Physical Therapy + Primary Care = Improved Access for Veterans
By Alex Strauss
The Sioux Falls VA Healthcare system is in year two of a bold experiment that is changing the way patients access care for musculoskeletal dysfunction - for the better.
Since 2016, the VA has had a physical therapist embedded in the primary care clinic. The goal of the program - which started as a three-month trial quickly became permanent - was to not only speed up the time it takes for patients to be evaluated by a PT, but also to streamline the triage process for musculoskeletal issues, free up time for primary care doctors to concentrate on other ailments, and eliminate unneeded neurology, radiology, and orthopedic referrals.
According to Brandon Peterson, DPT, Cert. MDT, who heads up the project, it has accomplished all of these goals and more.
“The research has repeatedly shown that, the quicker someone can receive hands-on treatment after musculoskeletal injury, the quicker they resolve and the quicker they return to normal life,” says Dr. Peterson. “I had a lot of objective information to share with my leadership when we proposed this in 2016.”
Before the new process was implemented, veterans, like patients in the private sector, saw their primary care doctor first for things like back pain, neck pain, sprains and strains, and received a referral to a PT for further evaluation. Once referred, the patient had to wait again for an appointment.
Under the new program, the patient can see a PT first in the primary care clinic. If the problem is simple, such as needing a cane or walker or a low back pain screening, it may be taken care of then and there. If further evaluation is needed, the appropriate referral can be made immediately without waiting for a PT appointment.
“Say a veteran comes in with a laundry list of things they want to discuss with their primary care provider,” says Dr. Peterson. “The provider can address all of their needs and can refer that patient to me for the low back pain part of it. So we are meeting the veteran’s needs comprehensively and providing better care while simultaneously saving time for the primary care doctor. It is a win for everyone.”
In the first year of the program, the number of specialty consults from primary care dropped by more than 220 in the first year. There were also more than 500 fewer X-rays ordered and 200 fewer MRIs, a situation that not only saves money but also improves access to imaging tests for those need them.
Meanwhile, because primary care doctors no longer have to spend their time on musculoskeletal issues, the wait time for an outpatient primary care visit has improved by six-days. Thanks to numbers like these, the program is being implemented in the remaining 8 sites within the regional VA service area.
“There is starting to be a national movement toward embedding PTs in primary care,” says Peterson. “Our VA is setting a model for other VAs as well as private sector hospitals.”
Here is what providers and patients have had to say about the program:
Primary Care Staff Testimonials:
“This program has been beneficial in getting timely care, for acute musculoskeletal issues, both with evaluation and with prescribing a treatment plan. It is a system focused and complete exam, and it has been instrumental in evaluating the need for more complicated problems or a goal directed need for advanced diagnostic studies, treatment plans or specialist services. PCPT has helped my practice with access and my patients with quick resolution of acute musculoskeletal issues that directly affect their quality of life and restoring their health.” – Audrey Kost, PA
“The physical therapist in Primary Care has helped Veterans get the care they need when they need it most. Veterans are very pleased to be seen the same day and leave Primary Care with the tools they need to treat their pain before they travel home.” – Keith Behl, CNP
Veteran Testimonials:
“I noticed improvement after one visit without having to take any medication and I was able to return to work the next day. I am grateful for this service.”
T. Veteran – SFVA
“The results I have experienced have been realized using a combination of proper diagnosis, moderate physical therapy and educational materials. As a result, I clearly understand my physical condition and I am empowered to manage and minimize my symptoms on an ongoing basis. This process has been a life changing and extremely rewarding experience.”
M. Veteran – SFVA