The Surgeon-Therapist Relationship

Derek Cuff, M.D.Suncoast Orthopaedic Surgery and Sports Medicine

Goals

• Discuss the role therapy plays

• Discuss ways to improve communication

• Discuss ways to improve education

• Encourage you to document your value

Surgeon-Therapist Relationship

• Surgery is a team sport

– Surgeon– Patient– Operating room

personnel– Nursing – Therapists

Surgeon-Therapist Relationship

• Therapist are a critical part of the team

– Multiple interactions post-op

– Involved through duration of healing process

Surgeon-Therapist Relationship

• Best outcomes when both excel

• Bad surgery + great therapy = bad outcome

• Great surgery + bad therapy = bad outcome

Surgeon-Therapist Relationship

• Open line of communication is critical

– Instructions should be detailed and clear

– Interact with your surgeons beyond PT notes

– Phone, email, text etc if needed

– Alert us to compliance issues

Surgeon-Therapist Relationship

• Beware of “Eval and Treat Shoulder”

– Hold the surgeon to a higher standard

– Protect yourself by requiring more guidance

Surgeon-Therapist Relationship

• Expanding your education is key

– Learn more about the procedures

– Go watch a surgery

– Incredible online access as well

Surgeon-Therapist Relationship

• Gives you a mental picture of the mechanics

– How does the repair construct look?

– How does that artificial joint move?

Surgeon-Therapist Relationship

• Document your value

• Changing era in healthcare

• Value = Quality / Cost

Surgeon-Therapist Relationship

• Going to be a fight for healthcare dollars

• Treatments deemed high cost but low results will be cut

• Those who demonstrate the value of their care get paid

Surgeon-Therapist Relationship

• Fee for service model- Compensated for the number of treatments irrespective of outcome

• Value base model- Compensated for the level of outcomes you produce

Surgeon-Therapist Relationship

• Illinois- Avg. 43 visits: Cost $8066

• Florida- Avg. 32 visits: Cost $2343

• California- Avg. 22 visits: Cost $1529

Surgeon-Therapists Relationship

• Journal of Shoulder and Elbow Surgery 2012

– Dipalo et al.

– 36% reduction of PT visits via an independent home program = no difference in outcomes after RTC repair

Surgeon-Therapist Relationship

• “You are an endangered species in the coming health care environment if you do not prove your value.”

– JP Warner-Harvard School of Medicine

Surgeon-Therapist Relationship

• Fee for service model is in jeopardy of fading

• A therapists value may be higher if you treat the patient 22 times vs 43 times depending on outcome

• We will be judged (and compensated) on our outcomes

Surgeon-Therapist Relationship

• If we are judged on outcomes then surgeons and therapists are linked

• Surgeon is = to therapist in this equation

• Collaboration is critical

Surgeon-Therapist Relationship

• My advice

– Document your outcomes

– Only way to show and track your value and show you are critical part of the team

– Use validated outcome scores to show you make a difference

Conclusions

• Therapist are a critical part of the team

• Push for open communication

• Maximize your education

• Document your outcomes

Thank You