How do you navigate limited insurance visits after ACL reconstruction?
Phil: Hey, everyone. I have the pleasure of being joined by Dr. Kyle Matsel. We did several courses for MedBridge on returning to full performance after ACL reconstruction, and we get a lot of questions, so I thought we'd take this opportunity to answer one of those questions today. One of the things that always gets brought up is that we talk about needing to see the patient for an extended period of time, usually a year postoperatively. And the immediate question that is on everyone's mind is how do you navigate limited insurance visits? Meaning sometimes they only have 20 visits a year, or twelve, or six. What does that look like? Do you actually deal with that? And how do you deal with it?
Kyle: That's a great question, Phil. We encounter that all the time. It just seems like anymore nowadays people have less and less PT visits and are being squeezed just a little bit tighter, a little bit more. So being able to have a plan in place to navigate that is so important, and really, it starts at the beginning.
The most successful patients that I found navigating this model is to be clear upfront with them and say, this process is going to take some time. We need to make sure that we have navigated all your biomarkers, all your risk factors, but also giving your body time to heal and really let that solidify in before we're getting you back to full return to sport or discharge. Just setting the stage early, managing those expectations of this is going to be a 9 - 12 month process, and then tailoring your treatment plan based off that.
If someone only has 25 visits a year, this is not someone that I'm going to see three times a week in that first month, I'm going to manage their visits, make sure they're hitting their milestones, and their biomarkers. And then if I need to see them a little bit less, maybe that's every two weeks, maybe that's every few weeks to manage those visits throughout the course of that time frame, then I'm certainly going to do that. But I think PTs get in sometimes a little bit of a quandary. They use all these visits, 15-20 visits upfront, and then they don't have any left, and then they just have to discharge the patient. So I think just being a little bit more judicious with your visits early is the big key.
Phil: Yeah, I think the two points that you made there are essential. Number one, we have to communicate very clearly and quickly with the patient. This is likely how many visits we will need to get you to the appropriate level. And I always start with optimal and ideal. It's amazing how we burn through visits early on. I think the most important visits are probably those first two weeks post op, where that is where I'm seeing the person maybe twice a week, but then quickly after that it is only one time a week and I am setting them up on a very solid program that they're going to be doing in the gym. And this is regardless of their insurance visits, but if you, like you said, you look at three times a week for four weeks, that's twelve visits right there in a month.
And I don't know that we needed to use those right then regardless of insurance coverage. If you start with twice a week for two weeks and then once a week for four weeks, we're only at eight visits at that point in time. And then we're going to go once every two weeks for a couple of times, and then once a month after that. And suddenly 20 visits last you a year. Now, this assumes that you have a compliant patient.
That's also part of the education process and we're going to really dial that in. Additionally, you need to consider letting the patient make the decision on what they want to do early on, "hey, this is what it's going to cost after insurance has run out, that it's going to be X dollars per visit." And after those 20 visits, we are going to need six more and really making it clear. And we have to meet these milestones in order for me to know that you are rehabilitated and you are back to where you should be. So I really am big on changing physical therapists perspective on not letting the insurance tail wag the dog on this one. These are people's lives we have in our hands and we need to make those shared decision making model together. Any other thoughts on that?
Kyle: I think you hit another great couple of points there. Gym memberships are so important and they're very cheap and affordable. You can get gym memberships now for $10, $15 a month and have access to the equipment that you need to maintain the strength and continue making gains. So I think talking with the patients early about gym memberships, getting them on a program that even if you'renot seeing them every other week, or even if you're only seeing them once a month, they're on a very solid program that they can be working on in the gym with those expectations in mind. So, cash visits, gym memberships, these are all great ways to get around those insurance barriers sometimes.
Phil: Absolutely. I think we limit ourselves with our belief about how much we're worth as rehabilitation providers. And I think we need to kind of stop that and just like these are what our services cost, this is what we need to do to get you your best outcome.
So thanks for answering that question.I sure appreciate it. If you haven't been to the MedBridge courses, I hope you join us there for some great discussion. Here is a complete list of our ACL Reconstruction Courses with MedBridge.
About Kyle Matsel PT, DPT, PhD
Dr. Matsel is faculty at the University of Evansville where he teaches in the musculoskeletal content areas of the Doctor of Physical Therapy curriculum. He received his Doctor of Physical Therapy degree from the University of Evansville in 2011 and his PhD in rehabilitation sciences form the University of Kentucky in 2021. Dr. Matsel is the director of the ProRehab & University of Evansville’s Sports Physical Therapy residency program. He is a board-certified clinical specialist in sports through the American Board of Physical Therapy Specialties and a certified strength and conditioning specialist
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