The Overflowing Cup and Your Nervous System

"Discover how simple, consistent actions like deep breathing, walking outdoors, or practicing yoga can transform your well-being. Start small, build one habit at a time, and watch your nervous system thrive. Learn more about creating space in your cup for life's challenges."

By: Dr. Katie Wadland, PT, DPT, Board-Certified Geriatric Clinical Specialist, Owner: Healthy Aging Physical Therapy

I went to yoga this morning, in an attempt to regulate nervous system after a week of solo parenting while my husband was out of town. Normally, I can balance all the regular demands of my life, which as a mother, caregiver, business owner, and home owner, are many. But with him away, the balance shifts. Suddenly, it’s double the drives to the pool for swim team, only one man on deck for the morning routine, and each meal and clean up falls to yours truly. By the end of the week, my metaphorical ‘nervous system cup’ was overflowing; while I meet all the needs of my business, my kids and my home on weeks like this, I frequently deprioritize my own needs, failing to get enough water, proper nutrition, exercise or rest. While I know the cycle well, it’s still hard for me to maintain a good balance when something like this tips the scales. During my much-needed yoga session this morning, I got thinking about how interesting it is that while this phenomenon, and the resulting impact on our bodies and nervous systems is so universal, the triggers and manifestations differ from person to person. The good news is that while our own experiences of stress, overwhelm and exhaustion may differ, the ‘treatment’ is relatively simple, evidenced-based, and enjoyable. The first step is understanding your nervous system:

The Overflowing Cup Metaphor

Think of your nervous system as a cup. When it’s half full, it has room to absorb life’s stressors or give more to those around you. But when your cup is full—due to stress, pain, life’s demands or a physiologic change like an illness—even a small addition of water overflows it. As I mentioned, our individual manifestations are varied, but often lead to symptoms like fatigue, brain fog, or heightened emotional responses. Dysregulation activates the body’s "fight or flight" mode, flooding it with cortisol.

Chronic elevations of cortisol have wide-ranging effects on health. Prolonged stress and high cortisol levels can lead to systemic inflammation, insulin resistance, hypertension, and impaired immune function, ultimately increasing the risk of chronic diseases such as cardiovascular disease, diabetes, and autoimmune disorders. There is no lack of evidence in this area. Research published in Frontiers in Endocrinology emphasizes the connection between chronic stress and metabolic disorders, while findings from the National Institute on Aging highlight the role of cortisol in neurodegenerative diseases, such as Alzheimer’s.

Even if you’re "managing" well and the impacts of dysregulation haven’t yet caused physiological change, a dysregulated nervous system simply feels crappy. It leaves you less efficient in your work, less present in your relationships, and unable to be the best version of yourself. When your nervous system is dysregulated, it’s harder to focus, connect, and enjoy the things that matter most. Prioritizing nervous system regulation is not just about avoiding future health issues; it’s about improving your day-to-day experience of life. It’s about creating more space in your cup so you can thrive, not just survive.

Dysregulation in Chronic Pain, Fear of Falling, and Parkinson’s Disease

Many of the patients we see in our practice experience nervous system dysregulation, often as part of a broader health condition. These patients show patterns of heightened stress response that exacerbate their primary symptoms. Whether it’s chronic pain, fear of falling, or neurological conditions like Parkinson’s disease, the effects of dysregulation can significantly worsen their quality of life. Below are some specific examples and approaches for nervous system regulation in these populations.

Chronic Pain

Patients with chronic pain often live with a nervous system in overdrive. Long-term exposure to pain can cause the brain to become hypersensitized, interpreting even minor stimuli as significant threats. This constant activation of the sympathetic nervous system amplifies pain and perpetuates a cycle of stress and physical discomfort. Gentle movement, mindfulness-based stress reduction, and diaphragmatic breathing can help calm this cycle, retraining the brain to regulate pain responses more effectively.

Fear of Falling

In older adults, the fear of falling is not just psychological—it’s a full-body response that often keeps patients trapped in a state of hypervigilance. This fear increases muscle tension, disrupts balance, and raises the risk of further falls. Patients in this state frequently withdraw from physical activity, which only worsens functional decline. Interventions such as balance training, slow-paced walking, and grounding techniques can help mitigate these responses and restore confidence.

Parkinson’s Disease

For individuals with Parkinson’s, nervous system dysregulation exacerbates motor and non-motor symptoms, including tremors, freezing, and cognitive challenges. Stress often worsens these symptoms, creating a feedback loop that further destabilizes the nervous system. In these patients, incorporating aerobic exercise, yoga, and social connection into their routines can help regulate the nervous system and improve both physical and mental outcomes.

Evidence-Based Tools for Regulating the Nervous System

Nervous system regulation is key to maintaining physical, mental, and emotional balance. The key to regulating your nervous system isn’t always about eliminating stressors—because often, we can’t. We can’t always reduce our demands, get rid of our chronic diseases, or eliminate every source of stress. Instead, it’s about building a bigger cup. When we do things that increase our capacity, the same amount of water—the same stressors—can fit without overflowing. By expanding our nervous system’s capacity (otherwise known as our resilience), we can absorb more challenges without triggering the negative effects of dysregulation. Below is a list of simple, easy-to-incorporate strategies that are backed by research. These practices can help you expand your capacity, regulate your nervous system, and create more balance in your life.

1. Breathwork

Breathwork practices such as diaphragmatic breathing, box breathing, or the 4-7-8 method stimulate the vagus nerve and activate the parasympathetic nervous system. These techniques reduce heart rate, lower blood pressure, and counteract the effects of the "fight or flight" response. Controlled breathing has been shown to significantly reduce stress by shifting the autonomic balance to favor parasympathetic activity. For some easy-to-follow videos and tips on breathwork, check out the resources on our website here.

2. Mindfulness and Meditation

Mindfulness meditation helps bring attention to the present moment and reduces stress hormones like cortisol. Techniques like the 5-4-3-2-1 grounding method are particularly effective during acute stress. Studies, including those supported by the NIH, show that mindfulness can lower inflammation, improve emotional regulation, and enhance the nervous system's ability to adapt to stress. For a step-by-step guide to the 5-4-3-2-1 method, check out our resources here.

3. Physical Activity

Exercise, particularly rhythmic and moderate-intensity activities such as yoga, walking, or swimming, helps regulate the nervous system by releasing endorphins and improving brain plasticity. It also enhances heart rate variability (HRV), a key marker of parasympathetic activation. Research from the National Institute on Aging highlights that consistent physical activity supports the body’s stress recovery mechanisms, making it a powerful tool for nervous system balance.

4. Quality Sleep

Sleep is essential for nervous system health, allowing the brain to consolidate memories, process emotions, and clear out metabolic waste. Poor sleep disrupts the balance between the sympathetic and parasympathetic systems, exacerbating stress. Adopting sleep hygiene practices—consistent bedtimes, reducing screen exposure, and creating a restful environment—improves sleep quality and nervous system regulation. For comprehensive sleep hygiene tips, you can refer to the National Institute on Aging's guide here.

5. Nature Connection

Spending time outdoors in natural settings promotes grounding and nervous system regulation. Nature exposure has been shown to reduce cortisol levels and increase parasympathetic activity. A 2020 review in Frontiers in Psychology reported that "forest bathing" or similar nature-based activities improve mood, lower blood pressure, and enhance mental clarity. How easy is that? Feeling overwhelmed? Just go outside.

6. Socialization

Strong social connections play a critical role in nervous system regulation. Meaningful interactions with trusted friends or family members activate the parasympathetic system and promote emotional resilience. Research from the National Institute on Aging indicates that loneliness and social isolation are linked to heightened sympathetic nervous system activity and increased inflammation. In contrast, social bonds lower stress markers like cortisol and improve overall well-being. Group activities such as exercise classes or support groups are particularly effective in this regard. For this reason and many more, Healthy Aging loves teaching our group fitness classes. You can see where we teach on our Group Fitness page here.

Moving Forward: Make Nervous System Regulation a Priority

While we know these strategies sound simple, in reality, it’s the consistency that makes the difference—and that’s often the hardest part. The key is to start small and meet yourself where you are. Focus on adding just one thing at a time. Whether it’s five minutes of deep breathing, a short walk outside, or a single restorative yoga pose, small, consistent steps can begin to regulate your nervous system and create more room in your cup over time. Progress doesn’t have to be perfect; it just needs to start.

References

  1. Frontiers in Psychology (2018)
    Study Title: The Effects of Controlled Breathing on Stress and Autonomic Function
    Annotation: This study highlights how breathwork techniques like diaphragmatic breathing and the 4-7-8 method can activate the parasympathetic nervous system and reduce stress-related symptoms.
    Link: Frontiers in Psychology

  2. National Institute on Aging
    Resource Title: Getting a Good Night's Sleep
    Annotation: A comprehensive guide to sleep hygiene, detailing practical strategies to improve sleep quality and regulate the nervous system.
    Link: National Institute on Aging

  3. National Institute of Neurological Disorders and Stroke (NINDS)
    Research Title: Deep Phenotyping of Neurologic Post-Acute Sequelae of SARS-CoV-2 Infection
    Annotation: Explores the biological mechanisms of nervous system dysfunction, including the impact of autonomic dysregulation and immune response.
    Link: NINDS

  4. Therapist Aid
    Resource Title: Grounding Techniques (5-4-3-2-1 Method)
    Annotation: A clear, actionable guide for using the 5-4-3-2-1 grounding method to manage acute stress and promote mindfulness.
    Link: Therapist Aid

  5. National Institutes of Health (NIH)
    Resource Title: Long COVID and Autonomic Dysfunction
    Annotation: Details autonomic nervous system regulation and strategies for improving resilience against stress-related symptoms.
    Link: NIH

  6. Frontiers in Endocrinology
    Study Title: Chronic Stress and Metabolic Disorders: Insights from Recent Research
    Annotation: Discusses the long-term health effects of elevated cortisol, including systemic inflammation and increased risk for chronic disease.
    Link: Frontiers in Endocrinology

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Embracing Life and Death as a Geriatric Physical Therapist

As a geriatric physical therapist, I’ve come to view death not as something to fear, but as a natural part of life. Through meaningful relationships with patients, I’ve learned that life is precious, and our quality of life can change in an instant. This post reflects on how healthcare providers like myself navigate loss, while embracing the importance of kindness, compassion, and living each day with gratitude.

By: Dr. Katie Wadland, PT, DPT, Board-Certified Geriatric Physical Therapy, Owner: Healthy Aging Physical Therapy

Today, I attended the funeral of a patient I’ve had the privilege of knowing closely for the past four years. As a geriatric physical therapist, I spend a lot of time with my patients, more than many people might realize. During our visits, not only did we work on her strength, walking and balance, but we talked. We talked about her life, and my life and her thoughts and experiences. We spent hundred of hours together and developed a true connection.

She was a remarkable woman who embodied one of my favorite phrases: "It's not about the cards in your hand, it's about how you play the cards you’re dealt." She was living with a disease that made life incredibly difficult, and she had no immediate family—her husband had passed, and she didn’t have children. Yet, despite all that, she faced each day with optimism. Every time I saw her, she greeted me with a huge smile, always taking the time to ask about my life, my girls, and how the practice was doing. Her capacity for kindness, despite her own struggles, left a lasting impression on me.

Being a geriatric physical therapist has changed my perception of death. It used to be something I feared, something I dreaded, but now I see it as a natural, and inevitable, part of life. This work has taught me that life isn’t guaranteed. Health and quality of life are precious, and either one can change in an instant. My patient lived that truth every day, and I’m thankful for the example she set. She reminded me that no matter what life throws our way, we have a choice in how we respond to it. She played her cards with grace, compassion, and positivity, and I hope to do the same.

As healthcare providers, we deal with loss all the time. Our patients pass, and it’s a reality of our work. Over time, we become very good at putting on a strong face, talking openly about the tough subjects like illness, end-of-life decisions, and death. We have learned how to have these conversations without letting our personal feelings cloud the discussion or influence the direction. We are trained to guide, support, and help families and patients navigate these moments while holding back the emotions that might make it harder for them to benefit from the conversation. From the outside, we may seem strong and stoic, but the truth is that these experiences accumulate. They touch us deeply, and they impact each of us in different ways. Some losses are harder than others, and sometimes, it’s not until later, that we realize just how much a particular patient meant to us. It’s in those quiet moments, when we let down our guard, that we feel the weight of the work we do and the connections we’ve formed.

Through my work, I’ve come to understand that life is about appreciating each day for the gift that it is. I’m determined to approach each moment with kindness, compassion, and gratitude. Helping people, building relationships, and making a difference - that’s how I want to play my cards. And when the time comes, I hope to embrace death as simply another step in my journey, not as something to fear, but as the conclusion of a life filled with purpose and love.

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Breaking the Fall Cycle for Fall Prevention Week

Falls are a common and serious concern for older adults, often leading to fear, reduced physical activity, and a cycle of increased fall risk. At Healthy Aging Physical Therapy, we break this cycle through personalized fall risk assessments, evidence-based interventions like the Otago Balance Program, and home safety evaluations. Our comprehensive approach helps rebuild strength, improve balance, and restore confidence, allowing older adults to maintain independence and reduce the risk of future falls.

Call us at (617) 398-4508 or visit Healthy Aging PT for more information!

Written by: Dr. Katie Wadland, PT, DPT, Board-Certified Geriatric Clinical Specialist and Owner: Healthy Aging PT

Falls are a significant health concern for older adults, often initiating a dangerous cycle that can lead to more frequent falls and serious injuries. This Fall Prevention Week, we’re focusing on how the Cycle of Falling works—and, more importantly, how it can be broken with the right interventions.

The First Fall and Fear of Falling

The cycle often begins with an initial fall, leading to significant fear and anxiety about falling again. This fear impacts confidence in movement and results in avoiding daily activities. Nearly 50% of older adults who have fallen report limiting their physical activity afterward, which increases their likelihood of future falls.

At Healthy Aging Physical Therapy, we go beyond traditional therapies by teaching fall preparedness skills, including how to land safely and recover from a fall. Evidence shows that learning these techniques, along with the ability to get on and off the floor, reduces the fear of falling, which in turn lowers the risk of future falls.

Reduced Physical Activity

When fear limits physical activity, muscles weaken, and balance worsens. This sets the stage for more falls, as musculoskeletal strength is essential for stability.

We provide tailored programs that encourage safe, gradual increases in movement, helping individuals regain strength and reduce their fall risk.

Musculoskeletal Decline and Gait Instability

Reduced activity leads to muscle loss, joint stiffness, and decreased mobility, which all contribute to gait instability. This unsteady walking pattern makes falls even more likely.

Our therapists focus on improving strength, flexibility, and gait stability through evidence-based interventions like the Otago Balance Program, a proven exercise regimen designed specifically for fall prevention in older adults. By incorporating Otago exercises, we help patients maintain steady movement, balance, and mobility, significantly reducing the risk of future falls.

We also offer Strong and STEADI balance classes, which focus on improving balance, coordination, and strength to help reduce fall risk. These group classes create a supportive environment for patients looking to improve their mobility and confidence. You can find more information about these programs at Healthy Aging PT Group Classes.

Increased Fall Risk and Repeated Falls

As the cycle progresses, the likelihood of repeated falls grows, leading to a dangerous pattern. Breaking this cycle requires a comprehensive approach.

At Healthy Aging, we offer personalized fall risk assessments and targeted interventions, focusing on balance, mobility, and confidence to stop repeated falls before they happen.

One key aspect of our intervention is the Home Safety Evaluation. Our therapists assess your living environment to identify potential fall hazards and provide practical modifications. These changes, such as securing rugs, improving lighting, or installing grab bars, are crucial in creating a safer home, reducing fall risk, and promoting independent living.

How Healthy Aging Physical Therapy Can Help

We offer a variety of specialized services to address the Cycle of Falling, including balance and fall prevention programs, gait retraining, and strengthening exercises. Our team is committed to promoting safety, independence, and confidence for each individual. Check out more about our Balance and Falls Program here.

If you or a loved one are at risk of falling, take the first step towards breaking the cycle. Call us at (617) 398-4508 or fill out our New Patient Registration Form to schedule a fall risk evaluation.

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Mastering Your Fitness Routine: Simple Ways to Meet WHO & CDC Exercise Guidelines at Any Age

Finding time for exercise can be challenging, but adapting the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) guidelines to fit your lifestyle is key. This guide breaks down how to achieve 150 minutes of aerobic activity and 2-3 days of strength training per week, tailored for various fitness levels. Learn how to integrate balance and flexibility exercises into your routine and discover practical tips for staying active, whether you're just starting out or looking to enhance your current routine. Check out the Move Your Way Activity Planner for a personalized approach, and explore resources like our Club HAPT for strength training and PWR! Moves for Parkinson’s. Start fitting exercise into your week today and enjoy the many benefits of staying active!

Written by: Dr. Katie Wadland, PT, DPT, Board-Certified Geriatric Clinical Specialist and Owner of Healthy Aging PT

We all know the importance of regular exercise, but fitting it into your lifestyle can sometimes feel overwhelming. The World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) recommend that adults aim for 150 minutes of moderate-intensity aerobic activity combined with 2-3 days of strength training per week, along with balance and flexibility exercises. However, not everyone starts at the same fitness level or has the same lifestyle, so learning to adapt these guidelines to suit your life is key.

What Are the WHO and CDC Guidelines?

The basic recommendations for adults include:

  • 150 minutes of moderate-intensity aerobic activity (like brisk walking) or 75 minutes of vigorous-intensity activity (like running) per week.

  • 2-3 days of muscle-strengthening activities (targeting major muscle groups) per week.

  • Balance and flexibility exercises, especially for older adults, to help prevent falls and maintain mobility.

Reality Check: How Much Are We Actually Exercising?

Surveys show that a majority of adults aren’t meeting these guidelines. According to the CDC, only about 23% of American adults get the recommended amount of both aerobic and muscle-strengthening exercise. Meanwhile, physical inactivity is linked to chronic illnesses such as heart disease, diabetes, obesity, and depression.

The good news is that even small changes in your weekly activity can have a significant impact on your health.

The Benefits of Regular Exercise

Exercise isn’t just about maintaining a healthy weight—it has wide-ranging benefits for both physical and mental health. Regular physical activity:

  • Reduces the risk of chronic diseases

  • Helps control weight

  • Strengthens bones and muscles

  • Improves mental health and mood

  • Increases your chances of living longer

On the flip side, physical inactivity can lead to higher rates of heart disease, stroke, diabetes, and some cancers. It's clear that staying active is one of the most important things you can do for your health.

What a Balanced Exercise Week Looks Like for Me

Let’s talk about how I fit exercise into my week as an example of how to meet the guidelines. My routine is built around balance, consistency, and flexibility:

  • Aerobic Exercise: Three days a week at my local gym, I aim for 30 minutes on the elliptical, treadmill, bike, or rower. Sometimes I do intervals, mixing short bursts of higher intensity with recovery periods. Other times, I do steady-state cardio. My goal is always to hit 30 minutes of aerobic exercise per session, which helps me meet the CDC's weekly guideline.

  • Strength Training: I lift three days a week. One day is focused on legs, one on upper body, and the third is a full-body workout. I also mix in core exercises throughout the week. This keeps my strength routine varied and helps me hit the goal of 2-3 days of muscle-strengthening activities.

  • Flexibility and Balance: On either Saturday or Sunday, I incorporate yoga into my routine. It’s my way of improving flexibility and balance, which is a key component of the guidelines, especially for preventing falls as we age.

  • Active Lifestyle: In addition to structured exercise, I like to stay active on my "rest" days by taking a small hike with my kids, mowing the lawn, or doing housework. These activities add to my overall activity level without feeling like a formal workout.

I also teach fitness classes during the week. While I consider these part of my active lifestyle, I don’t count them toward my personal exercise goals because they’re more about helping others increase their baseline activity levels.

Example 2: An Older, Moderately Active Adult

Let’s say you’re an older adult who is still fairly active but may not want or need to hit the gym as often. Here’s how you can structure your week:

  • Aerobic Activity: This person could take outdoor walks five times a week for 20-30 minutes each session. That would total 100-150 minutes of moderate-intensity activity for the week.

  • Strength Training: Twice a week, they could join a strength training class at their local senior center or gym. There are also great online programs, such as our Club HAPT, that offer guided strength workouts for home use.

  • Balance and Flexibility: Mixing in something like Tai Chi or yoga once or twice a week can help maintain balance and flexibility, key elements to prevent falls and stay mobile. Our balance programs can also be done at home to support long-term health.

  • Active Lifestyle: In addition to structured exercise, they can incorporate more movement into their daily life by parking further from the store, taking the stairs instead of the elevator, or working outside in the yard. These activities help add to overall activity levels and make it easier to meet the weekly exercise guidelines.

This routine is perfect for maintaining a healthy lifestyle and preventing the decline in muscle mass and balance that can occur with aging. There are also videos available on our Balance and Falls page that offer great exercises that can be done at home to improve stability.

Example 3: A Lower-Level, Sedentary Adult

For someone who is less active or has mobility challenges, it’s still important to find ways to incorporate movement into their week. Here’s how someone at a lower fitness level can meet the exercise recommendations:

  • Aerobic Activity: A seated recumbent elliptical like the Cubii can provide low-impact aerobic exercise. Walking in a mall with a walker or doing an aerobic workout on YouTube can also be effective.

  • Strength Training: Functional strength training doesn’t have to happen in a gym. Simple movements done in the kitchen or living room—such as sitting and standing from a chair—can provide the necessary strength training. These activities mimic the kinds of things we do during physical therapy and can be scaled to any ability level.

  • Balance and Mobility: Balance exercises, such as those done in therapy, can be adapted for home use. Programs like PWR! Moves for Parkinson’s Disease are great for adding in mobility work that supports overall health.

  • Active Lifestyle: For someone at a lower activity level, small bursts of movement—sometimes called "exercise snacks"—can be an easy way to build up daily activity. For example, they can march in place during commercial breaks, take an extra lap each time they go to the bathroom, or do 10 sit-to-stands every time they get out of a chair. These small actions add up and help improve overall mobility and strength.

Conclusion: Adapting Exercise to Your Life

No matter where you’re starting from, there are ways to meet the CDC and WHO exercise guidelines that suit your fitness level and lifestyle. Whether you’re hitting the gym, walking around your neighborhood, or working out at home, finding a balance between aerobic, strength, balance, and flexibility exercises is key to maintaining your health as you age. For help creating a personalized plan, you can use tools like the Move Your Way Activity Planner or join us at one of our Group Fitness Classes to get a great mix of everything combined. The most important takeaway is that every little bit helps, and even small steps toward being more active can lead to big health benefits.

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Understanding the Complex World of Medicare and Health Insurance: A Behind-the-Scenes Look

In this blog post, we explore the challenges facing Medicare and health insurance reimbursements, particularly in physical therapy and private practices. We delve into how reimbursement rates have steadily decreased over the past 20 years, highlighting key legislative impacts like the Balanced Budget Act of 1997. We explain the importance of offering cash-based services, such as Fitness and Wellness programs, to maintain financial stability and continue providing high-quality care. Learn more about how these services benefit both the practice and patients by allowing for flexibility and long-term health support. Discover why supporting local healthcare providers and understanding the intricacies of Medicare and insurance are crucial in today’s healthcare landscape.

Written By: Dr. Katie Wadland, PT, DPT, Board-Certified Geriatric Clinical Specialist and Owner of Healthy Aging PT

As a physical therapist and owner of a private practice, I often have conversations with patients and clients about the state of healthcare and the challenges that come with it. Many people aren't aware of the complexities of Medicare and health insurance, and how these complexities impact the care they receive. I wanted to take a moment to provide some "behind the scenes" information about Medicare, health insurance, and the state of healthcare today.


The Reality of Medicare and Health Insurance Reimbursements

Let's start with Medicare. For those of you who aren't familiar, Medicare Part B is the part of Medicare that covers outpatient care, including physical therapy. While Medicare is an incredibly valuable resource for many, it's important to understand that the reimbursement rates for services provided under Medicare Part B have been decreasing steadily over the past two decades. This isn't a trend that's specific to Medicare; health insurance reimbursements, in general, have seen significant reductions over the years.

For example, due to legislative changes like the Balanced Budget Act of 1997, there have been continual cuts to Medicare reimbursements. Over the last 20 years, Medicare payments for outpatient physical therapy have been reduced by about 25%. These reductions are compounded by annual updates that often fail to keep pace with inflation or the rising cost of delivering care. In fact, it's projected that in the coming year, there will be another reduction in Medicare reimbursement rates, which could be as much as 4.5%.

In addition to the cuts in Medicare reimbursement, many therapy practices, including ours, are also going out of network with certain managed care plans. The reason for this is twofold. First, these plans often come with significant administrative burdens, requiring extensive authorization processes and paperwork just to begin or continue care. This not only takes time away from providing hands-on patient care but also adds to the overall cost of running a practice. Second, the reimbursement rates from many managed care plans are exceedingly low, often averaging only 60-70% of what Medicare reimburses, which is simply unsustainable for many practices. You may have seen recent news about large hospital systems going out of network with certain Medicare Advantage plans for similar reasons. These plans frequently offer even lower reimbursements and add layers of red tape that can hinder timely patient care.

However, even though we are out of network with these plans, we strive to remain as accessible as possible by accepting out-of-network coverage when your plan offers it. We frequently see patients with Tufts Managed Medicare, UHC/AARP, Humana, and other managed Medicare plans, and we currently remain in-network with BCBS. This approach allows us to continue providing high-quality care without the limitations imposed by the low reimbursement rates and administrative burdens of managed care plans. We encourage you to ask about what out-of-network benefits your plan may have, and we are always happy to check on this for you if you are interested in receiving care with Healthy Aging Physical Therapy.

The Impact on Private Practices

So, what does this mean for private practices like ours? Simply put, it's becoming increasingly difficult for practices to accept insurance and remain financially viable. Each year, while the reimbursement rates go down, the costs of running a practice—like rent, utilities, supplies, and fair wages for our staff—continue to rise. It's a challenging balance to strike.

Despite these challenges, we at Healthy Aging Physical Therapy have made the decision to continue accepting Medicare Part B. Why? Because we believe deeply in providing high-quality, concierge-level care to those who need it most. Our commitment is to serve our community, especially those who rely on Medicare for their healthcare needs. However, we also recognize the financial realities that come with running a small business in today's healthcare environment.

The Role of Cash-Based Services

This brings me to an important point about why you might see therapy practices, including ours, offering cash-based services like our Fitness and Wellness programming. I know it might seem surprising at first—after all, isn't insurance supposed to cover everything? The reality is that insurance often dictates not only how long we can see a patient but also what types of services we can provide. There are many scenarios where patients would benefit from additional or ongoing care that isn't covered by insurance.

By offering cash-based services, we are able to supplement our revenue, ensuring that we can continue to provide quality care, pay fair wages to our therapists, and keep our doors open. These services—whether it's our fitness coaching and personal training programs, therapy wellness sessions, or virtual and in-person fitness classes—allow us the flexibility to meet your needs beyond what insurance covers. They also empower us to provide long-term care that supports your overall health and wellness, beyond just your immediate therapy needs.

Supporting Local Healthcare and Small Businesses

I want to take a moment to thank each of you for your continued support of Healthy Aging Physical Therapy and other small businesses and private practices. We know that the healthcare landscape can be confusing and that there are many factors at play that affect both providers and patients. We hope this post has shed some light on the current state of healthcare and why practices like ours are making the decisions we do.

We're committed to continuing to provide the best possible care to our community, and we're excited to offer a range of wellness programs to support your health and wellness journey. Thank you for being a part of our community, and for supporting small, locally owned businesses that are dedicated to your well-being.


As I tell all of my Healthy Aging therapists when they start with us, I value kindness and transparency above all else, so hopefully this helped make our complicated healthcare landscape a little more transparent for you. If you have any questions or would like to learn more about our post-discharge wellness programs, please don't hesitate to reach out. We're here to help you live your healthiest life!

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