The Outpatient Therapy Clinic Is a Second Product: Judge the Plan, the Report, and the Phone Before the First Visit

The hospital gave you a referral for outpatient therapy, and maybe a name on a sheet. That name is one option, not the answer. Outpatient therapy is a service you buy into, and clinics differ in how they run it. You can judge them before anyone walks in the door.

Local option: New Plan Care gives families in the St. Louis area in-home help so a parent can stay home: companionship, help with bathing and dressing, meals, and overnight care. Call (314) 405-0887.

Day 0, still in the bed

Ask the discharge planner three things before the car is called. Which therapy is ordered (physical, occupational, or speech), how often the order says to go, and whether the order names a clinic or leaves the choice to you. Write the answers on the back of the discharge paper.

Then check the insurance line on your parent's card. Medicare.gov explains how outpatient therapy is billed under Medicare Part B. If your parent has a Medicare Advantage plan, the clinic has to be in that plan's network, so call the plan and ask the clinic's name directly. Do not rely on the clinic's word alone for this.

Pick two clinics if you can. Compare them on distance from the house, the hours they keep, and whether they have a parking space and entrance your parent can manage. Ask each one the same questions, in the same order, so you can compare the answers.

Questions to ask on the phone

These are the questions that separate one clinic from another:

Do you have the referral and the discharge summary before the first visit, and who requests them?

Who writes the plan of care, who signs it, and how often is it updated? Ask what happens if the therapist changes the plan.

How many visits a week do you schedule, and what happens when a visit is missed for a ride problem or a bad day?

Who receives the progress reports, and how often do they come? Ask for a copy to be sent to you as well as the doctor. Check the Medicare Benefit Policy Manual, Chapter 15, if the clinic gives you a vague answer about the plan of care.

Will the therapist give you a written home program? Will someone show you how to do it, and will they check it at the next visit?

What is the copay line on your parent's plan, and when is it due? Write the answer down. Do not guess.

Who answers the phone on a weekday, and how long does it usually take to get a person?

A clinic that answers these with specifics is easier to live with. A clinic that answers in generalities will still be a clinic you have to chase.

Day 1, the car pulls in

Look at the entrance before you go in. Check the ramp or step, the door weight, the restroom, and where your parent can sit while waiting. Bring the referral, the card, and the written list of medicines your family keeps. Keep the medicine list with you. The clinic will ask for it, and the family keeps it.

After the first visit, ask the therapist to walk you through the plan out loud. Write down the goal the therapist names, the schedule, and what your parent should not do alone yet. If the answer is unclear, call the clinic that day and ask.

Day 2 to Day 3, the first full days

Set up the home program in the place where your parent will actually do it. Keep the sheet where it is seen. A hired helper can remind your parent that the exercises are due and help set up the space, but the exercises and any decisions about them stay with the family and the therapist.

Check the schedule against the calendar on the wall. If the first visit was missed, call the clinic and ask what the cancellation rule is and when the next visit can happen.

Day 3 to Day 7, the week

By the end of the week, compare what you were told with what happened. Did the clinic send the referral paperwork where it needed to go? Did the therapist explain the plan? Did a report arrive?

If the answers are no, you have a fair reason to switch clinics or to bring the issue to the discharge planner or your parent's doctor. Before you switch, ask the new clinic to request the old records so the therapist does not start from zero.

For local phone numbers and offices that help families sort these questions, see Local Help After a Discharge. Keep the plan of care, the schedule, and the home program in one folder. You will need all three the next time someone asks what the plan is.