Take Control of Your Recovery with Direct Access Physical Therapy

[00:00:18] Welcome to The Rehab Revolution. This is episode 5 where we're going to be talking a little bit about going beyond the prescription and why direct access to physical therapy can change everything. Now, let me ask you something. When you're in pain, who do you call first? Your primary care doctor, a specialist? What if I told you you could actually skip the line altogether? No referral, no waiting, just direct access to the expert who can actually help you heal.

[00:00:49] Today we're blowing the lid off of one of healthcare's best kept secrets, and trust me, it's going to change the way you think about your own recovery. This is The Rehab Revolution, and we're just getting started. So, Dr. Garifo, most people assume that they do need to see a doctor before they can start physical therapy, but that's not really true anymore, is it?

[00:01:12] That is absolutely inaccurate. It's one of the biggest myths right now still floating out there. I'm not sure why, but it is. In most states, including Pennsylvania, where I practice, you do not need a referral to start physical therapy. You just don't. It's called direct access for a reason. It's been legal here for years, but it seems as if not a lot of patients know about it.

[00:01:35] And what that means is that if your back's killing you, or your knee's locking up, or you're still suffering the same symptoms after a concussion, you can come straight to me. No gatekeeping, no gatekeeping, no red tape, no wasting weeks waiting for appointments or imaging or injections or medicine that might not even be necessary. You get evaluated by a movement expert, a doctor of physical therapy, on day one upon direct access, which is fantastic.

[00:02:06] As you know, the rehab room is inherently disruptive, and it's all about proactive care and self-referral. That's our model. Our model of care is self-referral. It's not insurance-based. It's not primary care-based. It's public-based. That's what we were built for, to restore control over your own recovery.

[00:02:29] We don't just treat pain as you know. We treat the whole person, psychologically, physically, and we do it without the red tape. So instead of waiting for someone to tell you, which really seems odd to me, like you're essentially waiting for your primary care or your specialists to say, it's okay for you to go get help. It's okay for you to go get pain relief. I'm here to tell you, you already can, and it can change everything.

[00:02:57] Yeah, that's definitely helpful. I mean, I'm not in PA, but I'm in New York City, and I worked with providers and doctor's offices and with insurance, and I was always under the impression that, for the most part, you do need a referral to see a specialist, especially a physical therapist. So it's definitely important for patients to know about direct access, but how does it impact their recovery time or the cost and their outcomes overall?

[00:03:24] Yes, it's critical. I really think it's critical because if you think about in healthcare, everything in healthcare, time lost is function lost. So if you're losing time for your rehab or you're losing time to get in to see your primary care doctor or your doctor of physical therapy or your orthopedic surgeon, the longer you wait to address that pain or that injury or that dysfunction, the harder it is to reverse. It's not impossible, but it gets harder as the time goes on.

[00:03:54] Direct access gives our patients the power to take action immediately, not wait two, three, four weeks to go see their primary care doctor, and that can make all the difference in their outcomes. Excuse me, from a discovery standpoint, physical therapy reduces the risk of chronic pain, unnecessary imaging, unnecessary injections, or even surgery. So from a cost standpoint, think about that.

[00:04:20] If I'm seeing study after study showing that when patients go directly to physical therapy first, they've reduced their spend dramatically overall across the boards. And from a system standpoint, it just unburdens the primary care and orthopedic piece of the model and frees them up to deal with truly medical cases.

[00:04:44] Oftentimes, a patient will wait to go see an orthopedic surgeon and orthopedic surgeons don't like to see non-surgical cases. It wastes their time.

[00:05:24] At the rehab room, we don't wait for the symptoms to get worse. We intervene early and tell her a plan directly for that patient to get them back to their life fast and not delay at all. Absolutely. It sounds like definitely a win-win situation all over. It does. The patient's getting the care that they need sooner. They're risking other things coming into play, like you said, surgeries. And no one wants to go through a surgery unnecessarily for sure.

[00:05:52] And from a financial standpoint, if you just cut out all of that in between and middleman things, you're just going to get straight to helping the actual root of the problem. It does. And insurances can be super tricky and complicated. I think everyone knows that. I don't think anyone loves to deal with insurances. I know I do not. But can you explain a little bit more about how insurance or state laws come into play with this?

[00:06:20] What kind of license specifically does allow you to accept patients directly? Yes, that's a great question. So specific to Pennsylvania, because that's where I practice, I also have a license in New Jersey, Delaware, as well as Pennsylvania. But we'll just focus on Pennsylvania. So licensed physical therapist. So you're a licensed physical therapist and you have your clinical doctorate in physical therapy. That does not mean you're a direct access physical therapist. That's an advanced kind of licensure, if you will.

[00:06:48] So you apply for licensure and you're a licensed physical therapist, but you also have a co-license, another license, another board certification that direct access. And that requires, I think it's five to 10 years of practice before you can be a direct access physical therapist. And that, again, additional experience, education, board approval.

[00:07:12] It legally allows me, as a direct access doctor of physical therapy, to evaluate and begin treatment immediately. No referral and no script is needed for the patient. Now, when it comes to insurance, that varies. So if you look at just traditional insurances like Independence Blue Cross or Aetna or Cigna, they cover physical therapy under direct access. Medicare, however, is a different animal.

[00:07:39] So Medicare allows for direct access for physical therapy. However, they want that patient to be within, in front of a primary care doctor within 30 days of that evaluation. However, at the rehab room, we don't take insurance. So then we're not limited by any of the insurance, you know, essentially laws or legally I'm allowed to treat a patient without a referral.

[00:08:05] So insurance is about coverage or reimbursement for that care, which is totally different than allowing that physical therapist to treat that patient or evaluate that patient. So it's not just legal. It's really designed to streamline care. If you're in pain or you have a dysfunction or you want help today, you don't need to jump through all the hoops that you have to do that to go see the physical therapist, specifically at the rehab room.

[00:08:33] We're designed that you walk right in and start healing right away. You know, I keep on bringing this up, but it just seems like really awkward that a patient has to wait for permission to go get pain relief. It just doesn't make sense. So to wait two weeks to go see your primary care doctor for your primary care doctor to spend five minutes with you to say, yeah, you know what, Layla, you definitely should go see a physical therapist. I have 47 patients out there.

[00:09:03] Here's your script. And then you come see me two weeks later. Why not come see me tomorrow and not wait two weeks for the pain relief? Absolutely. And not have to suffer being in pain for those two weeks and just navigating life with pain. I mean, no one wants to do that.

[00:09:23] And then I guess I just have a question in terms of understanding that better that I wonder if some of our listeners do too, since you don't take insurance and you are out of pocket, would that be like out of network where? Yeah. So that's a great question. So I have a few patients now that as an out of network provider, I can give them what's called a super bill.

[00:09:45] So you come in, you receive your care and we, you know, here we are four weeks later, you're done, you're healed and your bill was X. I give you a super bill. And oftentimes you can go back to your insurance company and say, Hey, I went to an out of network provider. I was billed this much. I paid this much and I want reimbursement. So we're seeing anywhere from 60 to 90% reimbursement around a cash paying patient.

[00:10:10] So they're able to go get their benefit of reimbursement after payment upon care. That's great. I mean, I'm sure that that's helpful for people who want to come see you in the rehab room and feel maybe I can't afford this fully cash out of pocket expense. But if they do have the option to reimburse themselves through the super bill with their insurance, they might be more inclined to take a look at the rehab room and see if it's a fit for them. Yeah.

[00:10:37] And we'll get into, you know, a little bit later, but the discovery visit is really unique to my practice. And that's a, that's a free visit. I offer every new patient and it's not an evaluation. It's not me palpating or checking your strength or your range of motion. It's merely a conversation. So you come into my office. We spend 15 minutes together. You walk me through what your concerns are, what your, where your pain is, what your care trajectory has been to date.

[00:11:05] Meaning you were had, you had injections, you had medicine, you had chiropractic, you had physical therapy. Nothing's working. Is there a fit with what I offer you? If there is, here's what I do. And I want to schedule an evaluation. I had a patient come yesterday. She came in for a discovery visit. She interviewed with me. She toured the facility and she said, you know what? I want to try my insurance. I said, fine, no problem at all.

[00:11:32] So she left my office, went down the street to a commodity physical therapy that we're surrounded by, went into the office, met the physical therapist, turned right back around, came back to my office and cut a check for her entire care. Why? Because of my interaction with her meant so much more than what she experienced in this high volume, fast paced clinic when she was surrounded by just chaos.

[00:11:59] And she went in and said, I don't want to be treated in this type of climate or this environment. So that's why I offer my patients. So the free discovery visit is crucial because if there's a fit, let me talk you through my model of care. How am I different? You know, I don't do six an hour. I do two an hour. You're with me the whole time. You're not with our aid. So that's a really huge incentive for the patient to come experience that free visit. And then they can decide if they want to come here for an informal evaluation. And that costs X.

[00:12:28] And we walk through all that. And we also walk through, Layla, what we just discussed around, like, what is a super bill? What do I offer you with a super bill? You know, there's no guarantees for reimbursement. However, I've had many successes with this particular bill that you go back to your insurance company, you could pay back 80% of your charges. Absolutely. Absolutely. It might not be applicable to everyone, but I think it's a great option to even have an awareness that that does exist, that you can potentially try to get some sort of reimbursement.

[00:12:58] That's right. Now, let's bust a myth. I know there's so many things about healthcare, and there's so many myths that go around, and some things are true, and some things are not. So what's something that people get totally wrong about how the healthcare system requires you to see a doctor first? I think of, with that question, I think of, like, my parents.

[00:13:22] I think about how everything, everything health-related was via the primary care, my family doctor. So the biggest myth is, today, is that your primary care doctor is the gatekeeper for everything, including physical therapy. People think, here we go again with that permission. People think, patients think, they need to get permission to address their pain.

[00:13:50] Or that, you know, I'm doing something wrong, or my doctor will be mad at me, and they don't follow the traditional path. That's just not true. That's a myth. You don't need to go to get the thumbs up to go get pain relief that you didn't want to wait two weeks for. So that is the biggest myth. The reality is that people don't need to be told they're in pain. You already know you're in pain.

[00:14:18] In many cases, the doctor's visit just adds a delay. That's all it does. It adds a delay. They might say something, and I hear it every single day. Go rest. Take this medicine. Here's another prescription. Here's another prescription for an x-ray or an MRI or a CAT scan. Before even someone lays a hand on you, they're three or four weeks out by getting additional diagnostics, additional prescriptions. They're heavily medicated.

[00:14:47] Why not come in tomorrow and get relief and hands-on health care tomorrow? Why wait three weeks to go see your primary care? Who do you think is the gatekeeper? They're not the gatekeeper. You know, pain, in my experience, 30 years of doing this, pain is rarely, rarely a prescription problem. It's not something the doc, the specialist, the surgeon can just prescribe away.

[00:15:16] Usually, oftentimes, it's a movement problem, and that's our specialty. As a doctor of physical therapy, a movement expert, I'm trained to assess, diagnose, and treat most, if not all, musculoskeletal issues from day one. And if I can't diagnose or treat, I know exactly who I'm going to send them to. I know the specialist for neuro or the specialist for ortho.

[00:15:42] I would never, ever delay in sending my patient that I don't know what's going on to a specialist who has better credentials than I or more advanced experience than I. No problem at all with that. The truth is, the system, healthcare system, has been built around referrals, around reimbursement, not necessarily what's best for the patient. It's a volume game. It's a referral game. It's a reimbursement game. And here's the myth buster.

[00:16:12] You have a right to choose from the start where you go for your care. And if movement is the issue, movement expert should be your first colon. That's where you should be colon, the doctor of physical therapy. It's really good information to know because me, as just an average person who might have a pain or feel, you know, some tension or any kind of pain, my reaction would honestly be the same way as probably most people. Mine says that you have to go to your doctor first.

[00:16:42] So it is kind of like the common way of thinking. So it's so good that this information is getting out there because we can just go straight to the issue, not go to the doctor, wait weeks to get an appointment, go to them, get medicine that's probably not even particularly well suited for the issue, and then just prolong the issue and the pain and not be treated properly. So it's really good information.

[00:17:08] And I'm someone who has worked in healthcare, and I would still have assumed that, yeah, you go to your PCP first. So I'm sure tons of people listening are very, you know, excited to hear this information as well. Yeah, a good friend of mine, the local doctor is a primary care physician. He's a good friend of mine. He's a patient, actually. And he does not want to see those patients.

[00:17:29] He's like, he feels bogged down by the patient coming to him to say, I waited two weeks to come see you for permission to go get pain relief. It's just a, it's backwards. It just doesn't make sense. And that's an agreement. Like, it's not just the primary care is like, oh, I want to be the gatekeeper for everything. They don't want to be the gatekeeper for everything. They know and they trust the skill set of the physical therapist that works hand in hand with them. I'm sending a lot of patients to him. He's sending a lot of patients to me.

[00:17:58] So there's that reciprocity and respect around the profession. Absolutely. And I know you work with so many patients, so you probably have a ton that come to mind. But do you have a favorite patient story where someone came straight to you and it really changed their whole recovery journey? I do. So I have, I have a couple. So one, I really, really, it's really fresh, like right here in my head. And this was on Monday.

[00:18:26] So I had a discovery visit on Monday and I'll just give you a little kind of bio on the diagnosis, et cetera. So total hip replacement, fresh surgery, two weeks old, total hip replacement comes in for discovery visit. So, you know, based on the brand awareness of my practice in the area, she had, you know, a friend recommended a friend and she came to me as a total hip replacement patient.

[00:18:52] And she was really, really frustrated, upset, concerned, nervous, everything, every, every emotion you could think of this woman had. So I sat her down. I talked to her about her, you know, her diagnosis, her prognosis, what I could offer her if she wanted to come to me as a patient. And then we got into the story around, okay, this is what it's going to cost. This is what I do. This is my model of care.

[00:19:19] This is the super bill, the whole introduction to the rehab room. So she said, hey, I want to talk to my husband about this. So she left. And she called me two hours later and said, hey, I want to come to you. When can you see me? I said, I could see you tomorrow, which was yesterday, Tuesday. I said, I could see you for an evaluation. It's about an hour and a half, hour and 45 minutes. She said, okay, I'm going to come in. So she came in and then we got into the story around what she's been through the past two weeks.

[00:19:49] And here's the net net, Layla. She went to the orthopedic surgeon, had surgery. Saw a physical therapist day one after surgery in the office. Physical therapist handed her a Google sheet of exercises and said, do these exercises and the doctor will see you in three weeks. She's like, what does that mean? What do I do for three weeks? I don't know. Call your doctor. So she called her doctor. And her doctor said, I can't see you until June 3rd.

[00:20:18] Okay, so here we are. She came to me and said, I need to go see my doctor. I said, no, you don't. She said, what do you mean? I said, I'm going to treat you today for your pain. She said, how are you going to do that? I said, because I'm licensed to do that. And by the way, I'm going to call your doctor right now and get your surgical report so I can see exactly what he did for you. I called there. Dr. Griffo called from the rehab room. Could I have a surgical report for Mrs. Jones? Total hip replacement. Had it in 15 minutes.

[00:20:48] Walked outside with her. She had a walker and a cane. Ill-fitted. Not diagnosed. It didn't fit her at all. I adjusted the cane. Adjusted the rolling walker. Had her walk with this. 15 feet, Layla. She stopped and just started crying. Oh my God. Just started crying. I said, what's wrong? Are you hurt? Are you in pain? She's like, no. You just brought me back to life.

[00:21:17] She said, I cannot tell you how dramatic you had an effect on me because you listened to me and you treated me with respect. You didn't just bypass me or say, here's exercises. You didn't say to me, I can see you in three weeks like everybody else did. You treated me with respect. You adjusted my walker that nobody saw me walk and said, hey, that's wrong. And I'm immediately able to walk now. And I just feel good. I feel like I made a great decision.

[00:21:47] And I'm so happy to be here with you as your patient. And then I treated her for an hour. She came out of here. She felt fantastic. That's just one story of many, many stories where that three-week delay could have resulted in contractures, atrophy, more pain, no gait, just sitting in her bed, waiting to see the specialist.

[00:22:10] Who I then fast-tracked and contacted that specialist and said, this patient's in front of me and I'm treating this patient. I'm not waiting for the reimbursement or the referral or the prescription or the insurance company to say, I'm going to approve two visits or three visits or seven visits. This is how many visits I think you need. Are you ready to commit to that? Because I'm ready to commit to you as my patient. Absolutely. Sign me up. That's my one patient.

[00:22:37] The other patient, a little bit younger, Sarah, in her 40s, a runner, nagging knee pain, went to see her specialist, had injections, orthopedic surgeon, was given these medicines, went to urgent care, went to her primary care doctor. Every visit led to the same cycle.

[00:22:58] Imaging, waiting, vague answers, more prescriptions, more narcotics, cortisone shots, advice to rest. Months, Layla, months went by. Nothing changed at all. She's in her 40s. She's a runner, avid runner, losing confidence, missing workouts, gaining weight, starting to believe this pain might just be her new normal.

[00:23:24] She walked into the rehab room, direct access, discovery visit, sat down with her, no script, no delay, just a conversation, a hands-on evaluation that day. And you know what? It wasn't a knee problem. It was a glute problem. It was a butt problem. It was a core problem. Something that never would have been picked up with an MRI. So here she is, a month later, MRI, negative. Injections, negative.

[00:23:53] Medicine, not helping. What's going on? Came to me, built a simple progressive plan geared towards a runner, because I know runners. I'm a runner. And then two weeks, she's all back on the treadmill. Six weeks, she ran a 10K. Here we are, right? That's what it is. It's sort of like, you didn't just fix my knee. You gave me my identity back.

[00:24:22] Both patients gave them their identity back. And I'm not just fluffing my feathers here. I'm saying that this happens every single day. Neglect happens every single day. And that's what direct access can do for these patients. It's not skipping a step only. It's about getting back the right step first, right? And reclaiming your life faster. The first step is the right step. The first step is coming to the rehab. Absolutely.

[00:24:51] It's like getting them and being able to provide this direct access and this direct care really takes the bureaucratic pain, the bureaucratic nonsense to kind of just get the care that they need and giving people their lease on life back. I can't even imagine how relieved these people feel, especially someone who is an athlete and like your last client that you mentioned is a runner, being able to just go ahead and

[00:25:19] get through their normal day-to-day without this pain that has been something new to them. Yeah, exactly. Especially as an athlete. That's also like, I know you treat the whole, everything, not just the physical aspect, but someone who's a runner or an athlete and they're used to this on their regular day-to-day basis. Not only is that pain affecting them, but not being able to run is probably taking a toll on their mental health. And like you said, they're gaining weight and they're losing confidence.

[00:25:49] All these other things that are going on with someone that can be avoided. They can avoid all these issues that are lingering there by just getting direct care faster. Exactly. And it's like two great points you made is that sometimes when the patient makes that switch of, wow, maybe this is the new normal.

[00:26:12] Everybody's telling me this is what I'm going to be in pain for six months, nine months, 12 months. Maybe this is my new normal. Maybe I'm never going to run again. And runners, athletes, soccer players, whatever it is I see every day, that is truly their identity. And identity doesn't have to be a sport either. Your identity could be something as simple as doing your half mile with your wife of 50

[00:26:40] years, every single night for the last 45 years. And you can't do that anymore. That's your identity. Your identity is I want to hold my hands with my wife and I'm going to walk in the park every night like we do, but I can't because my doc says this knee pain is my new normal. And I'm never going to go back to that because nobody knows what's going on with my knee. And that's a shame.

[00:27:05] It really is a tragic shame that we just can't understand how much of an impression we make on our patients every single day. And if you're indifferent to that or you'll move to that or you don't care, you shouldn't be treating patients. Period. Absolutely. Yeah. And to cause them that mental anguish, especially if it's something that can be fixed and can improve.

[00:27:32] And we did touch on this a little bit right now, but is there anything else that comes to mind when you think of what can happen to patients when they do wait too long to get care because they didn't realize they had these other options like direct access care? Yeah, I think. No, I don't think. I know that the consequences of that delay can be real, like really dramatic because maybe it'll go away.

[00:28:01] Isn't a good statement ever to have. Maybe it'll go away. If I just rest, like they tell me to, maybe it'll go away. If I take more narcotics and I don't go on this trip because I want to walk, but everybody's telling me this is the way it's going to be. I'm too old. I'm too fat. I'm too skinny. I'm too much pain. That is not where we are. You know what?

[00:28:25] What may have started out as like a small manageable issue or problem or pain becomes a chronic problem. Oftentimes. Muscles weaken. And we talked about this contractures, compensation patterns, pain spreads. And over time, it becomes harder, not impossible, but definitely harder to truly reverse the consequences

[00:28:50] of that delay or the consequences of waiting three weeks to go see my primary care specialist. I've seen patients come in many, many months after injury. And by then we talk a lot about this on this podcast. You know, they're not just dealing, just dealing with pain, but fear, deconditioning, even depression. At that point, the body starts to adapt. And that's scary.

[00:29:17] When the body starts to adapt around the problem, instead of healing from it, that's a big, big consequence of waiting too long to get care or waiting for the referral or waiting for the prescription. But here's the good news. There's always good news, Layla, at the rehab room. You know that. You always have options. You have options. The sooner you act, the better the results. Period. I'll say it again. The sooner you act, the better the results.

[00:29:48] That's why direct access is so, so important. It removes that delay. It removes that two-week wait, that three-week wait, or like Sarah, a two-month wait. You don't have to wait until it's unbearable. You just don't. You don't have to see five other specialists to say, like, I'm not sure what's going on. Maybe we need more diagnostics. Maybe you need another x-ray. Maybe you need another MRI.

[00:30:14] Oh, and by the way, when you call to schedule that MRI, we can see you in three weeks. So here we are, waiting six weeks to see the specialist, and then waiting another three weeks. Nine weeks out, still in pain. Hip still hurts. But I'm not seeing that hands-on expert, that movement expert. You can come straight to someone who specializes in getting you moving, healing, and confident again. Your direct access, doctor of physical therapy.

[00:30:43] At the rehab room, we help our patients catch things early. And those who wait it, we help rebuild them from the ground up. Either way, either way, we meet you halfway where you are, and we get you from there. But the earlier we start, the faster we finish. Absolutely. And it's scary that you said how your body can actually adapt to the pain. That's something that I didn't even think about.

[00:31:11] But that would also probably create so many other issues going down the line. Now your body is adapting to this pain, and that can probably initially, you know, create more problems. Because now you have this tolerance to this pain. And that's actually, like, wild to think about how you think on the patient end, as a patient, you think you're doing the right thing by, I'm reaching out to my doctor, and, okay, I scheduled this appointment.

[00:31:38] And you don't even realize how it could be potentially detrimental in a way to not act faster. By just having things drawn out and going through the typical healthcare process, as we kind of know it in a way, can not be the best route. And it's a lot better to just get seen for the exact pain initially and not go through all the, like, hoops and the waiting and waiting for the MRI.

[00:32:06] And I know, I mean, I live in New York City, so I know it can take a really long time to see a doctor because it's just so populated everywhere you go. So it's awesome that the rehab room exists to, you know, get direct access care. And later, you mentioned adaptation of the body. So I know you probably had back pain before, right? Everybody has back pain. So the first thing you do, think about it this way.

[00:32:36] Adaptation is movement pattern. So your movement pattern when you get out of bed is different when you have back pain. When you stand up, when you take a shower, when you go for a walk, everything is adjusted around the pain. How you hold yourself. If you hold your shoulder up. And then the body says, wow, you've been doing that for two months. That must be the adaptive pattern of movement. And your body then says, I'm going to compensate for that pain to try to help her with her pain.

[00:33:05] And then two months later, you're still standing up the same way or sitting down the same way or sleeping the same way because the pain is not going away. Why? Because you haven't had it diagnosed appropriately. All you had is medicine or diagnostics or EMG or CAT scan or MRI. But no one's touching you. No one's saying, is this where it hurts, Layla? Yes, that's the spot. Okay, we're going to fix that. That's what we offer. That direct access piece is huge.

[00:33:35] And it's all hands-on healthcare, right? Nothing better than hands-on healthcare. You want to go in somewhere and not just be heard. Of course, you need to be listened to. But you have to be diagnosed by somebody who's a movement expert. And that's what the doctor of physical therapy offers you. Absolutely. And we've talked so much about why direct access is so important. And it is such a big part of the rehab room.

[00:34:00] But why is it such a big part of what you're looking to build within the rehab room? Yeah. I think, no. So when we built direct access, direct access is not a loophole. It's not like, oh, I'm just going to bypass this one, go here and see this doctor. It's a cornerstone of how I built the rehab room. It represents everything we stand for. And that's threefold.

[00:34:28] Access, autonomy, and trust. I'll say it again. Access, right? So access is immediate. It's not a three-week delay, four-week delay. Autonomy, meaning you are self-care. Self-care, self-care, self-care. You're autonomous and able to say, like, I'm going to get relief today. I'm not waiting three weeks to see the specialist. I'm going to go see Dr. Gariffo. And trust, that's what we do in the discovery visit. We sit down and we talk. That's all we do is talk. I don't palpate.

[00:34:58] And then we build trust. And you believe in my skill set. And I believe in your commitment to being pain-free. And then we take it from there. And then we go right to the evaluation. And that's a formal evaluation. That's hands-on, diagnostic, range of motion, strength, balance, proprioception, all that. Not only that, but we've also created a safe space for the patients who don't want to wait for permission.

[00:35:23] Here we are again talking about this P word, permission, to go to your primary care doc to get the care they deserve. They can walk in and be heard, assessed, and treated by a doctor of physical therapy on day one. No red tape. No comeback after you see your doctor. Just help now. It also allows us, me, to practice the way I was trained. Full clinical reasoning. Full evaluations. Full ownership of the plan.

[00:35:52] It's not dictated by the insurance company says, Layla is going to be given three visits. Nope, sorry, two visits. Come reapply for additional visits. That's not what we do here at 3Habroom. That's why we don't take insurance because insurance dictates the care. Insurance should never dictate care. The doctor should dictate the care. And it's rare. It's really rare in today's healthcare system.

[00:36:17] It's why so many PTs are burnt out and they're undervalued and they're resigning and they're, you know, they're saying like, I can't do this anymore. I can't do 50 patients a day for the next 10 years. But at the rehab room, direct access lets me reclaim my profession. It shows my patients what physical therapy is actually capable of.

[00:36:43] So why it's such a big part of the rehab room is because it puts power back in the patient's hands. It really does. And lets us deliver the kind of care that truly changes our patients' lives. It's not a feature. It's not a feature. It's a philosophy. I'll say it again. It's not a feature. It's not like, oh, we're a boutique and we're unique and we're direct access. It's a philosophy of care. And that's what I abide by every single day. And I love that it's not a feature. It's a philosophy.

[00:37:10] And it's when it does come to insurance, I mean, I've talked to you about this, but I have a friend who's in, you know, was in a lot of need of a good physical therapist. And I wish I had known about the rehab room a few years sooner to potentially be able to give her some help. But it's true. It's like the insurance will say you're eligible for two to three physical therapy appointments. Like, what if you need more than that?

[00:37:37] And it's just, it's a pretty broken and flawed system in that regard. So, like, it's great to know that, like, there is a way around that. It doesn't have to be that way. And I think that getting this information out is so crucial and so helpful because a lot of people might just not know. Like, this is another realm, another world to a lot of people if they haven't experienced the direct need for a physical therapist.

[00:38:03] So, you rely on, you know, your PCP or whoever it is to kind of guide you. And it's through this system of webs and waiting and waiting games. So, like, it's awesome to know that this is an option. And if they're... Yeah, you know, you touched on a couple points that I want to just highlight.

[00:38:24] And the first one is there's a rhyme and reason why insurance company, they approve batches two, three, four, six, Layla. You know why? Because the onus then is on the physical therapist to over-document, spend a lot of time on outreach. Hey, can I get two more? How about three more? How about four more? And then it's a barter system.

[00:38:51] It's embarrassing because the insurance company is forcing me as your provider to go fight for visits that you already paid for by paying for your insurance. It's broken. It's absolutely broken because the insurance company knows it's tedious and oftentimes the physical therapist doesn't have time to do that. So, what they'll do is they'll say, Layla, you do need 10, but I'm not willing to fight for 10. I'll take the four and I'll discharge you after four.

[00:39:18] Even though you're not better, you're not healed, what I do is, Layla, you need 12. And we're going to commit to each other twice a week for next six weeks. And you're going to be here twice a week for next six weeks together, me and you, not me, you, and 16 other patients, me and you one-on-one. And guess what? When I discharge my patient, they are better and they are healed because I'm allowed to treat them like that because they deserve to be treated like that.

[00:39:46] The insurance company should not ever dictate care and they always do. Absolutely. I could not agree with that more. And I'm sure whoever is listening who has been through situations where insurance has dictated their care, they would agree as well. And it's just like a vicious cycle.

[00:40:05] I love what you said earlier about how the rehab room and direct access in a way let you reclaim your career because it has. It's given you even another lease on being able to really own your profession where I'm sure a lot of physical therapists started doing physical therapy to help clients.

[00:40:28] But the system that is the healthcare system doesn't even really allow them entirely to freely treat patients because of the way things work. And your autonomy as a clinician is gone because you land your first job, you land in a commodity mill of high volume outpatient orthopedic physical therapy practice. And you think that's normal. You think like, wow, am I, I went to school to see 40 patients a day.

[00:40:56] I don't know if I did that, but I guess that's the norm. That's all I know. See, I've been doing this for a long time. I know it's good and I know it's bad and that's not good. That's bad actually. And it's bad for the patient because the patient doesn't get the service or the hands-on treatment that it's called physical for a reason. You're supposed to touch your patients. You're not supposed to give them a piece of paper and say, go do these exercises over there because I have 16 other patients over here. That's not what you are. Yeah, absolutely.

[00:41:26] And I know we spoke a little bit about this earlier and how you don't need a referral specifically for the rehab room. But if there is a listener dealing with pain today and they don't want to wait for a referral or wait to go through this process, what should they do? What would their first step be? You know, if you're in pain right now, you don't have to wait anymore. You just don't. And your first step is to reach out to the direct access physical therapist in your area.

[00:41:55] If you're near media Pennsylvania or anywhere within, you know, 50 miles of media Pennsylvania, you come see me. Come straight to the rehab room. But if you're not, you don't need a script. You don't need a referral. And you definitely don't need to wait. So my recommendation is we make it easy at the rehab room. And if you are within 50 miles of the rehab room, come see me.

[00:42:16] But if you're not, go find that physical therapist who has a direct access license in your neighborhood, Kentucky, Virginia, wherever you are, and go in for a consult and see if there's a fit. Make sure that they're listening to you. Are they assessing you? Are they giving you a personalized game plan? No fluff, no commitment, just answers and a path forward. That's what I offer my patients. And that's what I hope other physical therapists elsewhere in other states are offering their patients.

[00:42:46] Here's the truth, Layla. The patients aren't stuck. You're not stuck. You're not broken. You're not alone in this. You just haven't been shown the right door yet. We built the door at the rehab room to be that door of access, of autonomy, of respect, of treatment that you deserve and that you should be going out.

[00:43:09] And if you're not getting the treatment right now today in that clinic in another state because of high volume or because of indifference to what you're trying to say to your physical therapist or your provider, then go somewhere else. Absolutely. And it is. It's also part of finding what works for you. And this is like such a better option. You're going to want that one-on-one experience. So it's worth looking into that in your area.

[00:43:39] And of course, if you're within 50 miles of PA, go to the rehab room. Yeah. But thank you for all the work that you do. I mean, I think you really empower patients and give them like their lease on life back, which is so, so, so important. Yeah. You know, it's, it's, it's not about, it's not just talking about better care, but building it, like actually building it. That's what we do every day at the rehab room. So it's not just like we talk about it, but we build it. We build it into our model.

[00:44:08] Uh, you know, if it's something today you heard that hit home, if you're in pain, you're frustrated by this system, this broken system, or just tired of waiting and you're ready to stop waiting, take that first step. And like I said earlier, go find that direct access physical therapist in your area. And if you're not local to the rehab room, to media, use what you learned today to go seek out that direct access physical therapist near you. You deserve care that works for you.

[00:44:38] Excuse me. Not a system that makes you wait. I'll say it again. You deserve care that works for you or you alone, not a system that makes you wait. It's broken. The system is broken. It's broken. Anybody that's worked their weight in gold is not taking insurance because it's not worth it. It's not worth the delay for reimbursement. It's not worth the delay for care. It's not worth the delay for saying you're approved for two visits. So if you like this episode, share it with all your friends, send it to someone you care about.

[00:45:07] Let's keep spreading the word for the rehab revolution from the inside out. Absolutely. Spread the word. Thank you so much, Dr. Griefo. This was such an amazing episode. I know I learned a lot. I'm sure everyone else did too. And how to even go about navigating, looking for care. So thank you again for not only empowering your patients, but empowering everyone listening. And we will talk at our next episode. Thanks so much, Leather.