The following article is slated for publication in ” The Point”.  Read the interview of Jolene Shuman MD, Elizabeth Remillog MD, and Dan Fleury PT, DPT on the success of their innovative practice model! 

Jolene Shuman, MD

Specialties: Family Medicine, Menopause and Women’s Health

Practicing Since: 1992


BS, Chemistry, University of South Dakota

MD, University of Kansas Medical School

Family Medicine Residency, Forbes Family Practice, Pittsburgh, PA

Professional Organizations

Board Certified American Board of Family Practice

American Academy of Family Physicians, NH Chapter


Dan Fleury PT, DPT

Portsmouth Physical Therapy

An affiliate of the Pinnacle Rehabilitation Network

Director of Development/ Partner


Like many organizations across the health care industry, Martin’s Point is redoubling efforts to reduce unnecessary medical expense through better utilization management. To this end, we have formed strategic partnerships with other health care providers who share our focus on improving population health, and the individual patient experience, while reducing the cost of care. An excellent example of this collaborative work can be found in our Portsmouth, NH health care center.


In November 2013, Portsmouth Physical Therapy, an affiliate of the Pinnacle Rehabilitation Network, moved into the Martin’s Point Health Care Center in Portsmouth, NH. This co-location of primary care and an independent physical therapy (PT) clinic has greatly reduced PT medical expense and utilization among Martin’s Point health plan members in the Portsmouth area. We recently sat down with Dan Fleury PT, DPT from Portsmouth PT and Jolene Shuman, MD and Elizabeth Remillong, MD from the Martin’s Point Health Care Center in Portsmouth, NH to discuss this successful partnership.


How do staff at the two practices interact with each other and collaborate on patient care?


JS: “I probably spend a third of my free time in the PT practice―running cases by them, introducing patients, reviewing notes. It’s very convenient and efficient. And they spend time in our health care center. When we have patients with injuries or mobility issues, we often invite them into the exam room to do a quick review during the appointment and help determine whether PT should be part of the treatment plan.”


ER: “They don’t actually treat patients in our exam rooms or make diagnoses. But they often come over and do a quick 3-4 minute evaluation during the appointment, to help the PCP assess musculoskeletal issues. If it is determined that PT is appropriate, often they can see the patient immediately, or shortly after their primary care appointment.”


JS: “They are so welcoming and always make time to show me what they are doing with our mutual patients.  I’ve learned so much about PT since they moved in and have been really impressed the techniques that are used such as dry needling, cupping, Graston, and spinal manipulation.”


How has this move benefitted our patients?


JS: “Overall, the patients think it’s great. At first, some have the misconception that PT is only about learning exercises to do at home. I explain what they are actually doing over there and how their diagnostic skills and knowledge of the muscular and nervous systems are so advanced. It helps the patient understand that they don’t necessarily need an orthopedic specialist, or x-rays, or an MRI for a twisted ankle or stiff neck. Often, they are amazed at how much their range of motion has improved after just one PT treatment.”


How does this relationship support the “Triple Aim” core metrics?

  1. 1.   Improving the patient experience (care, quality and satisfaction);
  2. 2.   Improving the health of populations; and
  3. 3.   Reducing the per capita cost of health care.            


DF: “The patient experience has improved on many levels. Patients with musculoskeletal injuries can be evaluated by an MD and a PT, often during the same visit or day. This saves the patient from having to make a separate appointment and trip.  So, we’re saving them time and money and they also benefit from in-person, provider-to-provider, interaction and discussions about their health.


Early treatment and shared clinical decision making often leads to shorter recovery times, decreased cost of care, decreased diagnostic tests, decreased chronic pain, and decreased use of pain medication. And early PT intervention also helps to avoid additional visits, emergency room visits, and future complications. Our approach has significantly decreased overall physical therapy costs and utilization at this location, while maintaining some of the highest clinical outcomes in the nation. Compared to the top practitioners internationally, Portsmouth PT has consistently exceeded patient health outcome averages in spine care, shoulder, neck, and foot and ankle.”*


JS: “Early intervention definitely makes a big impact on patient health outcomes. I’m able to connect patients with a PT when their injury is still in the acute stage rather than chronic. They can do an evaluation immediately and thus, have less injury to work with. Instead of having to undo the damage caused by treatment delay, or improvised self-care, they can treat the acute injury before it gets worse. This often means that fewer PT visits are required in the long run, and we can reduce referrals to MRIs, x-rays and other specialty services.


The ability to do “warm hand-offs” also improves the patient experience. I can print out my consult notes, walk patients over to Portsmouth PT, personally introduce them to the team and support that connection with my presence. In this scenario, the patient is much more likely to schedule an appointment and stick with the treatment plan than if we had just given them a phone number and instructions to call an off-site PT practice. My patients tell me that they appreciate it when I pop in later to check-in on them during a PT session, even if they don’t have an appointment with me that day. It makes them feel really cared for.


Another benefit is that I’m right here if something comes up. When they come in for their PT appointment and something has come up such as the need for a medication refill they can just come over and talk to me without making an appointment. And they do! Overall, it saves a lot of time, phone calls and hassle and helps to build more authentic, personal relationships. ”


How has this arrangement benefitted physicians and clinical staff at the two practices?


DF: “This environment is a dream. It allows me and my staff to participate in the care of patients at the highest levels of our license and clinical practice. Physical Therapists often struggle to contact medical providers for updates, paperwork, shared decision making, red flags, etc. Here, I just walk over and get the results I need immediately. Patients love it when they know their providers are taking care of their issues right away. That makes my job easier!”


JS: “It saves time because we don’t have to do an extensive evaluation with the patient, only to then refer them to a PT for another evaluation. The evaluation happens on-site, and if PT is the answer, it can start right away. If the patient needs an x-ray, the staff at Portsmouth PT let us know and we can set that up right away. Patients avoid the legwork of having to figure out where to go, how to get there, what to do, and their satisfaction is improved as a result.

My office is so close to their PT practice, I can literally see through into their therapy room. This creates an open-office/shared-space atmosphere that makes it seem like we are all part of the same group. Technically, we’re not, but it’s great to be able to work together that way.  And I’ve learned so much from them. How to really hone in on knee, hip and back exams, what questions to ask, etc..


In the past, when a patient came in with a badly sprained ankle, I would have examined it, iced it, wrapped it with an ace bandage, and sent them home with a PT referral. Now, I can assist the patient over to the PT clinic and treatment can begin that day. This makes a big difference in terms of speed and effectiveness of recovery and there is a lot of provider satisfaction in that. It feels good to do good work.”


I had a patient come in with a stiff neck. After our consultation, I sent her over to Portsmouth PT for therapy. She came back after a short while and said, “Look Dr. Shuman! I can move my neck now!” The results are not always so immediate but I can say with confidence that in general, our patients definitely recognize and appreciate the value of having co-located PT services right in the building. They are learning more about the value of PT and becoming more engaged in their own care and treatment plans.”


What questions do you hear most often from patients about the co-location of PT services at their primary care provider’s office?


JS: “A few patients have asked whether Pinnacle/Portsmouth PT is part of Martin’s Point and I make it very clear that we are separate health care groups. We are all careful to let patients know that where they go for PT is entirely their choice. If they want to do PT at location that is closer to their home, we don’t try to convince them otherwise. If they ask for our recommendation, I always say ‘you can go anywhere you want. I like to work with Pinnacle because they are right here but the choice is yours.’”


Any lessons learned? How are you refining the relationship as you go?


ER: “We installed a direct phone line on the far end of the Martin’s Point clinic to make it easier for our physicians who are not in close physical proximity to Pinnacle to consult with them and ask them to come over and see patients.”


DF: “We are also evolving and evaluating programs to address common issues such as fall risk, and diabetes-related injuries. And, we are talking about making PT evaluation a part of the annual physical to identify potential areas of decline and intervene proactively.”


*More information at


Published April 8, 2015 | Posted in Portsmouth PT Blog Posts.