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Colocation of Physical and Psychological Rehabilitation Services

A blog by Ali D. Kanji, DPT


As a Physical Therapist practicing in Maryland for the past 12 years, I have been primary witness to the slowly shifting foundation and respective evolution of our profession.

While we historically started off with roles similar to that of today’s Rehabilitation Technicians, Physical Therapists are now considered Direct Access clinicians with the capacity to treat patients without a direct Physician referral in every State in America.

Despite increased training, education, and certifications (all new graduate American Physical Therapists must now have a Doctorate degree), most other Allied Health clinicians (Nurses, Pharmacists, Occupational and Speech therapists) and physicians (both general and specialized) often continue to expect Physical Therapists to stick to their historically-determined scope of ‘exercise,’ and ‘massage.’

We must buck this trend, however, if we wish our patients to benefit from the full manifestation of wholistic, fully-integrated rehabilitation services.

As is evident from public discourse and yearly clawbacks, healthcare spending in America is at an all time high. CMS estimates that it spent nearly 3.5 trillion dollars in 2018 on healthcare – a staggering, unsustainable amount.

From my perspective, per-patient reimbursements relative to cost of living are shrinking and are expected to further shrink over the foreseeable future. Thus, if therapists (PT/OT/SLP) wish to maintain or improve their current relative level of income (a natural compulsion) we will need to find more affordable, effective ways to manage larger chronic patient populations, as time goes on. To explain, as the Earth’s population grows, so can one expect the number of acute injuries requiring rehabilitation to grow. Thus, the demand and for acute and sub-acute therapy services should continue, though reimbursement windows may contract.

The chronic phase of injury (any injury that is older than 14 days) from the patient’s perspective is the most variable in terms of length, intensity, and risk for reinjury. From the clinician’s standpoint chronicity speaks to the particular tissue or group of tissues being ‘stuck’ in the positive feedback loop of the inflammatory process.

Figure 1. The inflammatory cycle, leading to sustained chronicity. Scroll over image for source.

Chronic conditions, which place the highest burden upon both public and private payors, again from a physical therapist’s perspective will require:

  1. A wholistic approach in the implementation of new technologies, and

(Physical therapists are trained clinicians and skilled diagnosticians, however, are not versed in software engineering, design or the necessary user experience expertise to implement and roll out a theoretical patient management, home exercise or tele-rehab mobile device application independently or easily or over the short- to medium-term.)

  1. The combination of both old and new therapies to maximize patient return to function and indeed to maintain the gains in functional capacity obtained in therapy.
    (For clinicians in out-patient practice, this is an easier, short-term way to address gaps in patient’s care, and for, after brainstorming, this presented us with the path we needed to provide individually tailored, wholistic care).

Figure 2. BOR’s Multidisciplinary Approach, from the Clinician’s Perspective

This is the end of Vol. 1 of Dr. Ali D. Kanji’s blog continuum on integrating physical and psychological rehabilitation disciplines. Please check back next week for Vol. 2, which will include a further discussion on the Co-location of services, as well as a discussion on the Future of Rehabilitation, as well as perspectives on fees for pt improvement, technology in rehabilitation, telehealth and patient population concierge rehabilitation services. Dr. Kanji is a managing partner and Clinical Director at Baltimore Orthopedics and Rehabilitation (