"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Monday, June 22, 2009

The Future Price of Outpatient Physical Therapy

Will outpatient physical therapists face 'bundled episodes of care' from Medicare in August when the current administration brings it health financing reform package together?

Right now we are all speculating.

However, we can speculate based on evidence and perhaps gain some perspective. The sooner we know the sooner physical therapists can act.

I've posted some action points for physical therapists to prepare for bundled episodes of care here and here.

But, what recent evidence do we have that bundled episodes of care will be a part of the reform package?

This is a part of the speech President Obama gave to the American Medical Association (AMA) in Chicago on June 15, 2009. He specifically addresses the alternative to bundled episodes of care at 20:40 - just drag the cursor on the video.

(click here to start the video)

If you prefer to read I've posted the text below.

"Despite what some have suggested, the reason we have these costs is not simply because we have an aging population. Demographics do account for part of rising costs because older, sicker societies pay more on health care than younger, healthier ones. But what accounts for the bulk of our costs is the nature of our health care system itself - a system where we spend vast amounts of money on things that aren’t making our people any healthier; a system that automatically equates more expensive care with better care.

A recent article in the New Yorker, for example, showed how McAllen, Texas is spending twice as much as El Paso County - not because people in McAllen are sicker and not because they are getting better care. They are simply using more treatments - treatments they don’t really need; treatments that, in some cases, can actually do people harm by raising the risk of infection or medical error. And the problem is, this pattern is repeating itself across America. One Dartmouth study showed that you’re no less likely to die from a heart attack and other ailments in a higher spending area than in a lower spending one.

There are two main reasons for this. The first is a system of incentives where the more tests and services are provided, the more money we pay. And a lot of people in this room know what I’m talking about. It is a model that rewards the quantity of care rather than the quality of care; that pushes you, the doctor, to see more and more patients even if you can’t spend much time with each; and gives you every incentive to order that extra MRI or EKG, even if it’s not truly necessary. It is a model that has taken the pursuit of medicine from a profession - a calling - to a business.

That is not why you became doctors. That is not why you put in all those hours in the Anatomy Suite or the O.R. That is not what brings you back to a patient’s bedside to check in or makes you call a loved one to say it’ll be fine. You did not enter this profession to be bean-counters and paper-pushers. You entered this profession to be healers - and that’s what our health care system should let you be."
The article about high-cost McAllen, Texas from the New Yorker magazine by Atul Gawande, MD can be found here - Dr. Gawande recommends bundled episodes of care administered by 'accountable care organizations' (ACO).

Obama references Gawande who strongly recommends episodes of care and rejects the current fee-for-service system.

Currently we've got some bundled episodes of care that we can look to for examples. This example is of Lower Back Pain. Most surgical procedures are bundled with the pre-op and post-op follow-up. Any other examples would be appreciated - just comment at the end of this blog.

I'd say the Obama-Gawande tandem is strong evidence to suggest what we may see in August.

Free Tutorial

Get free stuff at BulletproofPT.com

Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

"Make Decisions like Doctors"

Copyright 2007-2010 by Tim Richardson, PT.
No reproduction without authorization.

Share PTD with your Peers!

American Physical Therapy Association

American Physical Therapy Association
Consistent with the American Physical Therapy Association Vision Statement for Physical Therapy 2020, the American Physical Therapy Association supports exclusive physical therapist ownership and operation of physical therapy services.