I have had a lot of conversations around pay in Physical Therapy over the past couple of years. A pattern has developed that leads me to believe we have been approaching pay the wrong way. We have failed at improving PT insurance pay, but not for any lack of effort. Suddenly, there may be a new opportunity for systemic change that I believe we must take full advantage of. In the last few months, we have seen the COVID pandemic set the stage for large changes in just about every aspect of life – especially in the provision of healthcare.
In physical therapy, we have taken the stance that our services save the system money. When people interact with us, there is less medication use, less imaging, and less surgeries – usually with comparable results. Every time research is conducted on the most common musculoskeletal conditions – i.e. back pain, neck pain, meniscus tear, rotator cuff tears – we get the same results: purely anatomical findings are not as predictive of dysfunction as the medical model thinks. Physical Therapists often get superior results for exponentially less cost. This is the truth, and this has been our consistent talking point to insurers, regulators, and legislators.
Last year, I went to a conference put on by the American Chiropractic Association in conjunction with Physical Therapist and Osteopathic professional groups. One speaker, who was formally trained as a Chiropractor, but working as a higher-up in United Health Care spoke bluntly on the topic of increased insurance payment. He said, plainly, bluntly, and quite rudely, that insurance companies do not care who saves the system money. That is not what they are looking at. He does not care about our value proposition.
That was the first time I considered that our kumbaya approach to saving health care makes a lot of sense to us, but may only be valuable through a therapist’s eyes – not the view of others. This insurance exec went on to say that what UHC is looking for in a valuable professional encounter is one in which the patient doesn’t return. Meaning, they are cured and the insurance company is no longer on the hook for the bill. I’ve been turning this over in my head for more than half a year now, and I still can’t make sense of it. My best guess is people change insurance plans so often that the insurance companies want a short, finite episodes of care that ends in a tangible result (good or bad). They do not want the prolonged liability of someone who may be getting gradually better over several months of rehab, even if waiting to see the outcome of rehab would save billions of dollars over the entire population. It seems like bad math to me, but I digress.
Within a few weeks of the ACA conference, all the PTs, OTs, and SLPs I work with had a meeting with HR at our community hospital. There were some changes being announced in the pay structure at work and HR wanted to present it to us with an opportunity for questions – I assume we were given extra attention because we are notorious for complaining about being underpaid.
The hospital was switching to a market-based pay system. Meaning, our pay would be established by the pay of other hospitals around us. The HR employee told me, point blank, that the money our department brings in has no influence on what our pay is.
After hearing HR tell me the money I make for the hospital has no influence on the money I make for myself, and the insurance executive telling me that my saving him money doesn’t mean I’ll get paid more – I was starting to have doubts about our whole profession’s approach to increasing our insurance payments and overall pay. It seems the factors that we think impact our pay do not. Saving insurers money doesn’t get us paid more. Making our employers money doesn’t get us paid more. We need a new playbook.
At the end of last year, a large group of leaders in the Academy of Orthopaedic Physical Therapy (AOPT – formerly the Ortho Section of APTA) got together to make the strategic plan for the next 6 years. A part of that process was surveying the nearly 20,000 members about their priorities for the Academy’s work – about 300 people replied with information that would ultimately help guide our work.
The survey, though poorly responded, had clear results. Members of AOPT and APTA want leadership working on increasing insurance payment and the value of PT. This was made central to the strategic plan which I encourage you to take a very quick look at: https://www.orthopt.org/uploads/content_files/files/2020%20Strategic%20Framework.pdf
Increasing pay from insurers is work APTA has advocated for daily for years. That Members want increased pay is not new information to anyone. There are annual conferences focusing on payment, groups from all over APTA work constantly in many ways to increase payment, but what do we see? Decreasing reimbursements. Which brings me back to what I have expressed above – what we think should work, does not. Throw. Out. The Playbook.
AOPT will be addressing payment in a more direct way than previously. I hope novel approaches are researched, the who’s-who of payment in rehab are gathered, and the dissenting insurance executives are consulted. There has to be something we can do to increase our insurance payment for our valuable services that cure patients for far less cost than the other more invasive alternatives.
I had one more very recent conversation. I have this patient I’ve seen off-and-on for a couple years. He is a bonafide titan of industry – the real deal. He has held very big positions in businesses you know. The other day, he comes into his appointment talking to me as he often does about whats going on in the world and what might be the next big money-maker/world-changer. But this time, he is suddenly talking my language.
He says there are several major revolutions that will be coming from the COVID-19 pandemic and one of them will be in healthcare. He says we have long assumed that what the DOCTOR (Physician) says is right. That we rely on very tangible procedures for well defined problems to get tangible results – simply, surgery for broken and torn stuff, but that time and conservative measures can get a lot of the same results for far less money. He says people who delayed surgeries during COVID shutdowns are seeing good results in their recoveries without having had the surgeries they previously planned on having. He suggests that part of the revolution will be an investment in value-based treatments that save the system money. He stresses preventative medicine over interventional medicine. This guy isn’t saying the words “Physical Therapy,” but those are the words my ears are hearing.
So what do I think now? Is our old mantra, our kumbaya-ing, on the brink of finally paying off in our society’s most desperate time? Or is it time to move on and see what our new approach should be? I’m really not sure, but if you’re not a payment expert and you’re not working directly in the insurance industry, there is one way for you to directly contribute to and be a part of the effort that finally gets Physical Therapists the financial respect we damn-well deserve. Become a Member of APTA and AOPT – the work is being done at the highest level and may be on the edge of the breakthrough we have all been waiting for. This is your chance to contribute to the cause, and you might be jumping on the bandwagon at exactly the right moment.