By law, physical and occupational therapists are required to perform evaluations on all patients despite the fact that they may have previously been evaluated by a physician or another physical therapist. This law is appropriate because without the evaluation, it is impossible for the physical or occupational therapist to set up a specific program that would resolve the patient’s problem. Therefore, the patient would be on a more generic program, which would be ineffective.

Physical and occupational therapists are extensively trained in evaluative procedures that lead to a physical or occupational therapy diagnosis and appropriate intervention. It is incumbent on the physical or occupational therapist set up a program that will effectuate a rapid resolution. This also would include patient education to prevent recurrence.

When a patient is first evaluated, their job duties are extensively discussed with the patient as well as anticipated return to work goals. Right from the very first day we are directing our care at return to full function or modifying the work environment so that the patient can return to work as soon as possible. To that end, we work extensively with work simulation and conditioning activities with emphasis on repetition in order to prepare the patient for his or her return to work. Additionally, we work closely coordinating with any case managers assigned to the patient’s case to be sure all aspects of the patient’s care is covered.

Additionally, Jill M. Tomasello, PT, FABDA, Cert. MDT is a Fellow with the American Board of Disability Analysts and performs Functional Capacity Evaluations to determine the patient’s ability to return to their previous job duties. These evaluations involve 2 days of approximately 4 hours of tests assigned to determine the patient’s ability to return to previous job duties. Because Functional Capacity Evaluations are already validated and reliable, this is important information for the insurance company to have.

As mentioned previously, a complete evaluation is extremely important in determining the problems that exist. Goals are developed so the patient can return to their normal daily activities as soon as possible. Most importantly, at any physical or occupational therapy facility, the insurance company should be sure patient’s are being re-evaluated and treatment programs are being progressed as appropriate to ensure attainment of goals. If re-evaluation is not performed, and specific progress is not documented, the insurance company should not be required to pay for care. It is incumbent upon the physical or occupational therapist to show progress. What is helpful in these situations are peer reviews done by a physical or occupational therapist to be sure your patient is being treated appropriately. Please see our question regarding peer reviews on this website.

Because of the level of expertise in our clinic, our therapists, in addition to performing subjective information and objective testing, the therapists work diligently to document any inconsistencies that may manifest themselves as a behavioral component. To this end, we also perform specific testing using validating and reliable testing tools to come up with positive signs for behavioral patients. Therefore, we are able to identify these patients, coordinate with the physician and/or case worker, in order to move the patient on to appropriate services, not keeping them in physical or occupational therapy unnecessarily.

An insurance company has to be careful about sending patients to facilities that utilize a variety of equipment generically. Although equipment has its place in rehabilitation, the most important aspect of care is the therapists expertise and ability to evaluate and set up a treatment program designed to resolving the patient’s problems. At Advanced Physical Therapy Center, we have over 20 private treatment rooms that allows for one-on-one manual therapy sessions with the therapist. As the patient’s pain resolves, we are able to progress their therapy to include stretching, strengthening and conditioning exercises, with final goal of independent symptom management skills. ;We keep the claims managers and claims adjustors updated through weekly reports and have an "open door policy" that encourages them to visit our facility AT ANY TIME and actually observe treatment of that patient.