September 2020 NEWS
ACL INJURY? GET BACK IN THE GAME! MOVE YOUR KNEE
INSIDE: � Getting Started On A Post- Surgical Treatment Plan � Exercise Essentials � Practice News
FREELY ONCE AGAIN, AFTER ACL SURGERY
Health & Fitness The Newsletter About Achieving and Maintaining Optimal Well-Being
ACL INJURY? GET BACK IN THE GAME! MOVE YOURKNEE FREELYONCEAGAIN, AFTERACL SURGERY
Our knees do a lot of work throughout the day and we too often take them for granted. You never notice how complex and necessary our knee joints are for everyday movements until we sustain an injury that hinders their use. The vast majority of functions you need to perform each day (whether it’s getting out of bed, bending down to empty the dishwasher, crouching to tie your shoe, or simply going upstairs) are only possible when your knees can perform their full range of motion. Your patella (kneecap) is designed to glide up and down within the thigh bone groove. If even a minor injury prevents that from happening, the resulting friction causes a buildup of debris, leading to inflammation, pain, and crucial loss of function. That’s why it is so important to seek the help of a physical therapist following an ACL repair. This is a major surgery that can greatly affect the way your knees move. Fortunately, our licensed and experienced physical therapists at CLINIC NAME can help you move freely once again! WHAT CAN I EXPECT AFTER MY ACL SURGERY? When the anterior cruciate ligament (ACL) tears, it typically happens from a sudden stop, twist, or change in motion. This may make you feel as if you can’t put any weight on your legs at all.
Because this is a ligament that is crucial to knee movement, post- surgical rehabilitation is typically a lengthy process – requiring approximately 6-9 months of extensive physical therapy and hard work. We understand that this can be physically, mentally, and emotionally challenging on an athlete. There are a lot of ups and downs to the rehab process - you go from being a star athlete to sitting on the sidelines for as long as a year. However, at CLINIC NAME, we will work hard to make your rehabilitation process as smooth as possible, so you can get back to playing the sport you love. In order to achieve this, some important aspects of your treatment plan will include: • Strength training • Balance • Body awareness • Leg symmetry • Jumping and landing techniques This is all done to make sure that you are performing optimally and not compensating. Our mission is to provide the proper techniques and resources to you so you can get back to the game with regained function and a significantly decreased risk of sustaining another injury. (Continued inside)
GETTING STARTED ON A POST-SURGICAL TREATMENT PLAN:
Hands-on care to restore ROM and decrease swelling are the keys to speeding up your recovery time. During your physical therapy sessions, you’ll begin restoring the crucial fluid circulation in your knee joints, which ensures optimum natural joint movement. PT also builds strength in the muscles surrounding your knees, providing better long-term support for the complex joint system, and decreasing the risk of sustaining another injury in the future. At CLINIC NAME, we will get you set up on a treatment plan following your surgery so you can begin your recovery process as soon as possible. Our expert physical therapists will also help you learn methods and techniques for protecting your knees in the future, in order to prevent further pain or injury. Don’t let your injury hinder your life or take you out of the game for good - regain your function and get back to the sport you love with physical therapy.
There are some intimidating statistics regarding ACL injuries— according to the National Institutes of Health, it is estimated that approximately 350,000 ACL reconstructions are performed annually across the nation. Despite surgical repair, those who sustained an ACL injury in need of correction are 79% more likely to develop knee osteoarthritis in the future and 20% more likely to suffer a re-injury within 2 years of their procedure. In addition, athletes may not be able to return to their sport with the same level of play, and they may struggle with confidence issues or fear of re-injury when they return. Post-surgical rehabilitation can help decrease these statistics. Our trained professionals will determine what your knee’s current range of motion is, along with the location and nature of the pain, swelling, or stiffness you’re experiencing from your ACL repair.
MINTED COUSCOUS SALAD
INGREDIENTS • 1 cup dry couscous • 1 cup jarred roasted red peppers • 2 tbsp olive oil • Juice from 1/2 lemon
• 1 tomato, seeded and diced • 1 English cucumber, diced • 1/2 cup mint (or flat-leaf parsley) • Salt and pepper
DIRECTIONS Cook the couscous according to package directions. Fluff with fork. Meanwhile, dice roasted red peppers and add diced tomato and cucumber to a bowl. Add lemon juice and olive oil and stir to combine. Finely chop mint (or parsley) and add to bowl, along with the cooked couscous, and toss to combine. Season with salt and pepper to taste. Enjoy!
THE LANGUAGE OF INSURANCE (GOOD STUFF TO KNOW)
You’ve called and scheduled your first appointment with us, awesome! We cannot wait to help you! So, what do we do in the meantime to prepare for your first visit? Before we answer that question, let’s go over some insurance terms that you commonly run across when getting PT. a. Insurance verification — This is step one in the process, here we go through and verify a patient’s policy and their benefits for the services they will receive. b. Your deductible — This is the amount you need to pay before your benefits become available to pay for your medical bills. If youhave a $1000/year deductible and only have met $500, you will have to pay the next $500 out of pocket before your insurance will help pay your PT bill. c. Cost share —This is a termused to define your estimated costs for coming to PT per treatment. It is an estimated amount since cost per treatment vary at times depending on the type of treatment that day with certain insurances. d. Copay — This is your portion of the cost of treatment after your deductible has been met. It is a fixed amount per visit like $25/visit. e. Coinsurance —Similar to a copay in that it is your portion of the bill after the deductible has been met, but instead of a fixed amount it is based on a percentage of the bill, like a 20% would be 20% of the total bill and would be around $25-30 typically in PT. This is why cost share can be an estimate. f. MaximumOut-of-Pocket —Some policies have amax out of pocket with your deductible and copay or coinsurance. After that ismet, your insurance would cover 100% of the bill. This is an important benefit sincewith a severe illness or injury, you have a cap in costs for that year. g.Medical necessity —This is a confusing termbut itmeans your access to physical therapy benefits depends on whether your problem has enough complexity to require the skilled services of a physical therapist for its solution. In otherwords, are you having enough pain and functional
limitations that you need help to get it resolved? As well, as you improve the PT must determine when the patient has satisfied the medical necessity question and you are able to manage and continue to improve on your own. It is not based on the number of visits allowed by your plan but on the degree of need you have to overcome your problem which determines the quantity of PT approved. h. Explanationof benefits (EOB) —This is a report you receive in the mail or online after you receive services and it lists what was received, its charges and how much they paid and how much you are responsible for paying. Usually there is a difference in the charge and the amount paid and it relates to fee schedules and your cost share. See in-network explanation. i. Participating — This means we have a contract with this particular insurance company and agree to accept their fee schedule, this is called in-network benefits. j. In-network — This means we have an agreement with an insurance company to accept their fee schedule for payment. So, we may charge $40 for a unit of service but that particular insurance only pays $25 per unit. So, we have agreed to accept this reduction; Medicareworks this way. Youwill receive anEOBafter the insurance processes a billed treatment and the charges and the amount paid will be different because we have agreed to accept their fee schedule and so we write off the difference. k. Out of Network — This means we do not participate with a particular insurance and their fee schedule, so you would have to pay the out-of-network cost to see us. At times it is notmuch different than in-network and at other times it can be a significant difference. It depends on the insurance company and their rules. Just remember, you are potentially using PT to solve your problem and it is always good to do some research on how well a practice get results for your pain and not just decide where to go based only on costs. And, that would go for location too; convenience is not easier if you do not achieve a good
result – do your homework before you decide onwhere to go. Check on-line reviews, check their website, or call and talk to aPTabout your problemandget a feel on thequality of communication and helpfulness before you even start. So, as you can see, there is a number of terms tounderstand. When we receive your referral from your doctor, we call you and get your insurance data so we can determine if we participate and we will schedule you at that time as well. We then contact your insurance company to determine your benefits and will have them defined before your first visit. When you arrive for your first visit, we will go over your benefits so you know a close estimate of your cost share. Some insurances require authorization before we can start PT, the common ones includeBlue CareNetwork, Blue Care Network Advantage, andMedicare Plus Blue. Here iswhere medical necessity comes in and an insurance controlling a patients access to PT by defining the number of visits they will authorize initially. There are a few insurances we do not participatewhich includeMedicaid programs, andCigna but overall, we work the vast majority of the insurances used in Holland. It is common to seeplans have a visit limitwhich is usually 30 or 60 visits per benefit year. In some cases, these visit limits are combined with occupational and speech therapy and sometimes even chiropractic. Visit limits and authorizations are used by the insurance company to make sure these services aren’t being overused and/or to make sure they are medically necessary. Oncewe have all this information, we put this into your chart andhave it ready for your first appointmentwithus.We check on your policy throughout your treatment to keep track of your deductible andout of pocket costs –when youhavemet it, we will adjust your payment to the appropriate amount. If there are ever any questions about how a treatment was paid or something that is not clear, do not hesitate to ask, we are always happy to help!
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PLAY THE REFERRAL GAME! At Full Potential, we know that a referral from our patients is the biggest compliment. Let us thank you with these 3 simple steps! 1. Write your name on this coupon. 2. Give this coupon to family and friends! 3. Be sure they bring this coupon to their first appointment. 4. Receive a Meijer gift card to those that refer us a patient!
286 Hoover Blvd • Holland, MI 49423 Phone: 616.392.2172 | Fax: 616392.1726 firstname.lastname@example.org | fullpotentialpt.com
Our New Patient’s Name!
Don’t miss this opportunity to help your friends and family! They will thank you, and we will too
OPEN LETTER TO PATIENTS FROM VINCE HANNEKEN, PT
Hello, With this issueweareputtingsomeattention on the world of insurance. Insurance is a key factor in how each of you can access the important benefit of physical therapy. Depending on your age each of you have some attention on the future and how you will be able to sustain your physical ability through time. There are many opinions and treatment philosophies on aging and health. Diet, exercise, stressmanagement, and medications along with the helping disciplines (PT, massage, physicians, and chiropractic) are all variables people use to some degree to sustain their ability to be active and feel good. Central to getting help is how will your insurance cover the cost of the help you choose? To access the benefits of your plan, it is important to understand the language of insurance. To help in this regard, our insurance verification person, Lori, has put together a short article on insurance terminology, how billing, collections work, and medical necessity. Your knowledge in this area can be helpful to not feel overwhelmed with this often foreign but important part of your benefits. Inour practice, about 40%of our patients are over 65 and access their health coverage through the various Medicare plans. I am writing today to discuss in brief Medicare’s current plan to cut reimbursement for physical and occupational therapy by 9% for the upcoming year. This will represent a 9% reduction in our fee schedule which determines how we get paid for one of your treatments. I think we are all pretty aware of how much waste there is in our federal government’s programs. A great example is, “By far the largest example of wasteful spending is the $48 billion in improper payments in the Medicare system. These payments include an international scheme to defraud the federal government out of $1.2 billion by chargingMedicare orthopedic
braces doctors prescribed “either without any patient interaction or with only a brief telephonic conversation with patients they had never met or seen.” (1). That example is sad since those are fraudulent schemes, but there are actual approved expenditures for outlandish programs like nearly $500k for studying the mating calls of the Panamanian frog. So howmuch federal money is spent with no return to our society? Those are tax dollars that should benefit those who pay taxes. Last I knew, no frog has ever paid any U.S. taxes or people living in Panama. As far as effectiveness and benefit per dollar spent, physical therapy provides
which patients attend PT appointments can also impact cost. Patients diagnosed with lower back painwho visited a physical therapist between 9-to-12 times reduced Medicare Part A/B spending by 32% compared with beneficiaries who only attended a single appointment.”(2) So, it is frustrating to see how these cuts could unfairly affect how we are going to be able to deliver quality care to each of our Medicare patients especially in light of how money is so wastefully spent in our federal government. In effect there is not a lack of money if we can study frogs in Panama, its more about distribution and valuing what we do.
and we got paid. So, don’t doubt the power of your voice. Life often works like a pendulum; we try to help you feel and function better and now the pendulum reverses and we need you to help us. Listed below is the contact data for our legislators, and even the President. Let’s let them know how important PT is for everyone and that it is one of the few federal programs that actually saves them money in the long run unless you feel better knowing more about the mating calls of frogs in central America. Thank you for your time and attention. To wellness, Vince Hanneken, PT Owner Bill Huizenga https://huizenga.house.gov/contact/ Gary Peters https://www.peters.senate.gov/ contact/email-gary Debbie Stabenow https://www.stabenow.senate.gov/ contact Donald Trump https://www.whitehouse.gov/contact/ 1. https://www.ourpursuit.com/senator-pauls- latest-oversight-report-finds-50-billion-in-wasteful- spending/ 2. Physical therapy episodes for low back pain: Medicare spending and intensity of physical therapy services. The Alliance for Physical Therapy Quality and Innovation. aptqi.com/ wp-content/uploads/2019/03/APTQI-Complete- Study-Physical-Therapy-Episodes-Lumbago- October-2017.pdf. Published October 2017.
“Last I knew, no frog has ever paid any U.S. taxes or people living in Panama.”
one of the best rate of savings for the federal government of any of their programs because it makes people more able and self-sufficient as they get older thus reducing the need for expensive assisted living facilities and surgeries. As an example of this savings here is a study summary of cost to benefits, “According to a study conducted by the Moran Company, use of PT as a first intervention for lower back pain resulted in 19% lower costs to the Medicare program when compared with injections as a first intervention, and 75% lower costs when compared with surgery as a first intervention. Beneficiarieswho received PT early (within first 15 days of their diagnosis) had lower average treatment costs than those who began PT later.5 In fact, those beneficiaries who received therapy within the first 15 days (compared to 45-90 days post diagnosis) had downstreamcosts that were 27% lower on average. Further, the evidence suggests that the frequency in
Here is where you come in and where we have been communicating to our legislators. Getting more key people to value what we do is the pivot point to change. There is not a valid reason why they are cutting our reimbursement. Don’t forget, you are the one who paid into Medicare for decades, it is your money paid in check after paycheck that has been funding it (although they havewritten IOUs against it to fund frog studies and the like). I am putting the names and contact information for our legislators for you to contact and will try to make it easy for you. If you access our digital newsletter on line you can just copy and paste these addresses and then communicate your opinion. Your voice is listened to the most by them. I remember once we were having trouble getting paid by a federal military program and so we wrote letters starting at the top with the President all the way down to the department and our legislators. Wow, I was amazed how I got a response
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EXERCISE ESSENTIALS: Try these simple exercises to strengthen leg muscles
Quadriceps Isometric (Towel Roll)
Lie flat on your back with a towel roll under your knee as shown. Tighten the muscles on the top of your thigh by pushing the back of your knee into towel roll. Relax. Repeat 8–10 times.
Toes Up Calf Raise | Bilateral (Towel)
Stand holding a chair as shown. Place a rolled towel under toes. Lift heels up, standing on your tip toes. Lower heels back to the ground. Repeat 8–10 times.
Always consult your physical therapist or physician before starting exercises you are unsure of doing.
Patient Success Story!
“My Dizziness Has Lessened!” “Since starting PT, my dizziness has lessened. I now know a few things to do to lessen dizziness due to PT. The strengths at Full Potential are their knowledge, friendness, and professionalism!” — Pamela M.
“Knowledge, Care, and Efficiency!” “The biggest change since starting PT is being educated and knowing what to do when I feel pain. And a reminder to do the preventive work. Their strengths include knowledge, care, and efficiency.” — Joel T.Page 1 Page 2 Page 3 Page 4 Page 5 Page 6
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