Table 4:
Physical Therapy Delivery Models Incorporating Health Promotion and Wellness
| Model* | Model 1 = Acute to Outpatient Continuum HPW Integration Model | Model 2 = Consultative, Proactive, ‘Dental’ Model | Model 3 = Skilled Maintenance Model | Model 4 = Health Promotion and Wellness Center/Clinic Model |
|---|---|---|---|---|
| Operational definition | • Introduce adapted lifestyle physical activity in acute rehab. • Foster independent community physical activity and enhance fitness in outpatient rehab. • Transition to semi-supervised or independent exercise through continuum of care.49 |
• Provide expertly tailored exercise prescription, monitoring, & progression. • Goals to restore, improve, or maintain function and to optimize movement. • Use proactively after diagnosis or for long-term monitoring in chronic disease.88 |
• Medicare coverage of SNF, HH, and OP services for skilled care to improve, maintain or prevent or slow further deterioration.89 • Functional gains not required. • Must be reasonable, necessary care that cannot be delivered by non-skilled personnel. |
• Exercise programs are completed with assist and progressed with PT monitoring or supervision as needed. • Part of a traditional rehab center, a stand-alone non-profit organization, or a community center. • Services provided by licensed or non-licensed professionals.90, 91 |
| Delivery considerations* | • Gradually fade visit frequency following restorative care to monitor transition to community exercise. • Consider transitioning to model 2-4, as needed. • Traditional payment model |
• Brief episode of care (~1-4 visits). • Follow-up episodes recommended every 3-12 months, depending on self-efficacy, independence, or risk of functional decline. • Traditional payment model |
• Bimonthly or monthly visits to monitor and modify optimizing movement programs.133 • Weekly visits if patient is at high risk for rapid change. • Medicare-specific model definition may not apply to all private insurers |
• Transition outpatient visits to community center outside healthcare delivery system. • Common barriers include accessibility and affordability. • Commonly cash or philanthropy-funded. |
| Documentation considerations** | • Document prior level of physical activity. • Create transition plans through continuum. • Document education and stage of change. |
• Document medical need for regular exercise and skilled exercise prescription. • Evaluate and document physical activity and exercise FITT-VP. |
• Justify skilled care clearly (i.e., medical need for exercise monitoring and adjustments due to complex and/or changing medical and functional needs). | • Vary depending on state practice act and individual center/clinic policies. • Evaluate and document physical activity and exercise FITT-VP. |
Common delivery considerations: All models should include screening for physical activity (structured exercise, sedentarism, and lifestyle physical activity, as well as nutrition, smoking, sleep, and stress management. Delivery should include HPW outcome measures, facilitating behavior change, and training caregiver and or extenders (e.g., PTA, non-licensed exercise professionals) as needed.
Common documentation considerations: All models should document physical activity and exercise assessments, as well as the need for skilled PT to assess, prescribe, monitor, and progress exercise in clients with neurologic conditions.
Abbreviations: FITT-VP, frequency intensity time type volume and progression; HH, home health; OP, outpatient; Rehab, rehabilitation; SNF, skilled nursing facility
Note: These delivery models may be modified with health policy changes over time.