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Arizona Couple Shows Patient Advantages of O&P, PT Partnership
By Tina Eichner Orthotic and prosthetic professionals and physical
therapists alike are quick to acknowledge the others clinical
importance in the patient care value chain. It is in the politics
and the legislation that defines each discipline where things can
get a little sticky.
Joe Pongratz, CPO, FAAOP, and Anissa Pongratz, PT, of Arizona,
have taken the O&P, PT symbiosis to a whole new level by
opening a private PT business within an O&P facility. The
husband-and-wife team are the only providers in the state providing
complementary services in the same facility--prosthetics,
orthotics, and physical therapy. The innovative concept has
received a warm response from the surrounding patient and medical
community. In addition, Joe noted that he and his wife do engage in
conversation about the current direct access debate--and he "is not
sleeping on the couch."
Pongratz O&P was established by Joe in 1997 and now has
three locations with a team of eight clinicians in Phoenix, Mesa,
and Tucson, Arizona. In 2004, his wife Anissa opened a private
physical therapy practice within the Mesa location.
"Anissa and I worked together for two years before we were
married while she was a staff therapist at Barrows Neurological
Rehabilitation in Phoenix," said Joe. "We were married in June 2004
and shortly after that she started her own PT clinic housed in the
Mesa office. It is the only combined clinic in Arizona and one of a
handful in the western United States."
Joe said Pongratz Orthotics and Prosthetics Inc. joined with
Pongratz Physical Therapy LLC with an aim to provide the most
complete prosthetic management for amputee patients with a team
approach to managing patients, emphasizing continuity of care, and
ensuring clinicians are up to date on each patient being treated.
The providers are able to work hand-in-hand to customize a
treatment program to better meet the patients' needs and help
amputees progress to their full potential. The couple thinks that
it is a logical business model for the future.
Patient Benefits
"It works so well because we don't have the borders to cross or
consider. In our environment everything is available at our
fingertips," explained Joe. "We do what is best to service the
patient in the best environment for the patient, including
on-the-spot consulting and alignments."
Both Joe and Anissa stressed that the greatest benefits of their
business arrangement are to the patient. For example, rather than
missing several critical days of physical therapy because of a
needed mechanical adjustment, the prosthetist is able to make an
adjustment immediately, physical therapy treatment can continue
uninterrupted, and the quality of care therefore is improved as
both team members are able to work together in an easily accessible
environment.
"We know that our team approach is outstanding," said Anissa.
"From the PT perspective, prosthetic adjustments are sometimes
needed because of PT progress. At our practice this can happen on
the spot. Get an opinion, make the adjustment, and move
forward."
Anissa said that since patients are able to progress more
quickly through the therapy program, they stay motivated rather
than waiting weeks for an appointment with the prosthetist for a
simple adjustment in order to continue therapy.
And as Joe said, the physical therapy available is tailored for
the amputee patient. "Our therapy is very specialized. Not many PTs
can brand themselves as O&P specialists. It is not a common
treatment modality for PTs in general to be working with
O&P."
Anissa has developed that expertise specializing in amputee gait
mechanics and balance training, although she continues to treat
neurological and orthopedic injuries as well.
Joe added, "We want to get the attention of the rehabilitation
community that this is a smart business model for patient outcomes.
We have strict boundaries [for who provides which services], but
all the resources are there at our fingertips."
The Pongratz's don't just want to emphasize the benefits for the
patient. The complementary business model also is cost-efficient
for payers and insurers in time savings, transportation, and other
costs, including fewer appointments.
On Direct Access
On the topic of direct access legislation and increased physical
therapy scope-of-practice, Joe stated, "Fabrication and
manufacturing is the line in the sand; dealing with materials, the
hands-on skill and art and expertise in making these devices--that
is what separates the professions."
He continued, "It is a warranted discussion. O&P knows what
is needed. We know the clinical, technical background to provide
exemplary care.
"I am not against qualified people providing service.
Unqualified people should not be able to provide service
based on minimal education and experience. With every profession
there should be a balanced blend of clinical application,
education, and experience," he said.
Anissa commented, "Direct Access specifically just allows
patients to receive an evaluation. The confusion is that PTs can
provide care without a doctor's referral, and this is not the case.
A doctor's order is required.
"I agree that unqualified medical personnel should not be
extending their scope of practice. PTs are bound by their code of
ethics that if they do not possess the clinical expertise and
education to support their treatment, they must refer services
elsewhere," said Anissa.
"Direct Access, however, seems often misconstrued," she
continued. "Direct Access specifically allows a Medicare
beneficiary to initiate and/or continue physical therapy
interventions without the burden of waiting for the physician's
prescription within the previously mandated 30-day interval.
Physical therapists can evaluate a patient and make recommendations
with regards to their care, but the plan of care must be signed by
the physician. This does not mean that a physical therapist may
prescribe and manufacture orthotics and/or prosthetics without a
physician prescription, which is how it seems to be
interpreted." 
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Physical Therapists: Colleagues or Combatants?
- March 2006
Feature
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PT 'Direct Access' —Why Is It Considered a Threat?
- July 2005
Feature
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PT Direct Access: Threat to O&P?
- September 2003
Should physical therapists have “direct access” to patients—being able to provide physical therapy
services without a physician’s prescription?
With or without the passage of “direct access”
legislation, should physical therapists be allowed to provide orthotic and prosthetic services and devices, without additional education, training, licensing, and/or certification, as part of their scope of practice?
Feature
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It’s All About Education, Training, and Experience
- June 2003
Perspective
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Physical Therapists: Are They Encroaching on O&P?
- April 2003
Are the two disciplines complementary or competitive? How much do they overlap? Here, two physical therapists with wide experience in working with prosthetic and orthotic patients give their views.
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Prosthetists: A Physiotherapist’s Perspective
- March 2003
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Physical Therapists: Partners or Competitors?
- October 2002
Orthotists and prosthetists share their views on this controversial question. Next month, physical therapists and those who practice in both fields will get their say.
Feature
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Table Of Contents - March 2006
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