral system which means providers who produce better outcomes are awarded positive fee schedule adjustments funded by the negative adjustments assigned to weaker performers.

    Patient Satisfaction – These scores measure several different things and most importantly give us a measure of overall satisfaction. How satisfied a patient was with their therapist by asking if they would recommend them to another person? Are we courteous, responsive? Do we respect patient privacy? Are our associates professional? Is there a limited amount of waiting time for patient appointments? Surveys also provide an opportunity for the patient to leave comments about their therapy visit.

    Goal Attainment – We have been addressing goals since the day we saw our first patient. These goals are a key in measuring and attaining patient satisfaction. Our goals must be patient centered, involve their input and celebrated when they are achieved. The patient must be aware of how they are performing in relation to the goals and educated when the goals are in “Therapy Speak” as to how they relate to making the patient’s life better. A best practice is to use the MIPS and FOTO tools to write functional goals where the patient may be having difficulty.

    Net Promoter Score – These scores are all very important and deserve a pat on the back, but they are also helpful in exposing where we may have some room for improvement. Digging deeper, into scores by individual therapist can help us learn from each other and develop company-wide “best practices.”

    The big question is…how do we stack up? The answer? Very well!

    1. Tx:Team has received the award of “Exceptional Performer” by the Center of Medicare Services (CMS) for the past 3 years (2020, 2021, 2022). The most recent score of 100 in 2022 places us in the top 1 percent of Outpatient Physical Therapy clinics in the country.
    2. In 2022, our Patient satisfaction scores have been recorded as a consistent 98% – 99% throughout the year.
    3. “Would you recommend your therapist to others?” 100% of our patients said they would definitely recommend.
    4. Awards – One of our employer-based clinics, IU13 Clinic in Pennsylvania has earned the top level of recognition within FOTO (Focus on Therapeutic Outcomes). This is an impressive accomplishment since this award requires meeting 12 months of consistent outcomes performance benchmarks. The award is called The Center of Excellence Award.

    Patient outcomes and patient satisfaction. There is a correlation!

    It has been said that a happy patient has better outcomes, participates in his or her therapy sessions, and has fewer cancellations. Happy patients can actually get better faster. The goal of all associates at Tx:Team is to provide the best clinical therapy services and delivering those services with the highest form of customer service. See why “working with us is good therapy.”

    New Roles and Promotions at Tx:Team

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    We are pleased to announce the promotion of several associates into new positions at Tx:Team. Please join us in congratulating them on their new roles!

    Bob Haan has been elevated to the position of Vice President of Clinical Operations and Quality. Bob started with Tx:Team in July of 1999 as a PRN Physical Therapist in the skilled setting. He was later promoted to Senior Team Leader and in 2009, was named Director of Rehabilitation Services. Bob’s extensive knowledge and experience as Director of Rehab, along with his involvement and oversight of our quality assurance systems throughout the company, have prepared him for this new role. He will be responsible for overseeing our employer-based clinics and Indiana hospitals, and will manage quality, compliance, clinical and operational reporting, and operational excellence for all business units.

    Ann Hightower has been elevated to the position of Vice President of Internal Operations. Ann joined Tx:Team in May of 2002 as part-time help for the education department. Over the years, she has worked in accounting, education, human resources, information technology, and marketing for Tx:Team. When it became evident that this was going to be more than a summer job, she was promoted to Director of Marketing, and later to Director of Internal Operations. In her new role, she will continue to look for ways to streamline Tx:Team’s marketing and human resources processes, focusing specifically on company growth, efficiency, measuring outcomes, and maintaining effective internal systems.

    Mike Holway has been elevated to the position of Director of Senior Living. Mike joined Tx:Team in March of 2019 as the Manager of Senior Living and has been responsible for all clinical and administrative operations, client engagement, and personnel oversightwithin the Bridge Senior Living portfolio of communities. He is passionate about our industry. Mike’s hard work and track record of success as Regional Manager have prepared him for his new role as Director. He will continue to oversee our growth andinnovation as a leading provider of rehab services within the Senior Living Community setting.

    We are proud of Bob, Ann, and Mike, and look forward to working with them closely in their new roles. Congratulations, all!

    Female Athletes and ACL Prevalence

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    As a former female division 1 gymnast, I personally experienced and witnessed many types of injuries. I had a few teammates who had recurring injuries that impacted their ability to continue the sport they loved. Seeing the sub-par rehabilitation process in a college setting without physical therapy interventions available, re-injury was extremely common. Many of these recurring injuries involved the knee and internal knee structures such as the ACL, PCL, MCL, and LCL. 

    ACL injuries are becoming more and more common in the young athlete, but did you know that female athletes are up to 10 times more likely to experience an ACL injury compared to men? This may be due to the anatomy and biomechanics of the female knee joint. Often due to wider hips and a smaller groove at the bottom of the femur where the ACL inserts, the ACL in the female knee may experience greater stress and further restriction during twisting, jumping, changing direction, and landing movements compared to men. Other contributors to increased risk of injury include weakness of the posterior chain musculature (glutes and hamstrings) and ligament laxity during hormone cycles. Recent studies have found that woman may be more susceptible to ACL injury just prior to ovulation compared to the follicular phase due to increased ligament laxity.

    The most common form of treatment following ACL injury is a reconstructive surgery using a graft from either the patient’s own patellar tendon, hamstring, or an ACL from a cadaver. Although an athlete may go through ACL reconstruction, it does not guarantee normal functions of the knee or prevention of subsequent knee injury. In recent studies, it has shown that about half of athletes who underwent ACL reconstruction return to high level sports, and only about 20% of these younger athletes will return to higher level sports in the first year following injury. Given these findings, it is extremely important that ACL rehabilitation encompasses deficits related to surgical interventions as well as initial cause of injury occurring prior to surgery.

    Current generalized ACL rehabilitations programs may not have all-inclusive motor training, and neuromuscular re-education needed to safely allow return to sport within one year’s time. It has been statistically proven that proper recruitment and strength of the posterior chain as well as muscles that stabilize the knee will decrease risk of  re-injury in the young athlete with a prior ACL tear. Physical therapists have the training and knowledge to specifically pinpoint weakness and instability within the hip and knee complex, analyze gait and movements patterns, and build sport specific training programs to assist in injury prevention of the young athlete. 

    In early rehabilitation, it is crucial to protect the graft site, and begin regenerating the quad musculature. Research shows that following knee injury or surgical interventions there is a reflex response to inhibit muscle activation called Arthrogenic Muscle inhibition (AMI). Physical therapy can assist in targeting the muscles that have been affected during this reflex inhibition process. Some examples include quad setting, resisted terminal knee extension, straight leg raises with a knee extension brace until the patient can complete a straight leg raise without knee flexion. Other exercises to assist overall hip and knee stability include closed chain activity such as partial squats, step ups, single leg balance activities, and bridges. It is critical for the physical therapist to ensure the patient is completing exercises without compensatory strategies and progressing toward proper movement patterns. 

    Due to the high prevalence of re-injury, as well as muscular inhibition following knee injury, it is highly recommended that athletes, specifically women receive intensive rehabilitative care following ACL repair. Without specific neuromuscular re-education, proper movement pattern restoration, and addressing pre-injury mechanical deficits, young athletes are at risk for re-injury or significant time lapses as they attempt to return to sport. Physical therapy can provide young athletes with the education and tools they need for success as they return to the sports they love. 

    Amanda Lievendag, DPT, CMTPT is a Physical Therapist in the outpatient setting at Frederick Health Physical Therapy & Sports Rehab. Amanda’s professional interests are Sports Orthopedics, Sports Rehab, Trigger Point Dry Needling, and Spine Rehabilitation. She is a high energy physical therapist who has specialized experience with post-op, sports injuries, return-to-sport training, overuse injuries, and general wellness with athletes and patients of all ages.

     

    Ask an Expert: Should I Stretch Before a Workout?

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    Question: Should I stretch before a workout?  

    Yes, but not in the way you probably think! Let’s look at the goals of stretching before a workout- to warm up the muscles and to prevent injury.

    To warm up the muscles we need to increase blood flow, which comes from movement. While stretching is technically moving, there are far more effective options, such as walking. A five-minute walk or light cardiovascular exercise (jogging, biking, elliptical) will warm up your muscles much more than stretching will.

    Does stretching prevent injury?  

    Laursen, et al in 2014 found strength training and proprioception (balance) training both decreased risk of injury but stretching did not have any effect on injury risk. Swing and a miss there. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials – PubMed (nih.gov)

    Is there any benefit to stretching? 

    Yes, yes there is! We do not need to stretch all our muscles, but if we have limited range of motion, then we should be stretching those involved muscles. A few movements we should be able to do- look up, down, left, right. When we raise our hand, our arm should be in line with our ear. While sitting with our feet in front and legs straight, we should be able to touch our toes.

    When we do not have proper mobility, our body will compensate; this can cause overuse or long-term injuries. So, while stretching does not reduce injury risk for your workout, it is still beneficial to our bodies.

    Warm-up Routine:  

    • 5-10 minutes of light cardio
    • Targeted stretching for flexibility deficit
    • Exercise!

    Alex Strahle, PT, DPT, CSCS is a Physical Therapist in the Employer Based Clinic setting in Indianapolis, IN.  Alex enjoys seeing patients return to an active lifestyle after treatment for their pain and dysfunction. He takes into consideration the psychosocial and physical requirements in treatment and believes in creating a positive and healing environment for his patients.

    Tx:Team Welcomes Liz Kotroba, Director of Rehabilitation Services at Frederick Health

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    We are pleased to announce Liz Kotroba, PT, DPT, MBA as our new Director of Rehabilitation Services for Tx:Team partnered with Frederick Health.

    Liz joins Tx:Team with an extensive background in both rehabilitation and healthcare leadership. She attended The University of Scranton in Scranton, PA, where she earned her Bachelor of Science in Health Sciences, her Master of Physical Therapy, and her Doctor of Physical Therapy. Liz went on to receive her Master of Business Administration from the University of Maryland – University College in Adelphi, MD. She has held leadership positions as Clinic Director, Inpatient Manager, Outpatient Manager, Director of Outpatient Therapy Services, and was promoted to Associate Vice President of Operations and Hospital Administrator with Adventist HealthCare Rehabilitation.

    Liz is passionate about rehabilitation services and will continue to advance clinical and operational excellence, innovation, and community engagement throughout the continuum of rehab care at Frederick Health. She has a wealth of knowledge in program assessment, development, and implementation, clinic start-up, mentoring and developing teams, financial management, and regulatory compliance. It was clear throughout the interview process that Liz’s skillset and experience were an ideal fit for this role.

    On behalf of Tx:Team, we are delighted to welcome Liz to our team. We look forward to serving our patients and our partners in the Frederick community.

    Inclusion, Diversity, and Belonging

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    In September 2021, Tx:Team launched a formal Inclusion, Diversity, and Belonging (IDB) Initiative. This initiative came out of a question we asked our leadership team: how do our associates and patients experience Tx:Team?

    Our mission is to provide everyone with the opportunity to live the healthiest life possible. Diversity of background, experience, identity, ethnicity, race, sexual identity and orientation, and perspective improves the creativity, innovation, quality, and effectiveness of the therapy we provide.

    On October 28th and 29th, 2021, we convened a meeting of Tx:Team’s IDB workgroup comprised of associates from around the country and members of our home office, along with guests from the Indiana University Schools of Physical Therapy and Occupational Therapy. Facilitated by Rob Shook and Bill Kirst, our workshop generated five specific initiatives that Tx:Team has adopted and will execute in 2022 and 2023:

    1. Develop an authentic and clearly articulated statement of Tx:Team’s IDB philosophy.
    2. Establish safe spaces for associates to be themselves, talk openly about key issues, and seek guidance from easily identifiable allies/mentors.
    3. Incorporate IDB into Tx:Team’s internal and external marketing and communication platforms and materials.
    4. Create a one-year fellowship for new Physical and Occupational Therapy, and Speech Language Pathology graduates with a specific focus on engaging therapists from groups that are historically underrepresented in our profession.
    5. Target groups in schools and organizations that are historically underrepresented in our industry and provide education, opportunities for shadowing, and other exposure to possible career paths in the rehab profession.

    One of Tx:Team’s core identifying characteristics is authenticity, and we take this very seriously. Our intent was to clearly and publicly state who we are and what we believe, and then put those beliefs into action. To broaden our reach and better reflect the diversity found in our communities, we are creating opportunities for historically underrepresented groups to access the education, experience, and support necessary to join the therapy profession.

    Tx:Team is a place for anyone with a passion for healing and a desire to change the world, and we are committed to fostering an environment where each associate can be included, valued, and seen. We want everyone who walks through our doors to feel safe and comfortable just being themselves.

    April is Occupational Therapy Month

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    Written by Carroll Nelligan, Tx:Team President and Chief Operating Officer

    “You know that occupational therapy is more than a profession—it’s a passion, and it’s about people.”  AOTA

    It’s April, an entire month dedicated to promote and create more awareness around the great field of Occupational Therapy. I encourage all of our Occupational Therapists to carve out some time to reflect on the great work you do and recharge yourselves with empowerment and inspiration. Here’s what inspires me about our profession:

    OT is Creative. I had the pleasure of attending the Quarterly OT meeting with OTRs and COTAs from our Bridge region and our Indiana hospitals. We opened with a sharing activity, “What is a favorite Therapeutic Activity that you use in your practice?”  The inventive and resourceful list included making overnight oatmeal, packing a suitcase, selecting and wrapping a gift and many others. OTs have the training and expertise to select an activity and break it down into all of the required motor, cognitive, visual, and perceptual components to help our patients achieve meaningful occupation based goals. As we were sharing, my first supervisor at Good Samaritan Hospital Georgina Miller’s words echoed in my brain. “If you are doing straight exercise with a patient, you are NOT an occupational therapist.” OTs are creative experts in therapeutic activity!

    OT is Evidence Based. Occupational therapy is a science-driven, evidence-based profession that enables people of all ages to participate in daily living or live better with injury, illness, or disability. This is accomplished through designing strategies for everyday living and customizing environments to develop and maximize potential. An independent study published in Medical Care Research found that “occupational therapy is the only spending category that has significantly lowered hospital readmission rates.”  What were the OT interventions that drove this?  Recommendations and training for caregivers, assistive devices, home safety assessments, assessing cognition around medication management, and functional mobility. Tx:Team Occupational Therapists and Certified Occupational Therapy Assistants in the hospital environment are impacting readmission rates each and every day!

    OT is Holistic. We do with people not to people. We are about helping people live life to the fullest, regardless of what their life is like or who they are. By taking the full picture into account—a person’s psychological, physical, emotional, and social make-up—occupational therapy assists people in:

    • Achieving their goals
    • Functioning at the highest possible level
    • Concentrating on what matters most to them
    • Maintaining or rebuilding their independence
    • Participating in the everyday activities that they need to do or that simply make life worth living

    We are experts in helping people perform the occupations they need and want to do every day.

    Forever an OT.  Every weekend I visit my Mom at her senior living campus to spend time with her and help her with household tasks. On my most recent trip, I arrived at her apartment only to I realize I had left an item on my kitchen counter that was meant for her. Honestly, I was a bit frustrated, and I hurriedly exited the building to return (for yet another trip) to CVS.  It was then I saw a car door open in the parking lot and a resident was on the pavement. Her rolling walker (tennis balls in the air!) was turned over and she was struggling to get up. God works in small mysterious ways by sending a frustrated OT out to the parking lot at just at the right time. Occupational therapists (no matter what we are doing) are OTs at heart and are indispensable healthcare professionals within our communities.

    Thank you to all of our talented, creative, smart, and dedicated Occupational Therapists and Certified Occupational Therapy Assistants. Take the time this month to celebrate and recognize our fabulous OTRs and COTAs for the passionate professionals that they are.

    Pre-Work Screening Program

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    There are over 2.9 million non-fatal work injuries per year. Of those injuries, about 30% of them end up being musculoskeletal cases including sprains, strains, and tears that end up costing an average of $30k per case.

    Workplace musculoskeletal injuries are often the most expensive of occupational injuries and also account for productivity loss and days away from work.

    Wouldn’t it be beneficial if you could identify the risks of work-related musculoskeletal injuries before they happen? That’s where Tx:Team’s pre-work screening program comes in.

    Our test replicates the roles and responsibilities that will be required of the employees while they’re on the job. Once we assess the functions of a job, we can plan and implement a strategy to prevent future injuries for current employees while also setting a baseline of what is required when hiring future employees.

    Watch this short video to learn more about our success with the pre-work screening program, and fill out the form below if you’re interested in partnering with Tx:Team.

      Please provide your email below to continue the conversation with Tx:Team.

      What’s Good for the Employee is Good for the Employer

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      As an employer, when you have healthier employees, you achieve more productivity and maintain a healthy bottom line. By delivering early treatment options and preventative care through physical therapy, your employees will be in better health and have an improved quality of life. This saves your employees money and also saves you, the employer, on your health plan expenses.

      At Tx:Team, our FOTO data, Net Promoter Score and patient satisfaction results show that we are consistently delivering superior outcomes and getting employees back to work with higher efficiency and effectiveness. Watch this quick video to learn more about how a Physical-Therapy First model can help address MSK spend.

      Our patients get better faster with almost three fewer visits than our competitors, which saves the employee time but also allows them to be more productive at work. Do you want to learn more about Tx:Team? Contact us today:

        Please provide your email below to continue the conversation with Tx:Team.