For my Site Visit project, I went to NovaCare Rehabilitation Center in Coon Rapids, MN (2104 Northdale Boulevard NW, Suite 100, Coon Rapids, MN, 55433) and interviewed both Jade Baxley, DPT and Kristine Trimble, PT. This site visit was a Rehabilitation Center that focuses on the rehabilitation of the patient after an injury, illness, or change in function.
There are several types of Rehab. Discussed in the Long-Term Care Services Chapter of Essentials of the U.S. Health Care System by Shi and Singh, “Restorative Rehabilitation involves intensive short-term treatments rendered by physical therapists, occupational therapists, and speech/language pathologists.” These services would be used with patients that undergo orthopedic surgery, amputation, prolonged illness, and stroke. “Maintenance rehabilitation has the goal of preserving the present level of function and prevent further decline.” These services would be used with patients who are on a decline in health and act as an aide in slowing the decline process down. “Adaptive rehabilitation improves function despite deficits that remain.” These services would be use for patients who need assistance in motion, such as using braces, orthotics, or splints to perform tasks like ADLs (Shi & Singh, 2017). NovaCare oversees many facilities that provide all levels and categories of care; their Rehabilitation Center in Coon Rapids focuses on all forms of rehabilitation for patients of all ages, backgrounds, injuries, and illnesses (Baxley, Personal Communication, 2018).
Rehabilitation as a career has been around for decades, and in some ways centuries. As Trimble put it, “There has always been someone to help the injured, ill, immobile persons. Rather than burdening a family member or nurse with additional tasks, it has become a specialty profession in areas like physical therapy, but also occupational therapy.” (Trimble, Personal Communication, 2018). According to APTA History, a team of 274 physical therapists created the “first professional association in 1921, called the American Women’s Physical Therapeutic Association.” By 1930 the Association grew to 1,000 members and continued to rise dramatically through the nationwide Polio epidemic and into World War II, rising membership to over 8,000. By the late 1940s, the association had changed its name to the American Physical Therapy Association (APTA). Today, there are over 95,000 members in the U.S. and well more on their way. As of 2008, the Physical Therapy Degree has turned into a 4-year undergraduate plus a 3-year Doctoral level degree; it originally was its own 4-year degree and then changed to a 4 year degree plus a 2 year Masters level degree (American Physical Therapy Association [APTA], 2016). Occupational Therapy is also starting to develop a plan to require a Doctoral level degree (Trimble, Personal Communication, 2018). The profession of rehabilitation is said to have started in physical therapy, leading to occupational therapy and speech/language pathology to branch off of its roots (Baxley, Personal Communication, 2018). The purpose of rehabilitation as a profession is to provide patients with skills to gain their normal ability levels back in their motions, and to prevent reoccurring injury. For some, the purpose of rehab is also to relieve pain and find comfort and quality in life (APTA, 2016).
The typical administrative structure in a Rehabilitation setting is tedious. With the several different types of insurance companies, there comes many different systems of recording and filing records for billing and future use. Most commonly at NovaCare, the therapists will take notes throughout the session related to the patient’s personal life and state of being. They will also take notes on progression, and strengths and weaknesses. These notes are then sent into a computer system to be analyzed; the receptionists are trained in the billing aspect and see the notes in the computer system to determine how to bill. They then send their forms back to the therapists and managers to be signed and sent off to the billing company through postage or electronically, depending on the provider. If a patient presents with pain that could be aided with medication, or is believed to need further imaging/testing and/or a procedure, the therapists will write up a recommendation to the Primary Care Physician of the patient. This is done electronically and can be reviewed and addressed in under an hour depending on the Doctor and their schedule. The doctor will send back either confirmation or declination to the request and write up an order for the patient’s needs. The therapists keep all notes and files in electronic systems that are protected and their work stays in the office to keep private information safe. Often times, therapists are also audited to determine if they are using their resources correctly, providing the level of care necessary, and billing correctly; this is to make sure the business side runs smoothly, as to put most effort into the patient aspect of the field (Baxley, Personal Communication, 2018). There are many other administrative tasks, that are complicated, but it is all in place to give the patient the best care possible.
Within the Rehabilitation field, there are many characteristic services offered. These services include physical therapy, occupational therapy, assistants and aides, speech and language pathologists, and many other specialists. These professionals all have options to specialize even further within their categories, such as through dry needling, sports focus, massage therapy, ultrasound, and more. These certifications require additional education through classes or courses ranging from years of fellowships or a weekend intensive (Baxley, Personal Communication, 2018). With each certification acquired by the professional, the more expensive it becomes to see them as a patient but the better care you may receive as they may be trained in a technique specifically designed to treat your condition (Trimble, Personal Communication, 2018).
A typical visit to a NovaCare center, specifically their Rehabilitation Center, starts with a reason. As a patient, your primary care physician, or a specialists such as your surgeon, refers you to a Physical or Occupational Therapist. Once referred, you are then admitted into their patient portal system where you choose your Doctor and can fill out consent and billing information forms electronically (Baxley, Personal Communication, 2018).
At your scheduled appointment, you check-in and are seated in the reception area until your Doctor comes and greets you. You then follow them back into a patient in-take room where the Doctor asks many questions to gather history and other important information regarding your visit. They follow by performing several physical tests and measurements to see an initial level that they can later compare progress to. Following the measures, you typically would perform a few easy-level exercises; if there is a need for imaging or further testing, the therapist often discontinues treatment and sends a request back to your doctor in efforts to not create further injury (Baxley, Personal Communication, 2018).
Once exercises are practiced in the therapy setting, you may be asked to continue practicing those skills at home. As you get stronger and able, the exercises increase in difficulty until you no longer need continuing therapy. Most patients have scheduled appointments 2-3 times per week for 4-6 weeks until they show signs of improvement. Once this occurs, therapy sessions are decreased to once a week or less and eventually discontinued and the patient is considered discharged (Baxley, Personal Communication, 2018).
There are specific organizations that accredit different parts of the rehabilitation care setting. Each professional is accredited through their affiliated Association; physical therapists: APTA, occupational therapists: AOTA. Each care facility is then required to seek accreditation from different insurance companies to confirm their practices are covered under each insurance policy. These accreditation measures are in place to protect the patients and the doctors from malpractice (Baxley, Personal Communication, 2018).
Physical Therapy will rise in popularity, as well as other rehabilitation careers, as our population is growing find it as a need. Current events revolve around the Baby Boomer generation entering their retirement years in all forms. This is to say, our population is aging at a dramatic rate and the demand for rehabilitation personnel is rising. As the population ages, there are more diseases, illnesses, and injuries occurring that need the assistance of rehabilitation. Job demands will be high; specializing in geriatrics will be high, specializing in chronic pain management will be high, and specializing in spine and back care will be high. There are currently not enough programs nationwide, accepting students to come into the profession, to accommodate the population’s needs; this will need to change. More Aides and Assistants will be needed to keep business costs down, but to provide care to more patients. More technology will need to be produced to help provide care to more patients than a Doctor can see (Baxley, Personal Communication, 2018). There are some big issues that need to be addressed in the short-term to be able to provide for the patients and help them gain quality in their long-term life.
