PART 3 | capstoneproject

Part 3 I have looked at multiple articles while doing my research, but these are the ones that have helped me the most: A New England Journal of Medicine. This is an article depicting a study that showed physical therapy can be just as, if not more, effective as surgery. Most of the patients in the study were 45 years old or older and all had some sort of knee injury. Those who went to physical therapy first found that many of their injuries could be fixed in a few short months with the proper treatment and they could avoid surgery altogether. The majority of patients who had surgery first discovered that they could have just as easily fixed the problem by going to therapy, but instead had to pay extra for the surgery and attend physical therapy anyway. "This study demonstrates what physical therapists have long known," explained APTA President Paul A. Rockar Jr, PT, DPT, MS. "Surgery may not always be the best first course of action. A physical therapist, in many cases, can help patients avoid the often unnecessary risks and expenses of surgery.” Through lots of research, the industries “findings suggest that a course of physical therapy in this patient population may be a good first choice since there were no group differences at 6 months and 12 months in this trial. These findings should help surgeons, physicians, physical therapists, and patients in decision-making regarding their treatment options." This study was done by qualified surgeons, physical therapists, and physicians. Multiple patients from many different background participated and were allowed to choose whether they wanted to go through physical therapy or have surgery first. I will be able to use this source to show how having surgery before trying physical therapy can be more harmful and costly than good. The next source that will be of much use to me is slightly different. "Georgia's Hospitals: Rural Hospitals In Crisis." This source describes the relationship between local rural hospitals in Georgia and physical therapy. The main subject is how physical therapist help hospitals financially, but also indirectly. When patients come to the hospital the doctors are required to give treatment. Most pay with medicare or medicaid. However these programs are causing hospital workers to go unpaid. When patients do not attend physical therapy they are going right back to the doctor over and over again, but with the proper therapy patients will only have to make one visit to the hospital and local rural hospital will be able to slowly get themselves out of debt. Many patients known as “frequent fliers” are using the emergency room for non-emergencies in order to get medical help without having to pay. “Penalties can be especially hard on hospitals that serve large numbers of low-income patients who may have difficulty following physicians’ instructions or taking medications after they are discharged.” Many patients do not have the insurance to go to physical therapy so they don’t and, on average, these people will end up back at the emergency room within 30 days of their initial release. The article is from the Georgia Trend and was written in December 2016. There are multiple quotes from local physicians, doctors, governors, and other governing officials to back up statements given. It was written only a month ago so it is not old news. I will use this article to demonstrate the connections hospitals and physical therapists have both intentionally and unintentionally.

Another way to help me gather more information is to interview someone that works in the medical field. For example, I interviewed Mrs. Betsy Farmer, an emergency room nurse for Northeast Georgia Medical Center:

1. Question: Approximately how many people do you think come to the emergency room for treatment a day?
2. Response: The emergency room sees approximately 300-400 patients each day.
3. Reflection: I think that the reason so many people per day is because urgent care either does not provide the type of care, the emergency is too serious, or the emergency room is closer than and urgent care or other medical service.
1. Question: Out of that number, how many would you guess have no insurance or have to pay out of pocket?
2. Response: Approximately 20-25% of the patients seen in ER are self-pay or do not have insurance.
3. Reflexion: There are a lot more people who pay out of pocket than I originally thought.
1. Question: Is it normal for patients to come to the emergency room for treatment when it is not an emergency?
2. Response: It is not normal; however many times patients have attempted to go elsewhere for treatment (urgent care's, primary care physicians) but are sent to the emergency room for treatment.
3. Reflexion: This is surprising considering you do not immediately have to pay for the services the emergency room provides. I understand why people try to avoid the emergency room though because it takes longer to get in and out since there are so many people. Plus urgent care or primary physicians may not have the treatment that some patients require.
1. Question: Do you have any patients who are continuously coming back to the emergency room for the same injuries and why do you think that is?
2. Response: We have patients who return for the some problems. There are various reasons for those returning. Some are in an emergent situation, some are instructed to come to the ER and some do lack the funds to go elsewhere.
3. Reflexion: This makes sense and could probably be fixed with either physical therapy or other care and recovery services.
1. Question: Does the hospital you work at have a rehab center? If so, do all patients attend, only those with insurance, only those without insurance, etc.?
2. Response: We do have an inpatient rehab unit. Patients who utilize the unit without insurance would be considered self pay.
3. Reflexion: the idea of an inpatient rehab unit is very helpful to most patients especially those without insurance. It would be interesting to find out how many patients utilize the inpatient rehab unit.
1. Question: What hospital do you work at?
2. Response: Northeast Georgia Medical Center.
3. Reflexion: My family goes to this hospital for yearly check ups.
1. Question: What hours are the busiest and how old are the majority of patients during these times?
2. Response: The busiest hours are usually from 11:00 am to 11 pm.
3. Reflexion: So most patients come to the emergency room during lunch hours. I thought that later hours would be busier.
1. Question: Many rural hospitals in Georgia are closing because of the insane amount of debt they are in due to a multitude of factors. In you opinion, what do you think is the biggest reason for the debt and closings of these local hospitals?
2. Response: There could be a lack or resources, an increased number of indigent patients,lack of insured patients – a possibility of insurance claims being rejected.
3. Reflexion: This makes very much sense and I expected this answer.
1. Question: If all patients were able to attend physical therapy after treatment would this be beneficial to the hospital and why or why not?
2. Response: We don’t send patient directly to rehab from the emergency room. (I will try and get an answer for you though)
3. Reflexion: I kind of assumed this was the case, but hearing it from someone who actually works in the emergency room helps me get a better picture of what goes on in that wing of the hospital.
1. Question: How does insurance play a role in the treatment of emergency room patients?
2. Response: Insurance does not change the treatment of plan of care for patients in the emergency room.
3. Reflexion: This is because the emergency room is required to provide medical assistance to anyone who comes.