For Healthcare Professionals

Frequently Asked Questions By Physicians:

  2. Can patients with extremity pain participate?
  3. Does PNBC participate in Medicare?
  4. What patients are inappropriate for PNBC?
  5. How does PNBC communicate with referral sources?
  6. Do you have any data to support your approach?
  7. What conditions does PNBC treat?
  8. What types of insurances does PNBC accept?

 

  1. How is PNBC different from other rehabilitation facilities or physical therapy clinics?

    2. 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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  2. 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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  3. 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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  4. 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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  5. 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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  6. 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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  7. 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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  8. 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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