Overcoming Obstacles and Finding Solutions

By Susan Nowell, PT, DPT

“Being busy does not always mean real work. The object of all work is production or accomplishment and to either of these ends there must be forethought, system, planning, intelligence and honest purpose, as well as perspiration.”—Thomas Edison

As an undergraduate student in the sciences, I deliberated for months on whether I should pursue postgraduate studies in molecular biology or physical therapy. I finally concluded that the physical therapy profession embodied my three primary passions and work skills as a researcher, a teacher, and a coach. Now, 15 years later, with over a decade of experience in the field, I would add a fourth role to the list: innovator.

Innovation, in its various forms, has been the cornerstone of advancing the fields of medicine and science for years. We could literally cite thousands of historical examples in which great leaders overcame adversity to drive society forward. Thomas Edison, an archetypal innovative figure in U.S. history, encountered numerous obstacles on his road to groundbreaking inventions. Comfort breeds shortsightedness. Contrarily, adversity and discomfort can serve to broaden awareness; they drive the search for better solutions. Innovation, at its best, is systematic implementation of a new solution to an existing problem.

In my opinion, there are two main aspects of the current health care climate that make running a private practice feel adverse: (1) the current reimbursement-dictated revenue paradigm, and (2) the potential dilution and misrepresentation of therapeutic language among the broader fitness industry. To quote Impact contributor Janet Lanham, RN and revenue cycle management expert, “In the old days (like the 1990s), you opened an office, saw patients, submitted a claim, and got paid. Easy!” That is definitely not the case today. With Medicare implementation of Sustainable Growth Rate (SGR), Correct Coding Initiative (CCI), and Physician Quality Reporting System (PQRS) requirements, we have seen subsequent reductions in reimbursement rates, an obvious challenge to clinic revenue and survival.

On top of the reimbursement challenges, we are confronted with growing competition from other health care and fitness industry professionals. We live in a constant inundation of fitness information on the web, in social media, and printed in health magazines. This leads to the potential dilution, misrepresentation, or misuse of the therapeutic terminology and treatment approaches we use. I personally find this unnerving and overwhelming. It is no wonder many private practice physical therapists echo concern over the potential encroachment on our profession.

Innovative concepts previously discussed include the implementation of clinic wellness programs, the growth of physical therapist–directed corporate employee health programs, and the development of physical therapy mastermind groups as collaborative problem-solving entities. I think we can take these innovative concepts even further to delineate our leadership as health care entrepreneurs. I believe we have the clinical knowledge and expertise to grab the lead in designing exercise products, developing sports-specific functional exercise programs, and collaborating with the tech world to pioneer new ways of streamlining nonproductive or nonreimbursable workload. An increased focus on tangible innovative tools will only strengthen our foothold in the health care industry and likely lessen our reliance on the current reimbursement-dictated revenue paradigm.

A good example of a physical therapist taking the innovative lead to design and patent a new exercise tool for physical therapists and other fitness professionals is the founder of CoreAlign, Jonathan Hoffman. Throughout his career, he worked as the head physical therapist for several European professional basketball teams, Israeli basketball and tennis national teams, and for the Association of Tennis Professionals. Inspired by his own athletic challenges and work in hospital rehabilitation and sports team settings, he created the CoreAlign device in 2004. The device encourages vertical posture for the majority of movement patterns. Many of the exercises promote core stability with functional movement patterns. The method was then transferred to Balanced Body, Inc., from California. Since then, together with the Balanced Body international team Jonathan has been teaching the method to movement-based professionals on an international level.

From my own experiences as an ultrarunner, a competitor, and a physical therapist, I have developed a specific set of training tools and running programs for runners participating in multiday running events. My approach involves a focus on injury prevention and awareness, which I believe separates my expertise from that of a personal trainer. I periodically travel to work as an onsite physical therapist for off-road multiday running events. In my last work experience in Iceland, I was impressed by how many runners needed physical therapy management and post-race recommendations for a variety of true clinical diagnoses including sciatica, metatarsalgia, posterior tibialis tendonitis, and piriformis syndrome. This reconfirmed to me that the off-road niche is indeed an appropriate place for a physical therapist to offer clinical expertise and knowledge.

In local settings, I have heard private-pay clients state that they would prefer to work with a physical therapist for recurring care instead of using insurance or working with a personal trainer because of the complexity of their medical situation their medical complexity and need for focused multisystem care. This level of expertise is similar to when a client lacks a patellar tendon or undergoes a tracheotomy and needs to be working with a practitioner who has a higher level of medical background and biomechanical analysis.

Innovation, at its heart, is true leadership. It is being at the helm, steering a ship into unknown waters, embracing unexpected adversity and change today for a better tomorrow. Most physical therapists are in the profession because they have passion for movement, connect well with people, and truly care about making a difference. In the current unstable health care climate, we have an excellent opportunity to act as great leaders, driving change through systematic innovation. As exemplified by systematic innovators such as Thomas Edison and Steve Jobs, great leaders implement change by clearly defining problems, identifying the highest priority issues, and assessing what is known and what needs to be discovered in order to render change.

Susan Nowell, PT, DPT, is a PPS member and founder of Endurellect Physical Therapy. She can be reached at sunowell@gmail.com.

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