with Kyle Wolfe, SPT
Background
My whole life I have played ice hockey and endured many injuries. This led to quite a bit of time spent at physical therapy in the OP ortho setting for rehabilitation. As I spent more time in the clinic getting to learn the field of PT, while being introduced to a variety of treatments, I made the decision that physical therapy is what I wished to pursue for a career. Considering my injuries have primarily been soft-tissue related, at some point along the way I grew a fascination toward the theory and application of manual therapy and modalities. This has grown into a passion to make the physical therapy experience unique to the individual, while offering them treatment options that not only improve their wellbeing, but that are also enjoyable. I firmly believe that physical therapy should be patient centered as well as patient-driven. We as providers have the knowledge to offer treatments, including exercise, that will improve a patient’s well being. However, I feel that many physical therapists forget the importance of allowing their patients to be a part of the decision making process. Further, I feel that many therapists get caught up in the day-to-day that they forget to make physical therapy a positive experience for both themselves and the patient.
While my partner, Kyle Wolfe SPT, and I have different backgrounds leading into this project, our combined interests for pain management with physical therapy interventions led us to the creation of an On-Site Physical Therapy model. The premise of this business is that we would travel to large corporate offices or factories with many employees, and provide physical therapy services at the convenience of their workplace. The project is divided into two main parts; 1. A feasibility study, which contains some of the fundamentals of a business/marketing plan; and 2. An evidence table, that explores the research surrounding manual therapy and modalities for short-term pain relief. Combined, these products provide us with some of the tools needed to successfully implement an evidence-based physical therapy business.
Overview & Purpose
The motive behind this project was to explore a business model that offered patients treatment options that meet them where they are in the rehabilitative process. Simply put, many patients are not ready to make lifestyle changes that incorporate exercise. My personal belief is that it is okay if an individual is not ready to commit to an HEP. I would much rather provide passive treatments that reduce their pain, while building rapport with the patient, so that I can persuade them to integrate exercise at a later time. By pushing the patient toward an intervention that does not align with their goals and motivations, I believe many therapists are facilitating an unpleasant patient experience that does not lend to positive outcomes. A secondary motive for pursuing this project was to offer a way by which physical therapists could positively impact the opioid epidemic in this country. The premise here is that while passive PT treatments do not enable the patient to take charge of their health, they are a better alternative to taking medications. If we as PT’s can intervene to divert, or reduce the need for medication, I believe we would not only lower the total cost of healthcare, but we would also reduce the likelihood of opioid addiction with these patients.
Statement of Need
In 2012 the NIH reported that nearly 40 million Americans are experiencing severe levels of pain and that over half of the population reported pain within three months prior to the survey.1 Just 4 years later, in 2016 the NIH reported 50 million Americans were experiencing chronic pain.2 These values have been on a steady incline over the last decade and have coincided with the rising costs of healthcare in America and the birth of the Opioid crisis.3
One of the objectives of the On-Site Physical Therapy clinic is to provide pain mitigating solutions to North Carolinians as a means to reduce the need and/or the desire to seek out expensive medical evaluations and treatments. We anticipate that our passive treatment modalities will reduce the reliance on opioids for pain management. In many instances, our services will be the patients’ first exposure to physical therapy. This has a unique benefit of not only exposing our profession to a wider audience, which benefits all physical therapists, but it will also result in more patients receiving care that is appropriate for their degree of disability. By inserting ourselves into the patients’ lives at earlier stages of disease process, we can make key determinations whether this patient is appropriate for physical therapy, or if they require medical intervention beyond our scope of practice. In many instances, patients who are appropriate for physical therapy services seek medical care that supersedes their need. Therefore, the expense of the evaluation and treatment they ultimately receive far exceeds what is necessary for their particular condition.4 When Physical therapy is used as a first intervention, it’s been found to be a cost-effective way to save time and money for that individual.4 By providing individuals with services that are not excessive, but that are appropriate for their need, we can help reduce the total costs of their medical care.
Product Links
The products of this project are complementary. Below you will find the links to my sections of the feasibility study which include the User Profile, Employer Recruitment Email, Flexible Payment Models, Superbill and Employee/Employer surveys. In addition, you will find an evidence table and CAT that review manual therapy interventions for pain relief. To view the remainder of the feasibility study, please visit Kyle Wolfe’s capstone page.
Feasibility Study
- A brief description of the demographics and psychographics of two types of employees that would benefit from our business model.
- An introductory email for prospective employer clients that describes our services and benefits they will receive.
- Flexible payment models to cover our services that appeal to businesses of all sizes.
- An example document that allows cash paying customers to submit services to their insurance for reimbursement.
Example Survey (for prospective patient/employees)
- A market research tool to identify interest of employees for our services.
Example Survey (for prospective employers)
- A market research tool to identify interest from employers for our services.
Complete Feasibility Study (Both Chris & Kyle’s Contributions)
Literature Review
MT vs Exercise – Evidence Table
Critically Appraised Topic (CAT)
- Manual therapy versus exercise on pain and disability, specific to neck pain.
Evaluation
Over the course of our 3rd year I worked closely with Dr. Hacke discussing the capstone and my closely related independent study on dry needling. I received feedback along the way that helped shape the products of this capstone, but also supported my growth as a clinician. This project was a collaborative effort between myself and Kyle Wolfe where we combined our passion for pain management under the physical therapy scope to combat the rising issue of chronic pain, and lost productivity in the workplace. The intended audience to review our materials would include health care practitioners and employers of corporate businesses. An evaluation form was created in order to receive feedback about the proposed benefits and feasibility of our business structure.
Acknowledgements
There are quite a few people that deserve credit for the success of this project. I would like to thank professor Jon Hacke, DPT, PT, MA for agreeing to oversee this project as well as my independent study on dry needling. He was incredibly receptive to my ideas and offered practical and timely feedback all along the way. In addition, I would like to thank our two committee members Ellen Roeber, DPT, PT, MDT Certified, and Justin Wilhelm, DPT, PT, OCS. Both Ellen and Justin are physical therapy practice owners and their feedback is invaluable to our success down the road when we pursue this business. I would also like to thank my project partner Kyle Wolfe for his diligence, structure, and timeliness working on this project. We have very complementary skill sets and I look forward to pursuing this business with you.
Finally, I would like to thank our classmates, who first learned of this business idea in our PHYT 705 – Managing Contemporary Practice class taught by Dr. Roeber. Kyle and I have received and integrated input from our peers and I really appreciate the support and enthusiasm toward this business.
References
- NIH analysis shows Americans are in pain | National Institutes of Health (NIH). https://www.nih.gov/news-events/news-releases/nih-analysis-shows-americans-are-pain. Accessed January 7, 2021.
- Dahlhamer J, Lucas J, Zelaya C, et al. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults – United States, 2016. MMWR Morb Mortal Wkly Rep. 2018;67(36):1001-1006. doi:10.15585/mmwr.mm6736a2
- The Economic Burden of the Opioid Epidemic on States: The Case of Medicaid | AJMC. https://www.ajmc.com/view/the-economic-burden-opioid-epidemic-on-states-case-of-medicaid. Accessed January 7, 2021.
- Payers: Embrace the Value of Physical Therapy to Reduce Costs | AJMC. https://www.ajmc.com/view/payers-embrace-the-value-of-physical-therapy-to-reduce-costs. Accessed January 7, 2021.
- Mitchell RJ, Bates P. Measuring health-related productivity loss. Popul Health Manag. 2011;14(2):93-98. doi:10.1089/pop.2010.0014
7 Responses to “On-Site Physical Therapy for Workplace Pain Relief”
Debbie Thorpe
Hi Chris
Excellent project!! Very creative and supported well with the evidence. The idea of a mobile PT unit is perfect for large employers whose bottom line is productivity. Your model saves employee travel time, time off work , and preserves maximum employee productivity time. I would think employer like DOT and construction sites would be interested as well for their personnel where you could be on larger job sites to treat employees. You and Kyle really researched the business end of this project and it appears got some excellent feedback from your committee. Well done project….I will be looking for the truck pulling the trailer in the future!!
Best
Debbie
Ryan Brooks
Chris (and Kyle), I have enjoyed hearing the story of this business basically since the beginning of PT school with you both. I think this is a wonderful idea to capitalize on managing patient pain and seek out niche markets. I know many times in therapy we talk about how this is such a negative approach to therapy but as you laid out in this project, this may be their first experience with PT and if we can get them to buy in by helping make them feel good while simultaneously being cost effective, then I don’t see the downside. Additionally, this offers a great alternative to utilizing medication to treat pain. Another aspect of the project I enjoyed is your description of the reimbursement models. It was interested to see some of the information that was different than what we covered in our PHYT 705 course and introduced the idea to me of just how many different ways there were for you to bill for your services (billing employer vs billing employee vs billing the insurance company). I think offering target populations these options really allow you to reach people you might not otherwise. If the employer doesn’t want to pay for this for employees, then maybe the employees that want services come and pay out of their own pocket. And if none of these work, you could potentially even provide a business with a “free day” of service to show employees how you can aid in decreasing their pain. Eventually, the next time you show up at that specific site, this positive prior experience may entice some patients into seeking out your services.
One question I have for you is regarding target population. I know you stated corporate businesses/factories as the main target. However, I’ve recently seen a PT capitalizing in the commercial trucking industry (i.e. going to gas stations and offering services to truckers on the road that sit for prolonged periods and inevitably get stiff and painful). I see immense opportunity to expand this into other niche populations such as public service jobs (i.e., firefighters), labor intensive jobs (i.e., a Fedex facility), or even large community sporting events (i.e., marathons or AAU tournaments). Have you considered any other populations such as this? What do you feel is a key characteristic of these populations that make your business model fit these patients more so than seeking treatment at a traditional outpatient clinic? Thanks so much for the wonderful work and great job on this project!!
crsa
Hi Ryan,
Thanks for your in-depth response! I really like your idea of providing services to truckers. First thing that comes to mind is setting up a clinic at rest stops along major highways. Something that could be advertised with a road sign where truckers know they can dropin for quick treatment and continue on their way. I like your line of thinking! To answer your question about the characteristic of the populations we described, we believe these populations have common injuries inherent to being “overworked” or sitting for prolonged periods of time. Too much of any single position can often lead to pain. By providing PT at their workplace, we can offer education and treatment that would help employees throughout the day. The biggest reason we chose these populations, however, is simply logistical. I.e. there are many employee in one location. This guarantees that we have an adequate number of patients to see on any given day.
Thanks for reading!
Chris
Brianna Colello
Chris (& Kyle),
I love that the both of you have kept this dream for a mobile business alive, and have progressed the dream even further. I believe your business model can be highly successful by meeting a demand for PT that has not been widely used (work-place PT). I appreciate the resources you provide as they are versatile and can be used in most any cash-based model, in addition to any area. I believe that there is a strong future for cashed-based PT and have saved your resources for my own future use. Thank you for your hard-work and insights on this project, I am excited to see this business come to fruition in the future and best of luck ( & let me know if you ever need an investor)!!
crsa
Hi Bri!
I definitely think that the healthcare model is evolving and there are opportunities for creative businesses like this. While the goal of any business is to make money, I firmly believe this business would raise awareness for our profession while offering patients the help and education they deserve!
Thanks for the support,
Chris
Kaitlynn Durkin
Hey Chris!
It has been awesome to watch this business come to life over the past three years. You have identified how physical therapists can address the impact of chronic pain on workplace productivity in a creative and innovative way. Talk about literally meeting the patient where they are at! It is evident how much time and energy you have poured into both researching evidence-based interventions for chronic pain management and learning the business side of PT practice. Your payment models, competitor analysis, recruitment emails and surveys, feasibility study, and floor-plan for you mobile clinic are very detailed and create a clear vision of your business for investors and employers. It’s hard to come up with any suggestions or areas to improve. The only thought I have is that you could consider assessing corporate employees’ desk set-ups and providing education on ergonomic modifications since you will be located on-site; however, I recognize that this could be disruptive to the workplace and may not be desirable to the employer. All the hard work you have poured into this project the past several years have laid a solid foundation for you to start your business. I cannot wait to see where you take this after graduation!
Best of luck,
Kaitlynn
crsa
Hi Kaitlynn!
It has certainly been a passion project that I intend to bring to light. I agree with you on the ergonomics component you described as another way we can improve our patient lives, while adding more value to our business. To get our foot in the door with employers, we want to be least disruptive as we can be to their normal operations. This is why we offer such flexible payment models, including an entirely cash based option for employers that do not want to take a risk on us. However, I don’t think it’s unreasonable to make recommendations to the employees that include simple modifications to their desk set up! Great idea!
Thanks for the support,
Chris