The Value of Physical Therapy in Healthcare: Part 1 | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

The Value of Physical Therapy in Healthcare: Part 1


The Value of Physical Therapy in Health Care


Current Status in Healthcare

Economist John Mauldin states in his recent blog “the US healthcare system as it stands is dysfunctional and can no longer continue as it currently operates.”  The necessary changes in the US healthcare system are going to happen with or without Obamacare. The whole system is simply dysfunctional. So what is exactly wrong with our healthcare system?  I like to keep things simple so like Einstein said, “Everything should be made as simple as possible, but never simpler.” So there are 4 simple factors that we need to identify as problems with our healthcare system.
  • The overall cost of medical care1
  • Inflated billing cost and declining reimbursement. (For example: A hospital system may bill about $18 billion for medical services and collect around $6 billion.)1
  • Increased rates of chronic disease, illness, pain, and injuries. Also the increase in coverage needed from the implications of the Obamacare. So there is an increased need for healthcare services. 1
  • Lack of cost effectiveness and poor outcomes. Can the diagnosis and treatment be performed at a more efficient and cost effective manner?
I am not an economist, but this looks like a major health care and financial problem.  What will happen overall to medicine?  Now looking at the big picture of healthcare; hospitals and clinics need to reduce overall cost and expenses, healthcare providers will have to reduce the cost per patient, and clinicians being more innovative how care is given.  We could talk about this for hours with long debates of how to correct this problem we are facing.  Regardless of your individual beliefs, biases towards physical therapy, and political views,  in the future all medical professionals ranging from, hospitals, to skilled nursing facilities, to outpatient private practices, we will all have to perform healthcare services in a more efficient, innovative and cost effective manner.

Future of HealthCare and value of Physical Therapy

Again lets look at the big picture here, beyond just physical therapy services, and look at the reimbursement, insurance company, financial, and healthcare trends that are starting to occur.

1, Over the next several years we will go from volume-based reimbursement in medicine (based on the number of procedures or patients a provider sees) to a value-based or outcome-based system (being paid the same amount per patient no matter how well or sick, so the goal will be based on outcomes).
2. Health insurance companies are increasing premiums, increasing deductibles, increasing co-pays, adding coinsurances, and decreasing reimbursement and controlling what is actually covered.  Insurance companies are charging more but paying out and reimbursing less.  The interesting topic is how are insurance companies going to value physical therapy?
3.  Businesses are altering their employee’s insurance plans to decrease their expenses, and using more high deductible health care plans with health incentives, HSA, and FSA.  So the patient or employee will have more responsibility for services, financial, and where to go even with health insurance.
4.  Accountable Care Organizations (ACOs) are forming and dominating local markets.  Private practices are being bought out and their clinicians are joining into these large medical groups.  Where will the physical therapist fall in the ACO model and what will happen to the quality of care?

What is outpatient physical therapy and private practices going to do? Will insurance companies ever see the cost-effectiveness and value in physical therapy?  Will a private physical therapy practice survive?  How many more studies have to come out to show the cost effectiveness of physical therapy for musculoskeletal injuries?2,3,6,7,8,9,11,14,15,22,23   How many more studies need to come out to show the same long term outcomes as compared to surgery?13,16,17,18,19,20,21,  How many more studies show the benefit of direct access and good short-term and long-term outcomes with physical therapy services?4,5,7,10,11,12,14,15,24 Currently, physical therapist can implement evidenced based interventions and show great outcomes with patients as compared to standard care, show great patient satisfaction, but the governing health care system will still make it hard for outpatient physical therapy practices to survive.  The average reimbursement from Medicare in my state is roughly $75/visit and many physical therapy practices are one Medicare cut away from closing shop.  Recently a local Workman’s Comp group reached out to us because they heard of the great results we are getting and tried to offer and negotiate for $58/visit!  Yeah, $58!

So what is the answer to this problem?  What should we do as physical therapists and how can we make sure our patients are still gettting the high quality care they deserve?  

Part 2 coming soon........

By Ron Miller, DPT OCS
header image credit
Owner of Pursuit Physical Therapy
Adjunct Faculty of University of Central Florida

References
  1. John Mauldin. Thoughts From the Frontlinehttp://www.mauldineconomics.com.
  2. Fritz JM, Brennan GP, Hunter SJ. Physical Therapy or Advanced Imaging as First Management Strategy Following a New Consultation for Low Back Pain in Primary Care: Associations with Future Health Care Utilization and Charges. Health Serv Res. 2015 Mar 16.
  3. Childs JD, Fritz JM, Wu SS, Flynn TW, Wainner RS, Robertson EK, Kim FS, George SZ. Implications of early and guideline adherent physical therapy for low back pain on utilization and costs. BMC Health Serv Res. 2015 Apr 9;15:150.
  4. Delitto A, George SZ, Van Dillen L, Whitman J, Sowa G, Shekelle P, Denninger T, Godges J. Low Back Pain Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association.  201242(4):A1-A57.
  5. Deutscher D, Horn SD, Dickstein R, Hart DL, Smout RJ, Gutvirtz M, Ariel I. Associations between Treatment Processes, Patient Characteristics and Outcomes in Outpatient Physical Therapy Practice. Archives Physical Medicine and Rehabilitation. 2009 Aug;90(8):1349-63.
  6. Dan Fleury and Thomas Perreault. Oseopractic Physical Therapy Blog. April 2015. https://osteopractor.wordpress.com/2015/04/29/osteopractic-physical-therapy-cost-effectiveness-compared-to-national-average
  7. Pham HH,Ginsburg PBMcKenzie KMilstein A.  Redesigning care delivery in response to a high-performance network: the Virginia Mason Medical Center. Health Aff (Millwood). 2007 Jul-Aug;26(4):w532-44. Epub 2007 Jul 10.
  8. Martin BI,  Deyo RA, Mirza SK, et al. Expenditures and health status among adults with back and neck problems. JAMA. 2008;299:656–664.
  9. Fritz JM,Brennan GPHunter SJMagel JS. Initial management decisions after a new consultation for low back pain: implications of the usage of physical therapy for subsequent health care costs and utilization.  Arch Phys Med Rehabil. 2013 May;94(5):808-16.
  10. NordemanLNilsson BMöller MGunnarsson R.  Early access to physical therapy treatment for subacute low back pain in primary health care: a prospective randomized clinical trial.  Clin J Pain. 2006 Jul-Aug;22(6):505-11.
  11. MitchellJMde Lissovoy G.  A comparison of resource use and cost in direct access versus physician referral episodes of physical therapy.  Phys Ther. 1997 Jan;77(1):10-8.
  12. WandBMBird CMcAuley JHDoré CJMacDowell MDe Souza LH.  Early intervention for the management of acute low back pain: a single-blind randomized controlled trial of biopsychosocial education, manual therapy, and exercise.  Spine (Phila Pa 1976). 2004 Nov 1;29(21):2350-6.
  13. Delitto A,Piva SRMoore CGFritz JMWisniewski SRJosbeno DAFye MWelch WC. Surgery versus nonsurgical treatment of lumbar spinal stenosis: a randomized trial. Ann Intern Med. 2015 Apr 7;162(7):465-73.
  14. John D Childs,Julie M FritzSamuel S WuTimothy W Flynn, Robert S WainnerEric K RobertsonForest S Kim and Steven Z George.  Implications of early and guideline adherent physical therapy for low back pain on utilization and costs.  BMC Health Services Research 2015, 15:150.
  15. Fritz JM,Brennan GPHunter SJ. Physical Therapy or Advanced Imaging as First Management Strategy Following a New Consultation for Low Back Pain in Primary Care: Associations with Future Health Care Utilization and Charges.  Health Serv Res. 2015 Mar 16.
  16. Louw A,Diener ILanders MRPuentedura EJ. Preoperative pain neuroscience education for lumbar radiculopathy: a multicenter randomized controlled trial with 1-year follow-up.  Spine (Phila Pa 1976). 2014 Aug 15;39(18):1449-57.
  17. Kukkonen J,Joukainen ALehtinen JMattila KTTuominen EKKauko TAärimaa V.  Treatment of non-traumatic rotator cuff tears: A randomised controlled trial with one-year clinical results. Bone Joint J. 2014 Jan;96-B(1):75-81.
  18. Sihvonen R,Paavola MMalmivaara AItälä AJoukainen ANurmi HKalske JJärvinen TLFinnish Degenerative Meniscal Lesion Study (FIDELITY) Group.  Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear.  N Engl J Med. 2013 Dec 26;369(26):2515-24.
  19. Smith JS,Sidhu GBode KGendelberg DMaltenfort MIbrahimi DShaffrey CIVaccaro AR. Operative and nonoperative treatment approaches for lumbar degenerative disc disease have similar long-term clinical outcomes among patients with positive discography. World Neurosurg. 2014 Nov;82(5):872-8. Epub 2013 Sep 15.
  20. John N. Mafi, Ellen P. McCarthy, Roger B. Davis, Bruce E. Landon. Worsening Trends in the Management and Treatment of Back Pain. JAMA Intern Med. 2013;173(17):1573-1581.
  21. Holzer LA, Leithner A, Holzer G. Surgery versus physical therapy for meniscal tear and osteoarthritis. N Eng J Med. 2013 Aug 15:369(7):677.
  22. MitchellJMScott E. Physician ownership of physical therapy  Effects on charges, utilization, profits, and service characteristics.  JAMA. 1992 Oct 21;268(15):2055-9.
  23. Pendergast et al. A Comparison of Health Care Use for Physician-Referred and Self-Referred Episodes of Outpatient Physical Therapy. Health Serv Res. 2012 Apr; 47(2): 633–654.
  24. Ojha HA,Snyder RSDavenport TE. Direct access compared with referred physical therapy episodes of care: a systematic review. Phys Ther. 2014 Jan;94(1):14-30.





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