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For
Healthcare Professionals
Frequently
Asked Questions By Physicians:
- How is PNBC different from
other rehabilitation facilities or physical therapy
clinics?
Traditional Facilities |
PNBC |
| Pain is a warning: slow down |
Pain is expected: speed up |
| Encourage pts to return for treatment |
Encourage self care |
| Provider will fix me |
I can fix myself |
| Clinics profit by maximizing charges per patient
visit by providing multiple treatments/tests regardless
of scientific support |
Minimize amount per pt visit by avoiding costly
treatment/tests that do not scientifically improve
the outcome. Profit follows from increased volume
generated by positive word-of-mouth, good outcomes,
and lower costs. |
| Often emphasize temporary pain relief |
Emphasize lasting improvements in function |
| Randy Moss had an MRI, why not me? |
Educate about unnecessary tests |
| Surgery early |
Surgery late |
| Rely on subjective reports of pain to gauge progress |
Rely on objective measurements of strength, endurance,
and flexibility to gauge progress |
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- Can patients with extremity
pain participate?
Yes. More than half of the patients
we treat have some component of leg and/or arm pain.
Sometimes the pain is referred, sometimes radicular.
Some have neurologic
deficits. All variations have responded to the proper
kind of exercise.
There is often a perception that the
presence of extremity pain is cause for alarm, a reason
to immediately get
an MRI scan or refer the patient to a surgeon. But
if a neurologic deficit is not profound (i.e., a complete
foot drop) or progressive, conservative care is appropriate.
Fortunately,
the vast majority of patients presenting with neurologic
deficits will not exhibit profound or
progressive problems. It is important to remember that
even though disk herniations can be very painful, the
prognosis without surgery is actually quite good, and
90% or more should heal
with conservative care (References 1,3,4.5.6.7).
Disk herniations often shrink or are totally
resorbed; the larger the herniation the more likely it
is to resorb. Our outcome
studies have documented
the success of many patients with extremity pain, both
radicular and referred
Patients
who fail rehabilitation and have significant radicular
pain attributable to a specific disk lesion
are good candidates for a surgical evaluation. However,
our philosophy is to give patients a chance to get well
without invasive treatment.
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- Does PNBC participate in Medicare?
Although
we are not participating providers because of excessive
government interference and red tape, we
do individually contract with Medicare patients to provide
services. What is unique is that the patients only pay
a fee if they believe they have significantly benefited
from our treatment. The maximum charge is $1500 for as
long as it takes to optimize spinal
fitness (typically about 24 visits over 12 weeks for
elderly patients). At the end of the treatment they can
choose to pay what ever they feel the treatment was worth,
including nothing. This unique approach gives us a legal
mechanism to treat elderly patients for free, while
enabling us to receive remuneration from those who
can afford treatment.
The danger in a program like this is
that our clinics get overrun with elderly patients
that cannot pay for
treatment. We couldn't survive in such an environment
and would likely be forced to then limit participation.
For physicians considering referral of a Medicare patient,
the treatment has been successful for many conditions
including spinal stenosis, degenerative spondylolisthesis,
neurogenic claudication, degenerative disc disease, etc.
But severely compromised patients (COPD, congestive heart
failure, emphysema, etc., or those with severe osteoporosis
and vertebral fractures) are not good candidates. The
ideal candidate is the relatively healthy senior who
wishes to be more active but is limited by back and/or
leg pain.
At minimum, patients should at least be able
to ambulate independently. These patients are usually
a delight to work with, and we consider it a privilege
to interact with them and get them back to their regular
daily activities.
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- What
patients are inappropriate for PNBC?
A) Acute
injuries. Previously healthy
patients experiencing their first significant injury/episode
usually need only
reassurance or short-term passive treatment. 80% or so
should respond without needing further treatment. For
those whose symptoms last beyond 2-4 months, or for those
with a previous history of multiple similar episodes,
PNBC is a good choice prior to expensive diagnostic testing
or treatment.
B) Patients with contraindications to treatment including:
- Tumor
- Infection
- Acute fracture
(old healed fractures are appropriate)
- Pregnancy (for
low back patients; neck treatment is permissible)
- Visceral
source of low back pain (peptic ulcer disease,
pancreatitis, abdominal
aortic aneurysm, etc.)
- Recent eye or abdominal surgery
(must wait 6-8 weeks postop)
- Psychosis
- Severe debilitation
(heart or lung disease; patient should be independently
ambulatory)
- Patients with an agenda who
simply want to have an injury validated but have
no interest in getting well
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- How does PNBC communicate with
referral sources?
All PNBC physician reports
are faxed to the referring physician within a few
days. The information will include
objective data about the patient's status and how far
they have to go to reach their goals. If necessary, PNBC
will call the referring physician.
Referring physicians
can request to continue to control the case or they
can turn details such as managing return
to work over to PNBC.
Every three months, PNBC will send a summary report to
each referring physician listing the status of all patients
referred during that period of time. This report will
include objective data about strength, disability scores
pre-and post treatment, current status of chief complaint,
and patient satisfaction scores with treatment outcome
and treating physicians and therapists.
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- Do you have any data to support your approach?
Yes. PNBC personnel have published
over 40 articles in peer-reviewed medical
journals relating to the
efficacy of our treatment approach. Perhaps the most
important data involves reutilization. As all
physicians know, patients with chronic spinal pain tend
to re-utilize the health-care system over and over again
because any results from treatment tend to be temporary.
PNBC believes that the correct exercise approach combined
with patient education can decrease reutilization significantly
and we have proven this in two separate studies.
In the
first study we
compared reutilization rates between two groups of
patients.
The
first group completed the PNBC program while the second
group of matched controls participated in traditional
rehabilitation/therapy. At an average of 18 months post
treatment, reutilization in the control group was 42%.
The rate in the PNBC group was only 13%. For workers
compensation patients, the numbers were 76% for traditional
care versus 25% for PNBC care.
Another study combined
results from PNBC with patients treated in a similar
manner at
the University of California at San Diego. Both clinics
achieved reutilization rates of approximately 12% at
an average follow-up of one-year which it is quite good
in this patient population.
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- What conditions does PNBC treat?
- Herniated lumbar or cervical
disc
- Spondylolisthesis and spondylolysis
- Post surgical
pain (fusion or discectomy)
- Recurrent episodes of acute spinal
pain (“My
back keeps going out”)
- Degenerated
or bulging disc(s)
- Facet syndrome
- Chronic sprain or strain
- Old spinal fracture
- Non-specific neck or back pain
- Spinal stenosis
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- What type of insurances does PNBC accept?
We accept essentially all insurances
including UCare, workers compensation, motor vehicle,
Health Partners,
Medica, Blue Cross Blue Shield, Preferred One, Choice
plus, and literally hundreds of smaller carriers. We
treat Medicare patients according to question 3 above.
If there is any question, please call one of our offices.
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