PTPN Insights

Transitioning your patients to wellness clients.

March 24th, 2015 |

Transitioning your patients to wellness clients.By Mitchel Kaye, PT, Director of Quality Assurance, PTPN
and Joyce Klee, PT, Co‑Owner, Clinton Physical Therapy Center, and President, PTPN of Tennessee/Georgia

With millions of aging Baby Boomers eager to remain vibrant and healthy for as long as possible, fitness and wellness programs for older clients have become one of the nation’s hottest trends. And for good reason; not only do such programs meet an important need in a population that considers 65 the new 45, they also have been proven to reduce healthcare costs associated with both chronic conditions and the common aches and pains of aging.

Physical therapists in private practice are tapping into this demand with innovative and increasingly popular services such as wellness and prevention programs. For many physical therapists, however, the challenge lies not in promoting wellness, but in knowing how and when to transition patients who have been receiving medical care into a practice’s wellness program.

Knowing when and how to make this shift can mean the difference between a successful transition and failure to capture that client, and that between regulatory compliance and penalties. What factors lead to the successful transition of patients to wellness programs? What are the potential perils and pitfalls concerning regulatory guidelines? Here are some key issues to keep in mind when transitioning patients to wellness programs.

How can we avoid confusion between clinical treatment and a wellness program?
Perhaps the single most important step to make when transitioning patients from healthcare into a wellness program is to ensure there is a clear delineation between the clinical PT programs offered by a practice and its wellness programs. That distinction begins with a clear definition. Physical therapy uses interventions designed to return patients to a meaningful functional level caused by injuries, age, illness or birth defects. Wellness, on the other hand, promotes or maintains physical fitness and mobility, but does not treat or correct a medical condition.

When transitioning from PT to wellness, it’s important to ensure that patients recognize those differences and what it means to them. A patient needs to understand the transition from treatment by a licensed physical therapist to a wellness program where he will not necessarily be supervised or evaluated by a therapist, but will receive other benefits, such as:

  • Education and assistance in using exercise equipment;
  • The ability to participate in group exercise;
  • Other support from a trainer or other appropriate staff at the practice.

It is helpful to patients (and to your practice to avoid confusion down the road) to give them written materials about the transition and what they can expect going forward participating in your wellness program.

What criteria are used when converting a patient from treatment to wellness?
There are a number of criteria to consider when transitioning patients. The transition decision must follow regulatory guidelines, as well as your own knowledge of a patient’s health status. There are wide ranges of patients who no longer require insurance-covered therapy that could benefit from wellness and fitness programs. Examples include:

  • Individuals who need to improve or maintain general strength, conditioning and flexibility;
  • A patient who has reached his physical therapy goals and is motivated and interested in pursuing exercise on his own;
  • A patient who has reached a plateau in her progress with physical therapy and further visits cannot be justified; and
  • A patient whose insurance benefits are exhausted before reaching the desired level of physical improvement, but who is ready and willing to continue with independent exercise on a cash basis.

How does one determine when a patient reaches the point where he can be converted into a wellness program?
Most states have not yet codified their rules for when a PT practice transitions from being a provider of therapy to a source for wellness programs. That’s why internal written policies as to when and how to convert a patient from one to another are important to protect your practice. Such policies will vary by your practice parameters and goals, but at a minimum they should include guidance on patients appropriate for wellness, such as those with ongoing functional needs, as well as instructions and guidance on how to broach the subject of ongoing wellness programs with patients.

Those policies should be communicated to staff, monitored, and updated frequently, so if decisions are questioned, there is a written document to substantiate them. You should also document in the patient record the rationale for moving the patient to a wellness program. Be sure to continuously monitor professional associations, your state licensing board, and other regulators to determine if additional policy changes are needed.

What ethical issues should be considered?
Recently there was a case where a practice discharged patients from Medicare before the cap was met, referred them to their own gym, but continued billing Medicare for services. While this case received considerable attention, for most therapists misunderstanding the regulations is more likely than willful misconduct. For example, when a patient meets the therapy cap, a well-intentioned therapist may simply tell the patient that treatment can be continued using much of the same equipment, but under a wellness program.

Many ethical dilemmas can be avoided by not making decisions based on the economic interest of the practice or convenience. It’s also important that wellness programs be offered in a manner that highlights the benefits to patients, but also stresses that participation is their choice, with no negative consequences if they should decline. Assure the patient that even if she opts not to participate, you will continue to care for her should she need PT treatment again in the future.

As noted, make sure patients are very clear when they transition to wellness that they are no longer patients of the physical therapists — where they have one-to-one therapy — but are now in a wellness program, where there are trained staff to assist them, but not to provide therapy. Again, written materials here are quite helpful.

Doing well with wellness
While more needs to be done to provide therapists with clear guidelines for transitioning patients to wellness, the uncertainty shouldn’t lead to analysis paralysis. Patients have much to gain from wellness, and practices can improve their bottom lines, gain important sources of revenue and expand their referral base. The keys are to obtain as much knowledge as you can about existing regulations, to be clear with your patients about the transition from PT to wellness, and to ensure your wellness instructors provide the same level of commitment and quality as the therapists on the PT side of the practice. When these steps are taken, you and your patients will do well with wellness.

Printable version.