Just-In-Time Management Principles for Physical Therapy

Disruptive technologies and business models, paired with changing consumer expectations, will change healthcare.

In keeping with our theme of lean healthcare, today’s topic is a recap of the American Physical Therapy Conference CSM 2013 is a session called “Doing Today’s Work Today: How To Reduce Inefficiencies in Physical Therapy Service Delivery Through the Application of ‘Just In Time’ Management Principles.” Yes, the title was quite a mouthful, but the session was well organized, clear, and straightforward. Presenters Todd E. Davenport, Nicholas J. Ferlatte, Ivan Matsui, Carol Jo Tichenor, were all from Kaiser Permanente. Since Kaiser Permanente is a managed care consortium, they are able to experiment with programs and collaboration between disciplines all within the umbrella of their organization.

Starting with a recap of lean management principles applied to healthcare, presenters focused on case studies and learning from three programs at Kaiser, all designed to increase client satisfaction and decrease waste.

Roving physical therapists program

This program had physical therapists ‘on-call’ to be brought in if a consulting MD needed support. The therapist could quickly access the situation, make a prescription, and then decide whether the patient needed a referral. If the patient needed a referral to a physical therapist, they might have to wait 30 minutes to see that physical therapist rather than a few weeks. The results of the program were significantly happier patients, and a dramatic reduction in the wrong physical therapy prescription. Given that patients were seen sooner, there could also be assumed to be better recovery times as well.

While this program turned out to be the best for patients, some considerations needed to be taken on how to manage the physical therapist’s productivity. Kaiser’s structure of being a full-service managed care organization enabled this scenario, but it’s definitely worth considering how to bridge this gap with integrated care.


Telehealth is expected to grow 55% in 2013 and reach 1.8M patients. This is partially driven by Medicare’s penalties on readmission, but also as Kaiser Permante learned, by consumer preference. Patients liked the video check-in because it meant they didn’t have to leave work or battle traffic for their appointments. There was also a strong personal connection having the appointment at their convenience and location rather than a clinic. However, one extremely important reason they liked the Kaiser program was that it was free. This is a consideration that’s not possible for many clinics. However, we have seen changes in billing codes in most states that allow for telemedicine.

Patients Preferred Communication Modes

Patients Preferred Communication Modes

The presenters also shared some best practices if you’re thinking of implementing video visits into your practice which we’ll dedicate a separate post to in the coming days.

To judge whether telehealth is effective, you need to consider two factors: clinical outcomes and patient satisfaction. If you’re going to try a telehealth pilot, think about how you will measure in advance.

Workplace occupational injury prevention

Workplace injuries are decreasing, while workplace injury costs are actually increasing. That is, fewer people are being injured but it’s costing more to treat those injuries. The main users are younger men who work as laborers, and women 50-60 who work as tradespeople. Similar to other sessions, this session promoted physical therapists as ambassadors of total health and wellness, and in this case occupational wellness.

Kaiser Permanente implemented an occupational wellness program in their own workplace in two high-injury departments: radiology and materials management. Starting with an ergonomic assessment, they then created programs that include pre-shift and at-home exercise programs, and stress and weight management. The result has been a steady decline in workplace injuries over the last 15 years, and a general increase in the importance of health and safety.

While this program was internal to Kaiser Permanente, corporate wellness programs are quite common with their focus on preventative healthcare. This could be an interesting area of focus for physical therapy organizations.

Finally, the panelists encouraged the audience to start thinking about and embracing new business models by saying “It’s okay to ask for money for services provided.”

Posted in: Lean Healthcare, Rehabilitation Business

Leave a Comment (0) ↓

Leave a Comment