Lets discuss a critical issue for our profession…insurance reimbursement! What do you feel is or is not being done in our profession to combat declining reimbursement? Multiple studies show that we are the cost-effective route with the same results as other medical interventions for many cases.
Unfortunately, poor insurance reimbursement is negatively impacting us all as a whole. Salaries are stagnant, productivity expectations are unrealistic, burnout among therapist is increasing (especially among those new in the profession with astronomical student loan debt…yes even if you went to an instate school). The doctorate degree isn’t going anywhere any time soon and the benefits of obtaining it do not appear to be on the horizon any time soon. Also education programs won’t be changing their curriculum because they are rolling in the cash from it.
I believe many of these things would change if we would be reimbursed at higher rates. The APTA doesn’t appear to be doing much to help our cause…so what can we do in our profession to impact this in a positive way. Thoughts?
I think that, especially for outpatient, lower co pays would really make a big difference…paying $50 for an entire treatment period of 9 weeks instead of $50/session for 9 weeks would help immensely. Might encourage them to come more regularly, as well
Phoenix said: @Ashby
Not about copays. Insurance plans are moving to high deductible plans so most people are going to be 100% responsible for cost of each visit
And most people don’t have that kind of cash lying around.
@Ashby
Sure but high deductibles isn’t a PT problem, it’s an insurance in general problem. Most people are responsible for 100% of medical costs for the first $3000 at least. I actually think the transition to HSAs will make PT more affordable because the cost won’t be directly coming out of people’s checking accounts. But agree insurance model needs to change.
@Ashby
Although this is expensive and unaffordable for many people, I think our lack of decent marketing as a profession limits public opinion of what we provide. Many of the same people that complain we are too expensive pay the same for less educated personal trainers or masseuses without batting an eye.
On top of that, they also pay much higher rates in one time fees for other medical diagnostics or treatments that are diagnostic only or results are fair at best.
For example, my visit to an ENT who billed to use an endoscopic camera in my sinuses (which showed nothing) came to $660 for a 15 minute visit. Considering many PPOs cap PT at $70 per visit, that’s over a month of PT TX at twice per week even with a high deductible.
A CT scan (5-10 mins) costs $300-400.
Surgeries cost thousands, then PT, and time off work and often are not any more successful than a couple months of PT if given soon enough (ie. RC repairs and spinal surgeries).
Many Patients are much more at ease in giving up their hard earned money to these options over PT.
We need to market the profession better to gain more respect in society as a legit healthcare provider with a Doctorate, so people believe we are worth the money they pay. Soooo many people still don’t even know the amount of schooling we do, and think it’s a simple 2 year technical school degree.
It’s also crazy that the majority of the US population still thinks ‘chiropractor’ rather than ‘PT’ when they have back pain. Why? They market much better as a profession.
@Phoenix
Direct access in my state of Mass has been legal since the 70s as I understand. Not due to apta. Mute point anyhow, unless paying cash still need a referral for reimbursement.
Full disclosure, I’m not a big fan of the apta. I stopped giving the apta my money when I decided they were no help dealing with the acupuncture lobby in Mass, which seeks to ban dry needling about every 2 years.
@Nico
I think that says more about your local (ie. state) branch than the national branch. So, in this case, I think what InterruptingMOO’s message would be to get involved by becoming a voice in your chapter to increase awareness to address a likely shared concern.
@Feng
Yes exactly. I’m a New Englander myself and I know the people involved in the MA APTA, and they are very much doing their best to progress PT in the state. PTs dropping their apta membership only hurts their ability to work. I used to feel the same way but had the realization that I can’t complain about things unless I’m actively doing something about it, so I joined the APTA and feel that I’m at least working towards fixing the problems I see. The legal process is a slow one but you can’t give up and then sit back and complain.
@Phoenix
I appreciate your insight on this and I don’t think you’re wrong, but personally I still disagree. I think between the national and state chapters if the membership dues were cut in half I may feel differently.
I think what the APTA is trying to do is noble, and here in Mass they may in fact be trying to do their best, but doing their best isn’t the same as getting results. And in the time I’ve been a physical therapist, I’ve seen drastic changes in reimbursement and it doesn’t seem like what the APTA is accomplishing is able to keep pace. Maybe I’m uninformed, if that’s the case please fill me in as to what the APTA has done and is doing right now to fight reimbursement changes.
One can still get involved to better the profession without the APTA necessarily. This is ultimately what happened with dry needling in Massachusetts. I ended up finding an email thread of practice owners and we organized an effort to get in touch with our legislators and had our patients do the same. The APTA of Mass, again I realize this is just my state chapter, never once answered any of my inquiries as to what we can do.
@Nico
I appreciate your frustration with the system and insurance reimbursement for sure. If evidence dictated our reimbursement we would be making more than orthos for office visits.
But if dues were cut in half, membership would have to double to get the same amount of money to be able to do things. I don’t think that’s the answer. My employer pays my annual dues—that could be something you could ask for if cost really is your only barrier to participation.
The way our country works is you need to make a loud enough voice to be heard. The APTA is our best avenue for that. The more people who join, the more people there are to contact local reps and government officials, the more reason those reps will want to vote in favor of PT-friendly laws. That’s how this works, unfortunately. If we don’t collectively band together, nothing’s going to change.
@Phoenix
Thank you for your thoughts. Admittedly a skeptic and a cynic, I’m considering this perspective: my wife is a teacher and she belongs to the teachers’ union. Membership is mandatory and the dues are paid by her employer. Her union has negotiated for fair salaries, ample sick time, and access to a whole host of benefits that I could never have likely gotten. Now, obviously being a teacher is an entirely different realm entirely, however, it makes me realize how powerful these organizations can be. When I look at the APTA and its current leadership and agenda, I just don’t see them being the voice to speak on behalf of me.
I don’t disagree with your perspective, and I support the concept of what the APTA does. It’s just that in my experience when I was a member, I didn’t see the kind of effort or change that justified taking the money out of my pocket each year. Collaboration on a large scale can bring about positive change, but I haven’t seen the APTA impress me enough to give them my dues. To the APTA, what I’ve told them is ‘change my mind.’
@Nico
Sure, but the teachers’ union is powerful because of that exact reason: every teacher is a member! Meaning they have a lot of money and a lot of people standing behind them. How powerful can the APTA truly be if half of PTs don’t even support it? Real change takes time. You just need patience and to understand that the process takes a lot longer than everyone would like. But the answer isn’t to give up, it’s to get more involved. I just attended the state policy and payment forum a few weeks ago and it opened my eyes to everything the APTA is doing behind the scenes to support PTs. More dues collections and more involvement would only further help our cause.
@Phoenix
You make a lot of good points and you really have me reconsidering why I’m so stubborn about not joining the APTA. And then I remembered why I got so turned off other than just the dry needling issue I had with my state chapter.
I don’t trust the APTA because it’s run largely by those who have either academic ties or ties to large hospital-based organizations. For 7 years I worked for small outpatient private practices, and we got hosed repeatedly on reimbursement and lost referrals to these large hospital groups. I also used to work with a Canadian PT who held a master’s and not a doctorate like me. She could do everything I could do, was just as skilled as I was, and I trusted her judgment as well as any DPT. Yet she paid considerably less than I did for my education. And then I realized that the DPT may be one of the biggest scams ever pulled on physical therapists in this country. But it certainly did line the pockets of the academic institutions that give them out, didn’t it?
My understanding was that this was done in the name of direct access, among other things. My home state of Massachusetts has had direct access since the 1970s when PTs held bachelor’s. And it doesn’t matter because the insurance still requires a referral unless you’re paying cash.
@Nico
I hear your distrust and am sorry you feel that way about the DPT program. College tuition costs, in general, are absurdly high, but I feel the DPT has been very beneficial to the longevity of our profession. Several MPTs and PTs tell me that most DPTs graduate at a much higher level than they did right out of school. Yes, after years of experience, they are equal, but it creates a higher floor for quality, education, and training.
Again, if you don’t like the direction or focus of our profession, I encourage you to actively participate and work on changing it for the better. If the Mass APTA has underrepresented private practice owners, then you should join to better represent it and be their voice. That’s the only way they will be heard and taken seriously. Otherwise, if no one joins, the direction will be controlled by larger interests like hospital-owned facilities.