Recently, one of my front office staff required physical therapy. She has a hospital-based HMO plan and had less than a satisfactory experience in the past. The philosophy of her hospital-system HMO is that it offers only 30-minute treatments regardless of diagnosis or needs; and that after her initial evaluation, the remainder of her treatment is carried out by a physical therapy assistant (PTA) and she does not see the PT again. She ended up getting an out-of-network approval from her secondary insurance provider so that she could be seen in our clinic, where she and all of our patients receive 1:1 (PT to patient) care for an entire hour (if appropriate) by an experienced, licensed PT. Our office manager knew the difference and knew that she had options and did not have to accept less than satisfactory service or care. She knew that she was a "health care consumer" and that she had choices. Unfortunately, many patients do not know and understand this.

Over the years, I have heard stories from patients, friends, and relatives about unsatisfactory to bad therapy experiences with many different independent outpatient therapy providers. Common complaints were that they actually saw the licensed PT for only 5 to 15 minutes and then were pushed off onto a PTA or athletic trainer, thrown on an exercise bike or other equipment, and left to fend for themselves, being seen concurrently with multiple other patients, and not having any continuity of care because they were seeing a different therapy provider nearly each session.

The use of assistants, and scheduling with multiple PTs and/or PTAs, is allowed by all the regulations, including Medicare, private-insurance agreements, and state practice acts, although it may not be the best practice. However, the truth is that providers who do not truly provide 1:1 care, or who utilize nonprofessional, nonlicensed staff and who see multiple patients at the same time but still bill out for 1:1 care for the entire time and not group charges, are simply cheating—cheating the system, but also our profession. The regulations and contract for Medicare, workers' compensation, and private insurances are clear. Your insurance company is paying for 1:1 care by a professional and may not be getting what it believes it is paying for.

The profession of physical therapy is a wonderful profession and does have much to offer in maintaining and restoring health. Unfortunately, some—if not many—providers have cut corners due to financial gain. The patient is also a consumer, and he or she has a right to quality care or service. I tell my relatives that if they are referred to a provider that they are unfamiliar with, they should ask the following questions:

1. Will I be seen by a licensed PT for the entire length of my care?
2. Will I be seen for an hour (if appropriate)?
3. Will I be seen 1:1 for the entire treatment visits?

These questions will go a long way in creating an informed consumer. I also suggest that patients ask to see satisfaction-survey results if they want to dig deeper. Reputable providers will post this raw, unedited data on their Web sites or have a hard copy available per request.

As for Ohana Pacific Rehab Services LLC, we follow the philosophy that, "A lie has speed, but truth has endurance." It is a long race. We will always provide 1:1 treatments with experienced, quality, licensed physical and occupational therapists. It is a challenge practicing this way, because it is expensive to staff our services with only licensed, experienced therapists and truly apply them 1:1 during a time when reimbursement is declining and operational expenses are increasing. We have sought ways to cover our costs by informal partnerships of sharing space and operational expenses with other health care providers at both our clinic sites. We have also improved our billing and collection efficiency by developing an in-house program that improved our cash flow.

There are many editorials about reimbursement, direct access, and the value and legitimacy of the DPT credentials, but I have seen very little about our own profession holding itself accountable. It is easy to criticize insurers, physicians, and legislators, but our profession needs to look in the mirror. It is not only the education or experience that matters, but more importantly, how we practice.

I have been the president of our state's American Physical Therapy Association chapter in the past, and it was challenging defending our profession at the state legislature, or in meetings with insurance companies, when I was presented with case studies of how some of our colleagues practice. Physical Therapy Products ran a feature article on our practice in September 2004. At that time, I received multiple e-mails from therapists across the country applauding our philosophy—especially seeing patients 1:1—because it, unfortunately, appeared to be not common practice.

It is sad to me that value and honesty are not common. I challenge our profession to look at itself and evaluate how it is practicing. If you were the health care consumer, would you choose your own service?

To share your views in a guest editorial, contact editor Arati Murti at .

Kevin Lockette, PT, is the president and owner of Ohana Pacific Rehab Services LLC, which operates clinics in Honolulu and Kailua. He can be reached at .