He then asked me about the recent changes to healthcare and how they would impact physical therapists.
I told him that the next 3-10 years would bring about a gradual shift from Fee-for-Service to an outcomes-based payment system. A payment system based on patient-reported outcomes will create winners and losers in physical therapy.
Winners: physical therapist mangers with a unwavering focus on patient reported functional outcomes (PRO).
Losers: physical therapist managers that produce QUANTITY but not QUALITY. My friend may lose if he doesn't shift his focus away from his procedures, like laser.
Note: There may be some high-quantity providers who can also generate high-quality outcomes, in fact, there probably are - these are the physical therapist managers who have developed efficient, effective processes for managing patients, getting them better and making money, too.
I challenge providers to identify yourselves if you think you've mastered the process of creating great outcomes. Unfortunately, verifying your claims will be difficult since even the leading PRO provider commands only a tiny market share of the PT industry. That's too bad.
Better management processes are the key to winning vs. losing. My friend thinks that his procedures, like laser, are the keys to quality - but they're not. It's the management process.
The question for the future will be this: Who controls the process of care? Physical therapist managers or the government? Right now the government dominates the process of care with mandates on 'how' physical therapy is delivered. Processes like...
- the 8-minute rule
- the -kx modifier
- 'skilled therapy' (as determined by an 'expert' auditor)
- time-in & time-out
- PTA supervision requirements based on treatment setting
- Minimal Documentation Requirements
- 'one-on-one' codes
- physician certification of the physical therapy plan of care
- maintaining high productivity,
- good documentation compliance,
- high staff morale and
- excellent clinical outcomes
- creating management processes that make money and deliver good PRO
Costs are increasing but patients, in aggregate, are getting worse. Spine problems in the United States especially are getting worse. This article from the October 2009 Spine magazine states:
"National expenditures for spine problems increased 82%, or an average of 7.0% per year, from 1997 to 2006.Physical therapist managers don't know which treatments work and which don't for each patient. From the British Medical Journal, 51% of all medical interventions are of unknown effectiveness.
Paradoxically, measures of self-reported mental and physical health and activity limitations among those with spine problems worsened, and the percentage of respondents with spine problems who reported work, social and physical functioning limitations increased substantially during this period."
Physical therapists are good at creating high levels of patient satisfaction (one measure of quality) through caring, face-to-face interaction and hands-on care.
But which interventions create better value? Which create better patient reported functional outcomes? Better patient satisfaction? Lower costs while keeping people living independently? Reduce the risk of future adverse events? Do these following interventions do any of the above?
- Spinal Decompression therapy
- Myofascial release
- Craniosacral therapy
That is the challenge for the physical therapy manager.