Profit from referral scenerios have not been a hot topic in health care recently.  This subject seemed to wane from the media with a renewed focus on encouraging strategic partnerships and integration of providers and specialties.  The fact is, profit from referral is still a cost driver and clearly reduces value in health delivery by facilitating more risky and expensive services. 

Additionally, a recent orthopedic conference in California last month openly presented how surgeons should consider "owning their own physical therapy profit centers".  The spirit of such a presentation to those we trust to assist us with staying healthly sends shivers down my spine.  The Medical Industrial Complex is not dying!  See below a recent post from WCRI.

Jason Richardson, PT, DPT, OCS, COMT

The last two decades have seen substantial growth in the use of ambulatory surgical centers (ASC) and the number of physicians who have ownership interests in these centers. In Florida, orthopedic surgeons who owned ASCs did between 52 percent and 111 percent more surgery than orthopedic surgeons who were not owners, according to a new study from the Workers Compensation Research Institute (WCRI).

To help policymakers and other stakeholders better understand the relationship between ASCs and surgeons, WCRI has published, Why Surgeon Owners of Ambulatory Surgical Centers Do More Surgery Than Non-Owners. The study looks at several factors that contributed to owners doing more surgery, including financial incentives, previous surgery volume prior to ownership, and the ability to do more surgery in an ASC relative to a hospital.

The study examined 941 orthopedic surgeons – some of whom ultimately became owners of surgery centers – and compared the number of knee, shoulder, and wrist surgeries that each surgeon did before becoming an owner with the number performed after becoming an owner.

Copies of the study, as well as other WCRI reports, can be purchased online by visiting the WCRI website: http://www.wcrinet.org/recent_pub.html

WCRI Web Resources:

· WCRI What's New http://www.wcrinet.org/whats_new.html

· WCRI Search Our Studies http://www.wcrinet.org/search.html

· View WCRI Benchmarks http://www.wcrinet.org/benchmarks.html

· WCRI Conferences and Briefings http://www.wcrinet.org/conference.html

· WCRI Order Our Publications http://www.wcrinet.org/order_publications.html

If you have any questions, please contact us.

Thank you,

Richard A. Victor, J.D., Ph.D.

Executive Director

The Affordable Care Act (ACA) establishes new rules for what insurers must provide for both components starting in 2014. This requires balancing sometimes competing goals of standardizing plan design -- which provides certain guarantees to consumers no matter where they live or what plan they choose and facilitates comparisons across insurers – and permitting more diversity of choices in the marketplace. With recent guidance issued by the federal government on benefits and patient cost-sharing, how insurance options could vary by plan and by state has become quite a bit clearer.

Covered Services: The ACA requires HHS to identify essential health benefits for insurance plans offered in the individual and small group markets. The covered benefits must include at least 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.

While quite comprehensive, these 10 categories also leave some room for variation, including specifically what services within a category are covered and whether there are limits on those services (e.g., caps on the number of visits for physical therapy or home health care, both of which are quite common today). Rather than specify a complete standard benefit package, the federal guidance would let each state determine those specifics by choosing a benchmark plan.

Cost-Sharing: How much patients must pay out-of-pocket for covered services is determined by a measure called “actuarial value” (AV), which is the percentage of health care expenses a plan would cover on average for a standard population. For example, a plan with an actuarial value of 70% would be expected to cover on average 70% of health care expenses, with enrollees paying the remaining 30% through some combination of deductibles, copays, and coinsurance.

Some amount of diversity in cost-sharing is built into the statute itself, with plans required to offer coverage in any of four standardized “metal tiers:” bronze (AV of 60%), silver (AV of 70%), gold (AV of 80%), and platinum (AV of 90%). (To put this in perspective, current employer-based plans have an average actuarial value between gold and platinum, and current individually-purchased plans have an actuarial value between bronze and silver.)

Entire article here:  http://tinyurl.com/85plctu

The multi-year long debate on how to reform the American Health Care industry is full of many contradictions.  Below is a digest of several conflicting concepts that need careful analysis and consideration:

1)      Insurance/Third Party Reimbursement Reforms—Most interested in exploring ways to trim reimbursement per procedure or remuneration for health care services delivered.  Highly motivated to prevent policies and rules which limit premium rate reductions and rules dictating how premium dollars are spent.  Health Care Environmental Influenceà cut cost of services (Resulting in Millions of $ Spent to Lobby Congress on their Interests)

2)      Integration by Hospitals—With increased technology and Integrated Health IT health care efficiencies will prevail.  This group wants to desparately preserve fee for service payment methodology and integrate specialties to increase patient pool to access their services.  Health Care Environmental InfluenceàIntegrate specialties and employ physicians to enhance market control through the employed physician’s patient pool.  The concept that integration will improve efficiency through Health IT is false.  The real intent in integration is controlling the consumers through employed physicians.  Integration of services under a hosptial banner and integration of Health IT is supose to save money by reducing duplication of services, but no services are delivered economically in a hospital setting and there will still be conflicting pressures to admit patients (high $).  (Resulting in Millions of $ spent to Lobby Congress on their Interests)

3)      Private Practitionersà The little guy who went into practice to better the lives of their patients—Typically patient-centric.  Incentivized by internal interests to help their patients and not screw up their reputations.  Relies on examination and evidence in formulating an artful cure to patient ailments.  Doesn’t typically have the most expensive technology and thus not incentivized to self-refer (however this does happen with imaging and specifically Physical Therapy and does needs to be addressed boldly by MedPAC --I digress).  This group is trained to recognize when a more technical test or procedure is warranted and refer to the appropriate provider when it is in the best interest of the patient.  

As you can see, each of these 3 variables conversely impact the intent of health care reform—Improve quality and access of health care at reduced costs.  My fear is that the erosion of the private practitioners to hospital employment models will mean that society loses their choice.  Less private practices means less choice, less innovation and health care delivery is shifted from generating a patient-centric environment to a revenue-centric environment.  To cure this health care crisis we really need to throw away the old business model!  With that said, Health Care in America is the only industry in the world where nearly every transaction requires a third party!

C. Jason Richardson, DPT, OCS, COMT

Twitter @TNBackPain

Not all news this month is bad news for the American health care system.  Despite the news from the Commonwealth  Fund Commission that America’s health care system isn’t making any gains in areas such as preventable death, health insurance waste,  improved quality of care, and health care savings, there was good news published on innovative projects that use physical therapists to improve value in the healthcare system. 

What is evident from two articles published this month from Health Affairs and Health Services Research is that in the absence of politics and traditional thinking, physical therapists should play a greater role in primary care for managing musculoskeletal problems.

Both articles demonstrated (again) that physical therapists’ management of musculoskeletal problems on the front end improved clinical outcomes, reduced utilization of medical services, and reduced patient exposure to unwarranted risks associated with unneeded medical procedures, all while delivering high patient satisfaction.  What’s interesting is that the economic pressures associated with the rising costs of health care are producing unique care delivery models that are beginning to demonstrate greater value to the health care consumer than the traditional pathway of physician to physician referral.  Both of these articles referenced above offer additional evidence to this argument. 

As insurance policies continue to package cost-sharing models for the consumer, and reimbursement for medical services continues to fall, unique economic pressures will yield care delivery models that make business sense and bring more value to the consumer/patients.  These pressures will certainly produce a tipping point where the legislative turf battles can no longer be won by those with the largest PAC donations. 

This year there were a few legislative battles where the health care consumers were duped by those special interests.  The most recent include: 1) California’s push to enforce their corporate law intended to protect the public from Medical Corporations profiting from referral; and 2) State legislative pushes for direct access or enhanced patient access to PT by Alabama, Oklahoma, Florida, and Texas.  All had significant success with their respective general assemblies but ultimately came up short because of strategic opposition by special interest groups.  

In the absence of legislative special interest, the evidence is clear that patients should have better access to see a physical therapist without a referral from a physician and physical therapists should play a role in primary management of musculoskeletal injuries.  Once this is achieved, patients will have more choice and the market will then dictate where the value is within health care.  The patient is then empowered to research their treatment options and make informed decisions that are best for their unique lives and condition(s).  This market will then reward those who best meet the needs of the patient and who deliver the best outcomes.

Dr. C. Jason Richardson, PT, DPT, OCS, COMT

Twitter @ TNBackPain

A week later and my circadian rhythm is still dictating that I get up an hour earlier than what the clock says.  I spent my extra hour this morning reflecting on how insane the concept of daylight savings really is. 

The rationale for altering the clocks against everyone's biology is very weak.  The 2 mainstream reasons for daylight savings is: 

           A)  For the farmers to have additional light for tending to their animals (who also have their own circadian rhythms)

           B) To reduce energy consumption of heating and cooling homes while everyone is away at work during the day. 

Give these some thoughts and you will soon realize that these are very weak arguments for "falling back" and "springing foward". 

There are a few local governments where reason and logic have prevailed where Daylight savings time is not recognized--two places that I am aware are in Arizona and Indiana.  I wonder if there has been any additional studies looking at the Freakenomics that would suggest more harm than good with daylight savings time?  If so, please share.  If not, Levitt and Dubner, please get on this subject for your next book.

#Stopmessingwiththeclocks

It is time for a revolution in our profession--a political revolution which facilitates greater patient choice and reduces the incentive for profiting from a referral.  A revolution that requires our patients and fellow PTs to demand legislative changes that improve health care consumer access to safe and effective alternatives to medication and surgery—services that are valuable and are cost-effective that eliminate impairments associated with mechanical pain and offer patients a choice of better health.  Perhaps even a bridge from the couch to a formal wellness program that molds healthful behaviors.

It is necessary to provide better access to the services provided by licensed physical therapists whose entire roll is to reduce disability, reduce pain and improve quality of life for patients suffering from pain movement dysfunction.  We have to demand that our profession isn’t controlled by other professions who are only interested in controlling passive revenue streams.  We have to demand clinical excellence and innovation driven by those who understand how our profession fits in with the traditional health care delivery model.

Private sector corporations such as Healthways are developing generic wellness programs for Medicare populations and packaging them as alternatives to skilled PT in exchange for government subsidies. These programs are reasonable for healthy individuals, but are offering inadequate services for those with co-morbidities and other special needs.  Right now, under the Medicare, it is easier for these beneficiaries to access personal trainers, community organized group exercise programs, and the YMCA for exercise consultation than a physical therapist.  These facts should be an outrage for health care consumers considering the education requirements, safety and health benefits associated with the services provided by skilled physical therapists.  How this can be debatable in the eyes of law makers and insurance policy makers is offensive. 

Currently, the US ranks 46^th among industrialized nations in health care outcomes yet we are ranked number 1 in costs.  I would argue we are the best country in managing acute and emergency medical problems, but are the worst of all industrialized nations at managing post-acute and chronic cases. 

Beyond population lifestyle issues, a large reason for this differential in quality management is that the insurance industry and the medical communities rabidly control politics and policy which obstruct access to quality non-pharma management for post-acute and chronic disease.  It’s about controlling the post-acute market which is innately fragmented—keeping the dollars distributed among the few.  Why else would PTs have such large opposition from the medical community on direct access and anti-referral for profit legislation?  Clearly such bills or rules would offer the public greater choice to valuable and effective services which would stimulate innovation in care delivery.  Clearly the opposition wants control of these markets, this profession, and the dollars associated with our third party reimbursement. 

Safety is their argument, but how is specific exercise prescription a safety issue when it is exercise that can cure diabetes, control blood pressure, reduce the harmful effects of metabolic syndrome, improve restful sleep, and elevate mood?  This is what PTs are trained to do—prescribe exercise and use manual therapy and manipulation to safely reduce our patients’ impairments to restore function and performance.  With that, we also are trained to know what we can’t fix and when it is necessary to refer to another medical professional and/or diagnostic test.

My motive for writing this call to action comes after meeting complete apathy from a lawmaker and an insurance policy maker last week regarding unfounded political red-tape obstructing patient access to PT.  In addition, the news that Assemblywoman Mary Hayashi and the California Medical Association are introducing legislation to prevent enforcement of a current California law that protects patients from being victims of profit from referral.  We must unite and demand some changes in order to preserve patient choice and to assure we have an environment that permits us to provide our patients the best care.  We cannot sit back as passive observers any more.     

When arguing change to payment policy or changes to practice acts which extend scope you must be able to articulate sound reason and provide supporting evidence.   The key to making any binding decision is to accurately assess risks versus reward associated with those amended decisions.  This certainly should be the case with political and policy decisions—unfortunately it seems those in power are not that rational.  The overwhelming benefit of physical therapy management for most musculoskeletal problems is not debatable.  Consider that patients have direct access to obtaining naproxen and ibuprofen (over the counter) which has its place, but consequently cause exponentially more complications (and death) than any physical therapy care plan.

It is time that we harness these discussions with our patients, with our state and federal lawmakers and demand change.  Rational arguments and anemic presentation doesn’t facilitate change.  This is why it is time for a revolution!  We owe this to our patients and our profession.

C. Jason Richardson, PT, DPT, OCS, COMT

Over 200 state leaders within the Physical Therapy profession attended the American Physical Therapy Associations 2011 State Policy and Reimbursement Forum in Austin, Texas on September 23-26.  I had honor of being one of the Tennessee representatives.  The combinations of legislative mandates on health care delivery, reimbursement and technology are some of the reasons I was very excited to participate. 

The forum content included presentation specific to insurance policy trends (Federal and Commercial), legislative trends (State and Federal), and discussed emerging reimbursement methodologies in the wake of Health Care Reforms as defined by the Affordable Care Act (ACA).  Below is a summary of some of those presentations.

Trends to Watch for Medicare:

As many readers are already aware, Medicare will continue to ramp up efforts to identify and eliminate fraud and improper payments for Rehab professionals.  This has led to an increase in program integrity oversight in the form of increased enrollment screening for PTs in Private and Group practices, CORFs and Home Health Agencies, prepayment reviews by the Medicare Administrative Contractors (MACs), and post payment reviews by Recovery Audit Contractors.  Below is summary of the Medicare integrity programs with links for additional information:

Provider Enrollment—PTs in Private Practice (PTPP) placed on Moderate Risk for Fraud and Abuse under Medicare

                                                --PTPPs must have a site visit prior to enrollment as of March 25, 2011

                        --PTPPs are exempt from the new $505 enrollment fee

                        --http://edocket.access.gpo.gov/2011/pdf/2011-1686.pdf 

                        --Transmittal 371

Pre Payment Review—Reviews conducted by Medicare Administrative Contractors (MACs).

                        --Small Business Job Act of 2010 required predictive modeling to identify and prevent improper payments.  Medicare contracted with Northup Grummon to deploy algorithms and an analytical process that looks at claims in real time

                        --Program implemented July 1, 2011 to identify aberrant billing and coding patterns.

Post Payment Review—Reviews conducted by Office of Inspector General, MACs, Recovery Audit Contractors (RACs)

--MACs will target certain claims; will review, and recoup payment if deemed improperly paid.  Provider can appeal.

--Recovery Audit Contractors—expanded to include Medicare Advantage and the prescriptive drug benefit program.  RACs identify over payments (Part A and Part B).

--RACs--  www.cms.hhs.gov/RAC

--CERT—randomly selected Post Payment audit process

Trends to Watch Private/Commercial:

Expansion of the Multiple Procedure Payment Reduction (MPPR)—

-- Subsequent procedures performed during the same session by the same provider are reduced, usually by a percentage of the allowable rate.

-- Includes a tiered approach that reimburses the highest valued service at 100% and subsequent services will be paid at a percentage lesser than the highest valued service.

--Currently being adopted by many of the Blues (BlueCross KC, Wellmark, others)

--Aetna to adopt November 2011

--UHC to adopt as well—Date of implementation pending

            Continued growth of Patient Cost Sharing (increased Co-Pays, Co-Insurance, Deductibles)

--Employers are shifting more responsibility for health-care decisions to employees.

--Emerging strategies, designed to drive down costs for insurers and save money for employers, are resulting in higher co-payments and deductibles for consumers.

            Increased number of physical medicine and rehabilitation benefit management companies—Examples include:  Optum, Theramatrix, Universal Smart Comp

                        --Significantly drive down reimbursement

                        --Other services they market include:  Pre-Authorization Services, Retro-Reviews, Utilization Management, Quality Management and Outcomes, Claims Services.

            Like Medicare, the commercial payors are increasing payment integrity oversight. 

This year, state legislation aimed at improving patient access to skilled physical therapy services has been introduced in Tennessee, Texas, California, and Michigan.  All of these bills would enhance patient choice and access to treatment alternatives to surgery and medications for movement dysfunction and mechanical pain.

These pieces of legislation are being met with resistance from the medical community including orthopedic groups and state medical associations.  These groups perceive direct access to physical therapy as a threat to their financial stake in managing patients with mechanical pain. The primary rationale for opposing patient access to physical therapy is based on the view that this extension of services for outpatient PT without physician involvement would lead to increased utilization of medical services and therefore would increase costs to insurers and their beneficiaries.

This is a view is completely unfounded and is not supported by the evidence from countries in which there is a mature direct access base for physical therapy.  In fact, the current evidence demonstrates the opposite—where there is more imaging there will be more surgeries and greater disability rates.  See HERE and HERE and HERE.

The rate of back surgery in the United States is approximately 40% higher than in any other country and more than five times those in England and Scotland. Back surgery rates increase almost linearly with the per capita supply of orthopedic and neurosurgeons in the country. Countries with high back surgery rates also had high rates of other discretionary procedures such as tonsillectomy and hysterectomy.

The truth is, if the current system of physician referral for orthopedic interventions was working well and the system was coping with the current utilization, there would not be a problem and increased scrutiny toward orthopedic groups who employ their own physical therapists by MedPAC and the media. 

Direct access for physical therapy will only be of benefit to the general community if this system works cost efficiently and there is perceived to be incremental value in self-referred treatment pathways to PT.

If a patient is self-referred for rehabilitation and does not perceive value or benefit, they will not be compliant or continue treatment. Likewise, self-referred patients to physical therapists tend to be more motivated and require less treatment than physician referred patients.

In a mature patient direct access (to PT) market for musculoskeletal pain, where people in pain truly have a choice as to where they receive treatment, they will go where the product, and therefore the outcomes, are the best.

Internal medicine referral patterns to orthopedic surgeons for musculoskeletal pain has led to an overwhelming increase in imaging services, pain medication prescription and surgeries and the clinical outcomes have not improved and according to some has declined in recent years. Many orthopedic groups own their imaging equipment and also have their own PT departments and thus benefit financially from physician referral to their own facility. 

While the general community has grown cynical of costly and inefficient referral practices, it is also tired and disillusioned with ordinary and ineffectual physical therapy services. Patients are more and more looking to alternative treatment paradigms. The traditional exercise based physical therapy where a PT is required to perform an evaluation but often transfers the oversight of the treatment to an ATC or technical assistant will not wash in a mature direct access market.

That is the point.  In a mature direct access market, where a patient seeks the care of a physical therapist directly, only excellent physical therapy will thrive.  Physical therapy will get better and more efficient in a mature direct access market as the poor rehabilitation will fail to thrive.

When profit form referral motives are removed and there is truly a choice in where to receive treatment for musculoskeletal pain, people will not return and will not refer others to inferior options. Direct access will level the playing field and thus shift the power to the health care consumer where competition drives innovation, value, and clinical excellence—not the halo effect associated with cozy physician relationship based referrals.

If orthopedic surgeons can no longer benefit financially from self-referral, they will send to the best quality PT at their disposal and they will quickly learn who is delivering the outcomes they require in the rehab of their patients.

Similarly, part of being an excellent physical therapist and one who will thrive in a direct access market, is being an expert in differential diagnosis, and one who recognizes when a patient will benefit from referral for an orthopedic or neurosurgical consultation or alternative opinion. Direct access physical therapy must be good enough to know what is not responding within a reasonable timeframe and recognize early when some diagnoses need to be cleared before conservative rehab begins. This delivers value to the system, not cost.

Two weeks of conservative management is more cost-effective than MRI for most conditions as long as there has been a full and thorough clinical evaluation to clear more significant pathology.  This plays into the physical examination skills of the licensed physical therapist.

Direct access will gather momentum and the general community will benefit incrementally from the process, but physical therapy has to be good enough to become the gatekeepers for musculoskeletal pain.  Current physical therapy (PT) education mandates that these skills are taught in the entry-level curriculum, but obstructive laws prohibiting patient access to quality PT limits practice of these learned skills.  As in any market, the best will prevail and the rest will dwindle. We owe it to ourselves as a profession to promote patient direct access and be held responsible and accountable for the musculoskeletal wellbeing of our patients.  The medical profession isn’t meeting this need.

C. Jason Richardson, PT

Greg Spurgin, PT

Do our patients know they can see a PT without a referral?

Do our patients know what a PT does and what we treat? 

Do our patients know the education requirements of a physical therapist or how we function in the traditional medical model?  Do physicians know?

Why don’t we see more PTs interviewed for wellness, fitness, and ‘for your health’ stories in main stream media?

Why don’t we see more PTs interviewed on treatment successes for high profile athletes, politicians, celebrities?

Why aren’t more patients seeking cost effective PT management for musculoskeletal problems and movement dysfunction?

These are all questions that the APTA and our state component hear from our members and non-members alike.  Generally, with these questions there is an undertone of frustration by the therapist asking the questions, usually as if to say ‘why aren’t you doing more’ with educating the public.

The fact is that Public Relations and Marketing of physical therapy is a primary focus in the strategic plan and is a key facet in accomplishing the Vision 20/20 goal of being the practitioner of choice.  The problem lies in funding and how to best get our message across to the public.  The APTA’s  “Move Forward” campaign was the first PR move to define globally what PT is and does.   The challenge of defining PT for the public is amplified because of the large variety of specialty settings that PTs practice—Rehab, Orthopedics, Pediatrics, Occupational Health, Athletic Performance Enhancement, etc.  Imagine what the health care consumer thinks based on their personal experience when so many settings and specialties exists.

What we need are a group of enthusiastic therapists who are passionate about telling the story to others about what it is they do—hopefully this is the majority of you practicing.  A collective group that is as diverse as the settings and as diverse as the patients we treat.  In addition to engaging our patients in conversation about our education and role in health care, we need therapists actively participating as resources in community health fairs, sporting events, and civic and professional meetings so that our stories are amplified in the public.  Our message of how we effectively keep people independent and free of pain without medication and invasive surgery will resonate with the public.

More importantly, these ‘diplomats to the profession’ will set the expectation of how to communicate to the public and spawn their colleagues to be passionate about the skills they offer—these communication skills will become contagious and thus gain in momentum.  Once a critical mass is achieved every PT will then fully embrace direct access, and will not hesitant  to engage patients as to why we are the practitioner of choice for movement dysfunction. 

Every patient we see needs to understand that they can seek our advice and access our services directly.  We are all trained to recognize what we can and can’t treat successfully.  We are all trained when to recognize the clinical presentation of when to refer to our physician colleagues.  We have a moral and professional obligation to education the public to safe and effective treatment alternatives to pharmaceuticals and surgery. 

Right now is the perfect time to engage the public in these discussions.  The public is thirsting for cost-effective alternatives to treating their aches and pains without a mountain of pharmaceuticals and/or invasive surgical options.  We have an ethical duty to let the public know that there are other treatment options for their pain.  There is no profession more poised to offer these solutions.  If we don’t tell our story, someone else will.

Dr. C. Jason Richardson, DPT, OCS, COMT

Two weeks ago I met with a national health care payor to discuss the merit of linking with them on research pilots which would examine the efficacy and value of physical therapy triage of low back pain under their existing Accountable Care Organization (ACO) pilot.  I prepared a very detailed proposal which included specifics on how this particular pilot would link with their existing patient-centered medical home pilot where PT would be utilized to effectively triage all low back pain patients.  Essentially the medical home would send the majority of low back pain patients to see a PT who would then triage to a formal PT program, surgeon, or for further imaging.  Included in the proposal where suggested inclusions criteria, exclusion criteria, and metrics to track beyond costs accrued, but also on the patients functional outcomes at discharge, 6 months, and 12 months. 

I provided a wealth of supporting research from various peer reviewed journals from the US and abroad.  The Medical Director for this payor acknowledged the overwhelming evidence which supported PTs inclusion in primary care within the ACO model and conceded that  it had great potential at reducing costs while elevating outcomes.  What then came out of the medical directors mouth continues to resonate with me 2 weeks later.  He actually said that such a model may not get approval from the large multi-specialty group involved in this ACO pilot because of its potential for drastically reducing revenue streams for their participating surgeons. 

I, of course, expressed to him and the board that this is exactly the point.  Isn’t the function of the ACO and every variation of this ACO concept supposed to create a means for better outcomes at lower expenses?  What makes this statement so confusing to me is that I would have thought that the payor/insurance industry would be a tremendous stake-holder in determining care delivery models which improve health at reduced costs.  Wouldn’t this provide the payors with a competitive edge over competing insurers?  Couldn’t they sell better health and more value to their respective beneficiaries? This assumption certainly must be flawed when this particular medical director seemed more concerned with keeping participating surgeons happy than determining a more effective care delivery model for their members.

What is clear, is that we must continue to explore alternative care delivery options for treating musculoskeletal pain and injury.  The current system lead by the medical community has failed.  It is more expensive and arguably causes more harm than good compared with how other developed countries manage musculoskeletal problems--in most of these countries physical therapists play an integral role.  See http://tinyurl.com/299zeen

Also, we need to engage our patients in becoming advocates for PT.  Those patients we serve each day, those patients who send their friends and family members to see us, those patients who express their appreciation for getting through our doors because we prevented them from having surgery, those patients that expressed gratitude for getting their independence back, or back into sport are the advocates that can speak the loudest.  Until the public is on board with advocating valuable medical services to their respective payors, congressmen and congresswomen, and employers we will continue to make small strides politically and continue to be targets for balancing budgets.  I believe our patients as advocates will be the catalyst to seeing a political tipping point for physical therapy. 

I will not give up at pursuing these pilots with insurance payors.  There are competitors who are interested in the answers these pilots will demonstrate and they will not be afraid to exploit a better care delivery model to attract more favorable business. 

Dr. Jason Richardson, PT, DPT, OCS, COMT

VP of Clinical Operations
Results Physiotherapy Centers

Twitter: @TNBackPain