CREST HILL – Advanced Physicians in Crest Hill see about 50 patients a day, said Scott Racz, a physical therapist from the practice’s Willowbrook office.
Contrast that to Matsushita Orthopedics in Japan, which sees 230 patients a day. The reason for the volume, said Dr. Yasushi Matsushita, who runs Matsushita Orthopedics, is that only 20 minutes of physical therapy treatment is reimbursable.
“We need many patients,” Matsushita said.
In June, Advanced Physicians received a letter from Matsushita asking if he and Sayaka Mori could visit the Crest Hill office – Advanced Physicians has seven locations in the Chicago area – Sept. 21 to learn more about the clinic and how it operates, said Marc O’Neal, orthopedic clinical specialist.
Mori had personal experience with Advanced Physicians, which is why she asked Matsushita to contact this practice. Mori said she studied athletic training at Western Illinois University in Macomb and physical therapy assistance at Morton College in Cicero.
While attending Morton, Mori did her clinical rotations with Advanced Physicians. She worked mostly in the Joliet office, but had occasionally worked in the Crest Hill office as well. When she finished her education, Mori returned to Japan to work for Matsushita Orthopedics as an athletic trainer.
“We don’t have physical therapy assistants in Japan,” Mori said.
During their communication when scheduling the visit, O’Neal learned that Matsushita wished to observe Advanced Physician’s multi-disciplinary approach to outpatient orthopedics, with an eye toward patient improvement and enhancement of knowledge and skills.
O’Neal was happy to help.
“I thought it would be an opportunity to just observe – see the space, equipment and flow of patients – literally from the moment when they walk in the door to seeing a clinician, types of treatment and where we do the paperwork,” O’Neal said.
O’Neal said he also wondered how treatment is decided in Japan. Often in the United States, O’Neal said, insurance companies dictate and control what kind, how often and for how long.
“I’m very naive when it comes to their reimbursement structure,” O’Neal said.
experience for all
During the visit, Racz stepped in for O’Neal – who could not be present – to lead the tour and answer Matsushita’s and Mori’s questions.
Mori noted both Advanced Physicians and Matsushita Orthopedics are similar in setting, although the physical space at Matsushita Orthopedics is somewhat smaller. Both offer similar services and technology. However, staffing is a bit different.
Matsushita Orthopedics has seven physical therapists, two athletic trainers including Mori, four technicians and three to four nurses. Advanced Physicians has a medical doctor, a physical therapist, two physical therapist assistants, one to three technicians and a chiropractor – as well as directors for operations and marketing.
In addition, Matsushita Orthopedics only schedules about half of its appointments and even then, Mori said, patients can expect to wait. The remainder of patients are walk-ins.
“Almost like a busy restaurant here,” Racz said with a smile.
Such a system also means that if a patient needs physical therapy three times a week, that patient might see three different physical therapists. Although everyone is qualified, there is a downside.
“Everyone [does] physical therapy a different way,” Mori said.
How that therapy is determined also is different. At Advanced Physicians, Racz said, the patient’s doctor writes the order for physical therapy – how much and how often. But the physical therapist can request more or less therapy, based on the patient’s needs and response.
“I control the plan of care,” Racz said.
In Japan, that control belongs to the doctor ordering the treatment. Furthermore, a medical doctor must always be on-site during physical therapy, Mori said. At Matsushita Orthopedics, if Matsushita is too ill to work, he must find a replacement.
“No medical doctor, no rehab,” Mori said.
In addition, the universal health care system in Japan requires the doctor re-evaluates each patient every two to three weeks before further therapy is administered, Matsushita said.
Of the 230 patients Matsushita Orthopedics serves each day, Matsushita said, about 130 receive physical therapy and 100 see just him. For example, Matsushita said he has some patients with osteoporosis who don’t require physical therapy, just management of the condition.
O’Neal felt the visit was an amazing opportunity – for both practices – to see how health care is delivered around the world, especially since policies and procedures are ever-changing and evolving.
“I think if you’re complacent in the way you run your practice,” O’Neal said, “you’re out of it tomorrow.”