I frequently get asked, "how do I lower my visit average?" This depends on a lot of factors, but in general, if you treat the average patient who should be a Rapid Responder, the visit average should be somewhere around 6-8 visits.
There are some out there on social media who have visit average claims that are lower and higher. However, if in general, most of your patients are in therapy for 2 months or more, you're probably stringing them along and perhaps not even know it.
1) Have a plan
- the plan and progression/regression of the patient's program should be based on your experience for how the patient presents and what they are having PT for
- perhaps you're McKenzie trained and spine patients are mostly getting better in 4-6 visits
- you should be able to take those same principles of repeated motions to the extremities and TMJ and loading strategies to empower patients to self treat
- make sure the patient is involved in this plan with a clear prognosis
- I often tell patients, "Based on my findings and how you are responding to different positions/movements/treatments, I think this will take about 4-6 visits."
- it may be more or less depending on how rapidly you respond, compliance, and other factors
- bottom line: if you don't have a clear plan/progression in your head on where you want the patient in 3-4 weeks, how can you tell them a prognosis?
2) Frame your treatments as transient and ensure dosing is understood
- one of the first things I tell patients is, "No matter what intervention I choose today, scraping, wrapping, movement, exercise - the effects of that treatment will not last unless you reinforce them
- another thing I say, "If you walk out of here feeling and moving better, and I give you homework to reinforce it, you should come back next visit keeping at least some of the improvements."
- this is repeated over and over throughout the session
- after showing them their own self resets or correctives (and of course spending time making sure they know how to perform them correctly), I ask them, "Whose fault is it if you only feel good when you leave, but not when you come back?"
- check out this video on how I explain Resetting the Pain Threshold
- bottom line: if the patient understands the HEP, you chose the right self treatment strategy and they dose appropriately, the patient will get better, faster, and without 2-3 visits/weekly
3) Understand your limitations
- realize that with Rapid Responders, it normally will not take 5-6 visits for any one treatment to start having major effects
- pain and mobility can often be rapidly improvement through exercise/movement/manual means
- the technique and exercise most likely does not matter - choose a combination of what you're smoothest at explaining and delivering plus what the patient may prefer and had good experience with in the past
- if you think some breakthrough in pain reduction is going to happen after a month of little to no changes, it's probably not going to happen and it's time to refer out
- bottom line: it's unlikely you're going to stumble upon some amazing treatment after 1 month or greater than 6 visits of little to no effect
4) Make the patient's home program simple
- even if someone has a lot of deficits to work on, choose one that is both easy to work on and the one your gut tells you will give the patient the most functional gains
- a home program of even 4 or more exercises is likely not to be performed in the dosages that are enough to maintain improvements between visits
- keeping the home program to 1-2 things at a time that are novel and get rapid gains are also a sure fire way to keep the improvement going between visits, and also cut down on visits overall
- bottom line: if the average person cannot understand your HEP, or it takes longer than 5 minutes to explain it, it's probably too complex
5) Choose your patients wisely
- another way I keep my visit average down - I discharge mostly without exception after
- 2 no-shows or 2 cancellations
- in general, some patients have a good excuse, but those who cancel regularly, are more than 15 minutes late regularly, I count them as a cancellation
- they don't value your time, or for whatever reason going on in their lives, they cannot commit themselves enough time to help themselves
- if you keep on seeing patients and/or letting them reschedule, chances are, your visit rate is going to be higher than it should be
- bottom line: non compliant patients are wasting your valuable time
Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!
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