physical therapist surplus??

[kbl1975]

I would like to say that I am a PT, came from a country where one day the government said that only life saving medical services would be covered. 6 mo to my graduation we were all stunned. Physical Therapy truly does not save a patient's life. PT helps his/hers ability to get better faster, to help to come back to pre-op or pre-accident condition. Long story short, after I graduated I found myself unable to find a job, clinics were closing left and right and the few ones that stayed opened had a mile long list of patients waiting for a PT visit. Now I am here in the USA and I see the cuts in PT fees and reimbursements coming. It already has stared few years ago. It's true, there will be more "baby boomers" but they will have only few visits( enough to show HEP) and there will be plenty of visits not approved by Medicare (if sill exists). I don't think it will happen in near future, but in 10-15 years I am sure we will see large cuts in PT visits and reimbursements if the health care reform will go the way it is intended to go.

K.

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[mtm34]

K,
Interesting/morbid opinion... you seem to know more about the details of healthcare reform than those who wrote it. Where are you from and what PT setting do you work in the US?

 

[truthseeker]

KBL1975,

It seems that if there was a line a mile long to get into the physical therapy clinic that there is a market. Nowhere, to my knowledge, does it say that the only way to be reimbursed for PT is through Medicare.

What country are you talking about?

 

[kbl1975]

The mile long line was only because the regulations given by national health insurance(the mandatory government's health ins).There would be a number of visits a clinic could have a month/year. The government health people would make some statistical predictions how many possible patients a year/month would need PT visits at this particular clinic or county. Of course there was always more Pt in need then allowed visits for the county and somewhere by October the clinic would not see outpatient Pt. I have to say now that clinics existed only with connection with a hospital, where the inpatient PT care was available. Later in the year a PT would see only the inpatient Pt and outpatient clinic would be mostly closed. My friend did work like this as a PT and she has told me many times that she would see some Pt any way knowing that she would not be payed for the service because her clinic was out of available units. It's was just the right thing to do to help few Pt in a great need of PT care. My mother was one of the Patients that had to wait 3 months for her therapy after an accident because the only clinic in our town was out of allowed visits for the year.
So this was 13-14 years ago in Poland. Now the PT clinics still struggle,PTs are under payed and the unit system still exists although it's a bit different. But most of the clinics are private now dealing with national health care. If you work at a hospital you are payed by government and since they own almost all hospitals, they rule.
I could write here on and on about national health care but the point I wanted to make is that the "baby boomers" will have restricted PT visits either in number of visits or reimbursement.
The Medicare isn't the only way to get reimbursement for visits but when the national health care will happen then all of us are riding the same wagon. Eventually private heath insurances will go out of business. Medicare is difficult now with $ you get per visit/unit, everyone knows they don't pay enough for PT visits and in the future ,with more cuts to come........


K.

 

[jesspt]

The Medicare isn't the only way to get reimbursement for visits but when the national health care will happen then all of us are riding the same wagon. Eventually private heath insurances will go out of business. Medicare is difficult now with $ you get per visit/unit, everyone knows they don't pay enough for PT visits and in the future ,with more cuts to come........

I can't imagine that private insurers will go out of business any time soon. If you look at the financial performance of some of the major insurance carriers here in the US, you'll see that they are turning a very nice profit.

And, I sincerely doubt that we will ever have a national health service like the one described by kbl1975.

 

[jles]

I think using the term "need" is not the best choice of words. How badly does someone NEED to continue to be mobile, independent, and physically active, which by the way decreases risk of cardiovascular disease, diabetes, and other diseases? How bad does a patient NEED to stay active and healthy as close as possible to the day they die and not be suffering from the number of chronic diseases that usually cause suffering in the last years of life. It's all in how you frame it I think. With a painful and restricted knee after surgery a patient is less likely to continue moving which leads to all I mentioned above. Most likely, a patient is not going to push themselves to regain full range of motion after a TKA (total knee arthoplasty), nor are they capable of establishing and carrying out an individualized plan of care including mobilization and therapeutic exercise. It also depends on their prior level of function (PLOF: prior to surgery). The higher the better of course. If a patient is starting a lower PLOF then they are that much closer to becoming debilitated and not being able to use the knee that was replaced. That's cost savings, and patient value right there.

reimbursement rates lowering concerns me, but also if the amount of people who go see a PT will lower. I know there are a lot of baby boomers who could benefit from physical therapy, but they don't need physical therapy. Especially if they'll have to fight with insurance companies to get their PT covered, they might just chose to not go to physical therapy. My grandma, for example, was recommended PT for her knee surgery, but she passed it by because she didn't think it would be worth it. PT is important, but not needed, and I think a lot of people don't really understand how PT would benefit them, so they may just bypass it as insurance regulations become too strict.

j0hn: this is one way where pharmacy is overall more stable than PT, even if it may be more saturated. People need their drugs, so insurance companies can never cut that out or cut too much of it out. PT is another story, it can drastically improve lives, but not necessarily save lives.

 

[jles]

My whole reply will be about demonstrating the value of PT in a few specific areas and where research is headed to support what we do. It is not an exclusive reply to KBL but just highlighting a very few examples of how we as a profession can be advocating for ourselves.

In the US, more and more value is being demonstrated with physical therapy services and direct access over exclusive physician management for many musculoskeletal issues and vestibular problems (BPPV) - one of the common causes of dizziness and frequent costly visits to the ER. It is not important that we are not saving lives acutely as truly the only ones doing that are ER physicians, cardiac surgeons, ICU nurses, maybe EMTs, and others I have not mentioned. Much of health care is reactively managing/curing non-emergent illnesses which has much to do with sedentary lifestyles and poor diets. I believe that quality of life is just as important as saving it. That is the physical therapist domain and why we get our doctor degrees. Regarding safety, we are trained to examine the entire body and all systems (screening) to determine appropriateness for our care. Research backs this up.

Regarding PT treatment of BPPV: EPLEY maneuver x 2 for BPPV (benign paroxysmal positional vertigo) is >90% effective based on literature.

As a side note, consider the decreased amounts of medications needed due to PT which result in fewer complications (including falls/fractures, GI and kidney problems) from polypharmacy. This is all too common with geriatric patients and no doubt a cause of addiction to pain meds, morbidity, and mortality in these patients.

PT is full time in some emergency departments with increasing frequency:
http://www.innovations.ahrq.gov/content.aspx?id=2645
Some of the Results discussed:
Although no formal program evaluation has been conducted, anecdotal reports and internal surveys suggest the use of PTs in the ED has improved quality, enhanced efficiency, and increased patient and physician satisfaction.
Better treatment: ED clinicians believe the program has helped patients with musculoskeletal problems recover more quickly; reduced use of pain medications (and associated addictions) and return visits to the ED (due to reinjury); and enhanced access to outpatient physical therapy. In addition, ED physicians can now spend more time with patients who are severely ill or injured, thus enhancing their care.
More efficient use of hospital resources: Clinicians report that patients are now less likely to receive unnecessary imaging tests or be admitted to the hospital in cases where it is safe for them to return home.
Enhanced patient and physician satisfaction: Internal hospital surveys show that overall patient satisfaction has improved since PTs started working in the ED, and that patients who see PTs during ED visits report very high levels of satisfaction. For example, given four choices ("very beneficial," "beneficial," "neutral," and "not beneficial"), 80 percent of patients thought PT-ED services were "very beneficial" and 20 percent felt they were "beneficial." None chose the other categories. Also, ED physicians report that having the PT available has made their job easier and helped them to provide better quality care. A physician survey found 100 percent of ED physicians were "very satisfied" or "satisfied" with the program.

Low back pain:
Management Patterns in Acute Low Back Pain:
The Role of Physical Therapy (2010)
Alfred Campbell Gellhorn, MD,* Leighton Chan, MD,† Brook Martin, MPH,‡
and Janna Friedly, MD*

Methods. A national 20% sample of the Centers for
Medicare and Medicaid Services physician outpatient billing
claims was analyzed. Patients were selected who received
treatment for low back pain between 2003 and
2004 (n
439,195)

Results: (for those not versed in evidence based practice or medicine an odds ratio less than one is protective)
...odds ratio for undergoing surgery in the group of
enrollees that received PT in the acute phase (4 weeks)
compared to those receiving PT in the chronic phase (3
months) was 0.38 (95% confidence interval [CI], 0.36–
0.41), adjusting for age, gender, diagnosis, treating physician
specialty, and comorbidity. The adjusted odds ratio
for receiving a lumbosacral injection in the group receiving
PT in the acute phase was 0.46 (95% CI, 0.44–0.49),
and the adjusted odds ratio for frequent physician office
usage in the group receiving PT in the acute phase was
0.47 (95% CI, 0.44–0.50).

Conclusions. There was a lower risk of subsequent
medical service usage (physician visits, lumbosacral injections, or lumbar surgery) among patients who received PT
early after an episode of acute low back pain relative to
those who received PT at later times. Medical specialty
variations exist regarding early use of PT, with potential
underutilization among generalist specialties.

As more comparative research comes out and is shown to the payors I believe it just makes good business sense to support what we do. We just need to all advocate for our PT-PAC and be active APTA members. No doubt we all need to consider other models of reimbursement and supporting fee schedule improvements.

I would like to say that I am a PT, came from a country where one day the government said that only life saving medical services would be covered. 6 mo to my graduation we were all stunned. Physical Therapy truly does not save a patient's life. PT helps his/hers ability to get better faster, to help to come back to pre-op or pre-accident condition. Long story short, after I graduated I found myself unable to find a job, clinics were closing left and right and the few ones that stayed opened had a mile long list of patients waiting for a PT visit. Now I am here in the USA and I see the cuts in PT fees and reimbursements coming. It already has stared few years ago. It's true, there will be more "baby boomers" but they will have only few visits( enough to show HEP) and there will be plenty of visits not approved by Medicare (if sill exists). I don't think it will happen in near future, but in 10-15 years I am sure we will see large cuts in PT visits and reimbursements if the health care reform will go the way it is intended to go.

K.