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Why breathing?


Breathing is literally the only motor task that all living humans share. Your body is naturally designed to breathe well, but it can also adopt bad habits. Just like limping after a leg injury leads to problems elsewhere in the body, breathing with accessory muscles or maladaptive patterns uses valuable energy inefficiently and ineffectively, robbing us twice of optimal functional ability. The result is people with chronic pain, early fatigue, anxiety, decreased activity tolerance, reduced performance and endurance, incontinence, bowel dysfunction, poor sleep quality, stress and an overall decrease in quality of life. If you can't control your breathing, what can you actually control?




How do I improve my breathing?


By working with your therapist and doing your homework. The brain is remarkably adaptive and will start making changes the moment that you start to understand how to breathe. As a part of Academy West, you'll work with your therapist to develop an individual homework program that fits into your life. These exercises often involve neural re-training intended to make you feel, see, and understand your breathing. We breathe between 17,000 and 30,000 times each day. How many breaths can you devote each day to change your life?




Will I have more energy if my breathing improves?


Imagine your body's available energy like a bank account. Your breathing isn't supposed to cost you very much when working properly. Over time though, you can develop movement patterns that increase the cost of doing business of living your everyday life. When breathing is truly difficult, it takes all the energy you have just to make it through the day—just ask anybody with COPD. When you improve how you breathe, you drastically cut the cost of business, saving all that valuable energy for the rest of your muscles and systems to use for function. When operating optimally, incredible changes can be achieved in the human-powered machine that supports our respiration. As breathing improves, chronic problems begin to be more manageable and often abate completely. How much more could you be doing right now?




What if my condition is chronic?


We understand chronic. Academy West helps to put the big picture together from a functional standpoint using a multi-system analysis. The perspective of a physical therapist is unique in the medical community, trained to understand how the different parts of the body work together. A multi-system body analysis helps to identify where things are working less efficiently and how that impacts you. More complicated conditions require various specialties, but understanding how those specialties tie in to one another is exactly what an ICU therapist is trained to do. Academy West is built on the principle that no breathing problem is too deep-rooted or far gone to gain improvement.




Why "Academy"?


Because you are here to learn. A good physical therapist is an educator, and in order to improve your breathing you have to learn with both your brain and your body. We make sure that you understand your breathing and why it isn't working. Our hands-on approach teaches your body how to move, and we take the time to explain things so that you can build on that improvement when you leave. Being a part of Academy West means arming each person with knowledge about how your body works to meet your functional needs.




Can you describe my first session?


You will be in a private treatment space, one-on-one with your physical therapist, though a family member is also welcome and encouraged to attend. We perform a thorough review of your history including a discussion of medical and surgical history, sleep, stress, pain, and activity levels. We discuss your goals and answer any questions you have. After all that talking, we will use mirrors and video to assess your current breathing mechanics. We then move back and forth between teaching and re-examining your breathing to understand where you are having problems. You and your therapist will work together to develop a treatment plan that works for your life. Exams are extremely thorough and may take longer when the nature of your pathology is multifactorial and or chronic, or if you have a tendency to ask questions and be curious. How good is your understanding of how you actually breathe?




What are your hours?


Adaptability has never been more important than right now. Academy West offers a variety of appointment settings including home visits, telehealth, and office visits. We offer patient self-scheduling which allows you to easily pick a time and date from the comfort of your computer. What works best for you?




How many visits will I need before I improve?


Without an evaluation, this is impossible to answer. Many patients can improve their breathing immediately, but they will have difficulty sustaining these changes without follow-up with their PT as well as diligent but manageable home programs. Typically, patients will leave with a daily home exercise routine that takes 15 minutes or less. As a patient begins to incorporate breathing strategies into their lives, the brain actually changes and begins to work differently. Essentially, the more one thinks about breathing the faster and more profoundly it changes. Some patients are better in two visits, while other patients require a long-term approach. There are many factors at play regarding your health, and so much depends on the individual. Commitment to self-care, primary cause of dysfunction, and how long compensations have occurred over time all play a role. Most PT "follow-up sessions" are spaced out 1-3 weeks apart. The goal is to teach you and your body how to function and eventually cut you loose to breathe on your own. However, some patients find that regular physical therapy "check-ins" help keep them functioning at the level they desire. We offer scaled down "maintenance sessions" for this purpose. How much time has it taken for you to develop bad habits?




Do I need a prescription from my doctor?


No, but it helps. Oregon is an unrestricted Direct Access state for physical therapy, which means patients are allowed to seek evaluation and treatment from any licensed physical therapist without a prescription or referral from a physician. However, if you plan on seeking insurance reimbursement, your insurance provider may require a physician's referral, which you are more than welcome to obtain. You may also choose to self-refer to Academy West. When your evaluation is completed, your therapist can, at your request, send a Letter of Medical Necessity to your physician. Once signed, this acts as a prescription for physical therapy and can be submitted to your insurance. You can also complete this insurance benefits checklist to find out if your insurance requires a prescription or referral and choose to obtain one prior to your first visit. Has your doctor ever looked at how you breath?




How long are appointments?


The initial evaluation will last 60-90 minutes. This is the time that is reserved for you. Please come with your forms completed, which will be emailed to you ahead of time or printed off our website. If you need to fill the forms out when you arrive, this will take away from your evaluation and treatment time. Follow up appointments and maintenance sessions are 30-60 minutes based on complexity and length of treatment. We realize that extenuating cirumstances exist, and we will work to provide you the amount of time that your body requires.




What is the cost?


At Academy West, we feel it is important to be as up-front as possible about our fee structure, which is simple and based on type and length of treatment. Each patient is evaluated and then assessed. 90-minute Initial Evalution: $300 Physical Therapy: 60-minute PT Follow-Up: $200 30-minute Maintenance Sesson: $125 Performance Training 60-minute Performance Training: $125 30-minute Maintenance Sesson: $75 Group Classes 60 minutes coming 2021 Payment options include cash, check, HSA or debit cards. Payment can be most easily handled through a secure online portal in which you may safely save your card information.




Do you take insurance?


Yes and no. Academy West is a cash-based physical therapy practice or "out-of-network" provider. This means payment is collected at the time of service, and you are provided a receipt or "super bill" that you can easily submit to your insurance company. The insurance provider will reimburse you directly. If you want to understand more about what your insurance company will and will not reimburse, give them a call and have this insurance checklist ready. It is important for each person to understand exactly what their insurance covers.




What about Medicare?


We get this question a lot, and are happy to have a conversation to help answer. Academy West does not have a relationship with Medicare, which means patients who wish to submit to Medicare for reimbursement for treatment that Medicare normally covers may not be treated at Academy West. However, the list of conditions that Medicare does not cover is significant and includes any issue that began greater than one year from the start of PT service, wellness care, maintenance care, and more. In other words, you may be treated here if your condition is chronic (>1 year) or is considered maintenance or wellness care. Additionally, physical therapy for breathing performance is not really on Medicare's radar, and their definition of "pulmonary rehab" is extremely narrow. However, Medicare is exceedingly complicated and if you are denied reimbursement, that is a risk you take. Failure to comply with Medicare rules in every case, even with best intent, could result in federal investigation, fines, or other legal action. The Medicare Benefit Policy Manual is available in full as a series of downloads at CMS.gov; outpatient physical therapy benefits are discussed in Chapter 15, which is currently 289 pages. Under current Medicare regulations, it is illegal for a physical therapist to accept cash pay from Medicare patients for services that may be covered under Medicare, even if the services provided meet all treatment, documentation, and HIPAA requrements and have been prescribed by their physician. In some cases, a Medicare beneficiary may pay cash for services that are no longer considered medically necessary, for example a "maintenance" or "wellness" program. For this purpose, we offer Performance Training for those covered by Medicare. Confused? So are we...give us a call and we can talk it through. For those on Medicare, we offer performance training as an alternative.




How do physical therapy and performance training differ?


Physical Therapy Intended for patients suffering from breathing pattern dysfunction who seek to improve their condition through 1-on-1 sessions. It involves evaluation, examination, several sessions, baseline and progressive measurements of breathing power and capacity, home exercise program determinaton, and follow-up as needed. In most cases, insurance can be billed. Performance Training Intended for those who are not seeking to bill insurance. Baseline breathing performance measurements are taken, and an individualized strengthening program is developed. A variety of exercise techqniues can be combined with Academy West's "breathing first" ethos, and an activity-specific regimen is developed. Additionally, training can be provided for those who have completed a course of physical therapy and wish to continue their improvement. Group Classes - Coming in Spring 2021




What about COVID-19?


COVID-19 has changed the way that society values breathing, and it has never been more important. You might be experiencing symptoms from past infection or increased anxiety during the pandemic. Or maybe you're simply training and strengthening the muscles that support your breathing. Academy West is committed to providing care in a safe environment that fits your needs. We are available for in-clinic and home visits with strict safety standards, as well as virtual telehealth sessions. Masks are required to enter our clinic but will be removed at times to effectively evaluate breathing. All family members accompanying patients are required to wear masks.