Repeal and Replace Should have been Enhance and Improve

I was talking to a passenger on a plane recently. He is fully unsured but claims between very high deductibles and out of pocket, that his insurance doesn’t help much so he pays cash for medical services-says he even enjoys doing this. Claims to have negotiated a $200 MRI for all cash in a high volume center in Fl and then promptly turned the entire bill in to his insurance where it went against his high deductible. I think you can say, he has insurance but no benefits but he has access that he can afford. We opened a PT clinic in one of the most impoverished area codes in the country in West Louisville. It’s a population of over 25,000 without prior access to physical therapy. Many of these folks have #physicaltherapy needs and now have insurance but with copays and out of pocket costs, they cannot afford it. They are insured with no benefits and without affordable access.

Therein lies the heart of my major issues with ACA and general debate regarding healthcare reform. We are simply using the wrong metrics. The number of uninsured might be easy-like using a scale to calculate pounds but just like weight isn’t the proxy for fitness, either is somebody’s insurance card and active medical care. An insurance card doesn’t mean a person is under care anymore than a fitness club membership means somebody is in a fitness plan. While my genuine hope is that the 20+ Million uninsured are now under primary care services including disease management and prevention, there aren’t any real stats that support this. The benefits for this group at times are almost irrelevant as a significant number of providers don’t take medicaid or the exchange products which often like medicaid are far below provider cost.

While I think ACA is generally horrible given a larger perspective outside of number of insured, I don’t think it is an unmitigated disaster. I think repeal and replace was the wrong strategy at the wrong time and should have been “enhance and improve” deliberated by centrist democrats and republicans working together.

At issue:

-we were taxed on ACA 2 years before implementation on a bill that was going to make healthcare more affordable and lower the number of uninsured. It succeeded on the later part of this only and I believe the measure is illusory and at a cost that is unsustainable as there will be no more 2 year ramp up and the shift of funding to states is unrealistic.

-Payors are running from the individual market making the individual mandate increasingly difficult to comply. On the healthcare exchanges, when you have one insurance company option, you have no option and even in those markets, many of the one option payors are departing. There are problems with ACA, everyone agrees with it and a wait and see attitude is a failed strategy.

-It’s funding is to shift to states already over burdened with obligations including underfunded pensions, rising educational costs, antiquated tax systems as well as a myriad of other complicated benefits and expenses. Given changes in administrations, how can they be expected to deal with a new mandated expense? For this reason, block grants and state flexibility should be fundamental to dealing with uninsured and that needs to occur sooner rather than later.

-What often goes unsaid is the folks that were insured during ACA implementation have seen their premiums soar, their copays and out of pocket grow significantly and their overall benefits decrease. Does one really have a #physicaltherapy benefit if almost 100% of the cost comes from out of pocket? Employer cost’s escalated exceeding salary costs in terms of percentage increase. This is not a good formula for maintaining an engaged, competitive workforce. Raising healthcare costs occurred during a time when providers reimbursement went down-where did all the money go? Just like higher education tuition increases, the rising cost went to administration not to teachers or medical providers.

-when ACA passed 7 years ago, not one Republican voted on it. Had TrumpCare won, not one democrat would have voted for it. A big criticism seven years ago, and one that I agree, is that it passed too fast without almost anybody reading the excessive pages and fine print of the bill. Isn’t America made great again by a more lengthy debate process using metrics, retrospective analysis, and consensus to drive improvements? I sure hope so. The logic of repeal and replace was as ill founded as the logic of passing the monumental ACA without consensus.

-the regulatory impact of healthcare has lead to increased process and paperwork demands that have created more burned out medical providers than at any time in our history. Any reform efforts must address this issue as the last thing we want is insured patients being treated by completely disengaged and disenfranchised medical providers.

One thing we know for sure, the debate of healthcare is not over, ACA’s current form is not sustainable and must be enhanced and improved for the benefit of America. We can do this.

Thoughts?

@physicaltherapy

23 responses to “Repeal and Replace Should have been Enhance and Improve

  1. Missy Forrest says:

    Great read Larry!

  2. John Ware, PT says:

    I think ACA needs to be considered within the broader context of centrally-managed, government healthcare. Over the course of several decades now, we have Medicare/Medicaid and the VA system as examples of how effective and efficient the federal government in Washington DC is at running large sectors of the healthcare system. Medicare insolvency is about a decade away based on current projections. Medicaid is a mess. The VA is plagued with inefficiencies and outright corruption. Most Democrats and many Republicans hold up Medicare as model of efficiency based on some figure of overall administrative costs as a percentage of total costs. That low administrative figure looks small because overall spending in Medicare is so huge. Medicare per capita spending has roughly doubled since 2000. That’s about 5% per year annual growth, which is more than double the rate of inflation during the same period. Any private business running those kinds of cost overruns would have been out of business a long time ago. But, when the largesse of the American taxpayer continues to stream in, there’s no end in site to the growth in spending.

    Trump ran on repeal and replace of Obamacare, and that’s what he needs to deliver to his voters. The Tea Party movement was largely driven by strong objections to additional government involvement in healthcare. I can’t understand why so many people who have been working in healthcare their entire careers, witnessing on a daily basis the waste, lack of quality, and outright harm that is caused to patients, think that suddenly politicians, bureaucrats and lobbyists in DC will finally figure out how to “enhance and improve” the healthcare system.

    Further tweaking of what is essentially a government-managed system is not going to enhance or improve anything.

  3. Tim Mondale says:

    What part of better and cheaper do we not understand. It represents what the larger portion of the rest of the developed world does with their healthcare, than what we do with ours. It’s not that difficult. Government single payer is the only way to accomplish that, and that’s been proven time and time again by all the other countries that do it better and cheaper than we do with our precious free market. No one else does it, because it doesn’t work. We’ve tried it for long enough, and to try just to do it better is ridiculous.

    No that’s a different question from where we are now. Trump/Ryan care was a joke. Not even serious if you’re not trying to cover all your citizens. So our only viable option is the ACA improved (Medicare has been improved hundreds of times since 1965) with critical analysis of it’s coverage of all, and it’s promotion of optimal and efficient health outcomes for the population. We should not be in support of grotesque profit for private insurance companies, drug companies, hospitals, and medicine that does more than is safe and effective.

    At the very least maybe those red states that declined Medicaid expansion will opt in now, and rescue their states needy.

    1. John Ware, PT says:

      Tim,
      I regularly interact with PTs and other musculoskeletal therapists in Canada, Europe and other parts of the world, and there’s broad agreement that modern healthcare systems are routinely offering costly treatments that are of marginal or even low value. Many of these systems, such as in the UK, Canada and Scandinavia have a significant single-payer, nationalized delivery apparatus available to their citizens. All of these countries’ national budgets are under tremendous strain from healthcare costs. Certain countries are doing better in treating some conditions, but overall value is low, medical mistakes and over-treatment are high, and costs are rising faster than rate of inflation in the rest of the economy. The costs seem to increase with demographic complexity and population size. The US has a very large and uniquely heterogeneous population compared to other modern, industrialized countries. The one thing different about many of these other systems, such as in Canada and the UK, is that wait times for needed procedures, such as total joints replacements and transplant surgery, is often very long resulting in increased mortality and morbidity. Indeed, Canadians and some Europeans with the financial means often use the US system for these procedures.

      It’s pie-in-the sky to think that a large segment of the voting US public will go for a single payer system after being lied to and misled by President Obama and the designers of the ACA (“If you like your plan, you can keep your plan. If you like your doctor, you can keep your doctor,” “Lack of transparency was a huge advantage,” “You can see what’s in the bill after we pass it.”). Many Americans now see the ACA as a veiled attempt for government to take over the entire healthcare system and that it was not negotiated in good faith. That fundamental breach of trust by the Democrat leadership has killed any future healthcare legislation with even a whiff of single payer. The Democrats screwed the pooch, and they’re seeing the consequences of their actions in the voting booth.

  4. Brian D'Orazio DPT, MS, OCS says:

    I like Larry’s assessment, especially his statement….” where did all the money go?”. As the saying goes… ” when it’s not about the money, it’s about the money! “. Let’s look at where did all the money go…

    In the late ’70’s and early ’80’s, states voted to allow insurance companies to be publicly traded. For PT, that meant within 10 years isokinetic testing wasn’t reimbursed and we developed notes with ” so that…” statements to convey ” functionality ” for the insurers. They didn’t really care, because they are the financial decision makers and what became most important to them were their quarterly financial statements. As publicly traded companies, increases in profitability drew in more investors and hence billions in capital. It didn’t matter how ” functional ” we were. They didn’t really care about understanding out notes….they needed plausible deniability to stop paying for a specific service.

    Now, fast forward to 1997 and the BBA. What did that create for our profession….the cap on services! Why…because CMS needed to cut reimbursement and PT is an easy target, since we only improve quality of life and don’t save lives. We keep thinking they don’t understand us, they don’t value us and now we think we need to show that we can be ” VALUE OVER VOLUME “! One more study about our ” value ” and we’ll be rolling in clover! NEVER GOING TO HAPPEN! Why, because it IS about the money.

    What else is about the money…..POLITICS! It’s all about the money. They don’t elected without money, and who supplies most of the money for their elections? A clue….it isn’t PT. In fact, it isn’t the hospital association, the AMA or any patient centered entity.

    So where did all the money go? That is the most relevant question in the debate. Can we expect a functional ( yes…that word again ) healthcare system in an environment that elects legislators on the basis of large contributions from a small number of entities? Who are the insurers going to listen to….PT’s, or shareholders? What happens in a single payer system? Do legislators ever consider the health of citizens, or just the financial line item on their budget? Why is it that citizens, in countries with a single payer system, wait for months and months to have surgery?

    In our profession, if our national organization can’t answer these questions then we are doomed to continue down the same path that has led us to our current reimbursement debacle. Sure, lets continue to participate in more studies about outcomes….that must be the answer. I think it’s the answer that the insurance companies and CMS want, because it gives them an argument, in front of legislators, to cut reimbursement.

    Another question we may want answered is… ” do we want legislators, ( who primarily want to be re-elected ) to craft a healthcare program for the United States? Maybe we really want a new system of campaign financing that leads to less government corruption?

    1. Tim Mondale says:

      Brian,

      I don’t know where you practice, but where I practice (In one of the most densely medicalized places on earth; the Boston area), several month wait times for elective surgery is the norm; again perpetuated falsehood that we are somehow special because we whisk patients in on a magic carpet the instant it’s determined they might benefit from surgery.

      You do certainly make a valid point with politics and money, but you get it completely wrong when you suggest government can’t solve these kinds of problems. It’s done all over the world. What’s wrong is the notion that the “free market” is the solution. There are no examples in the world where that works best; and we certainly aren’t one.

      That said, all for campaign finance reform.

      1. Brian D'Orazio DPT, MS, OCS says:

        Your overwhelming bias for a single payer system is beyond reasoned argument. We don’t know what would happen if we go to that system, and given the current government climate, corruption would seem to reduce the likelihood of success….for that matter, any system is likely to fail as our government system fails.

        As to the wait times, I grew up in Niagara Falls. People waited over a year for sometimes lifesaving heart surgeries and more than 18 months for joint replacements or other procedures performed due to pain. During the ’80’s, there was a mass migration of healthcare providers out of Canada and to the US due to the imposed conditions and poor pay. For those Canadians who could afford it ( all of these countries have a two tiered system; one the government pays for and one the wealthier pay for ), there was also a mass migration of patients to the US. Unfortunately, as payment has contracted in states through the WNY area, insurance companies have monopolized hospitals and offices and further cut services. Not sure it’s much better to be treated in WNY than in Canada these days. Those are the facts of the case. How it might be here with a single payer isn’t clear given a differential of 300 million vs. 50 million citizens. One thing is for sure, healthcare would be a line item on a budget for Congress who rarely reacts to situations based on patient need….but then again, neither do insurers. There has been no proposal of a system in the US that seems to meet our needs. You’d think in a country known for innovation we’d be able to craft something better than is being done in other countries. Maybe not….at least not with rampant government corruption that seems to enjoy flaunting conflict of interest in our faces.

        1. John Ware, PT says:

          I think the “climate of corruption” around the ACA began when President Obama said, “If you like your plan, you can keep your plan. If you like your doctor, you can keep your doctor” – not once, but multiple times during the 2008 campaign and while promoting his signature legislation. And then when Nancy Pelosi said, “You can see what’s in the bill after we pass it”, it pretty much confirmed that the Democrat leadership was in on the scam. Of course there’s also the video of ACA consultant Jonathan Gruber talking about how a “lack of transparency” was necessary for the bill to pass and then attributing that sleight of hand to the “stupidity of the American people.” Well, turns out the American people aren’t so stupid after all.

          So, I’m not sure how you can suggest that the previous “government climate” is any less corrupt than the current one.

          Also, you’re off about 15 million on the population of Canada. Demographically, Canada is considerably less culturally and racially diverse than the U.S.

          I agree with you on the lack of innovation in US healthcare delivery as well as Congress having very little interest in advancing the interests of patients (unless it’s a family member), and therefore using healthcare as a political football. They already do that- we don’t need single-payer to see healthcare politicized. The lack of innovation, however, is directly related to the lack of competition at the right level, which is around a cycle of care for any given health condition. Currently, the competition is primarily around cost-containment through vertical integration and consolidation, i.e. “healthcare systems” and various joint ventures to reduce overhead and share administrative costs.

          Patients are an after-thought.

          1. Brian D'Orazio DPT, MS, OCS says:

            John,

            I agree. Corruption in gov’t is widespread…well beyond the ACA. When a legislator can accept large donations and still vote on issues relevant to that donor then fundamental conflicts of interest are being overlooked. Not sure we can trust much coming out of Washington on either side. Wish I felt differently. Sorry I wasn’t up to date on Canada’s pop.

  5. Tim Mondale says:

    John,
    The costs around the world
    don’t even come close to ours. We spend 17-19% of our GDP on healthcare, and don’t even get close to covering all of our citizens. In terms of quality, the WHO http://www.who.int/whr/2000/media_centre/press_release/en/would disagree with your contention that we do it so well here. The rest is just myth perpetuated by those who have been stuffing themselves from the trough for a long, long time.

    The rest of your post with your political analysis is just laughable. The only way there isn’t at least a government option in the ACA was in attempt to appease the Republicans.

    1. John Ware, PT says:

      Tim,
      I think you misunderstood me. I didn’t contend, suggest or state that “we do it so well here.” I said some other countries are doing some things well, but overall, healthcare delivery in modern economies, including here in the US, is expensive and low value, particularly for chronic conditions, like persistent pain related to MSK problems- from knee OA to low back pain. It’s a fact, however, that many Canadians and some Europeans (and Middle Easterners), who can afford it, come to the US for joint replacements and organ transplantation. You don’t see Americans going to the UK or Canada to get their TKA or kidney transplant because the waiting lines are so long just for their own citizens to get these procedures.

      You didn’t address my point about the complexity of our unique population demographics in the US, which is a big factor in cost escalation here. There are other factors, but that’s a significant driver of delivery inefficiencies, particularly given the lack of competition. The resulting lack of market discipline is poorly compensated for with process compliance rules- most of which are just onerous regulations that have very little if anything to do with providing or ensuring quality outcomes. What other industry says you have to spend at least 8 minutes providing a service for it to be of value? Yet, we accept senseless rules like this all the time. It’s embarrassing when you think about it. It’s like a game little kids make up on the playground where they just change the rules as they go along. The insurance companies didn’t come up with the 8-minute rule, the government did.

      The difference is, of course, that we care for actual patients who are really suffering. It’s pathetic that we allow bureaucrats and politicians to dictate to us how best to care for our patients.

      1. John Goodrich, PT says:

        Actually, you may recall the story of the gentleman who, faced with paying for a THA out of pocket, wound up going to Belgium, where, for roughly the cost of just the prosthesis in America (about $12,000 as I recall), all services were covered, including travel and board. But that’s just one case. I am convinced that some of us are suffering from short term memory loss. Prior to ACA, premiums and deductibles were going up sharply, while services were being dropped; the number of insured continued to rise; full time jobs were being replaced with part time in order for employers to reduce health care benefits, etc. I for one am growing weary of the mythology around the “free market,” when it comes to health care; I share your concerns with “onerous regulations,” but those apply to private insurers as well. As to the election, less than 50% of the population voted, and the majority voted for the opponent, so I’m not sure where you’re going with that.

        As for me, I’m close to retirement, and I look forward to being on Medicare.

        1. John Goodrich, PT says:

          Correction; voter turn out was less than 60%, but that’s another issue.

          1. John Ware, PT says:

            Who came up with the 8 minute rule? Who came up with the arbitrary dollar-amount cap on outpatient PT services? Who developed the entire procedural reimbursement system with all of its perverse incentives that can only be reined in by more regulations? Many private insurance and Medicare replacement plans have gone to a per visit rate for PT because it’s less costly to administer.

            What we have had is a capitalist healthcare system dominated by cronyism, not a free market system. In free markets, providers of the service or product compete around providing a higher quality service/product at the lowest possible price. That doesn’t happen in healthcare with any regularity. Competition is at the wrong level. The primary focus is on cost-containment. That’s why we’re seeing increased consolidation and vertically-integrated “healthcare systems.” The persistent failure to consistently meet standards of care for common conditions, like diabetes and low back pain, is strong evidence that our healthcare system still- even under the ACA- has utterly failed to improve the quality of care. No one’s talking about quality. All they’re talking about is access to care. Hell, I often find myself talking family members *out* of seeing a doctor for their back or knee pain because I know their going to end getting some prescription or procedure that’s worthless and expensive. A family member wouldn’t listen to me and just got his knee scoped. Of course, this increases his chances of feeling better due to the combination of surgery placebo and forced rest, but he spent several hundred dollars out-of-pocket, and his insurance paid a few thousand more. And we wonder why insurance rates continue to climb?

            In the current healthcare debate, no one’s talking about the deplorable lack of quality in modern healthcare systems. We’ve gotten so use to mediocrity and being treated like crap in medical offices that it’s hard to even conceive of a system that is actually focused on providing patient-centered care. We can do so much better.

  6. Tim Mondale says:

    “The US has a very large and uniquely heterogeneous population compared to other modern, industrialized countries.”

    John W,

    Not sure what you mean by that. We may be larger than many/most, but why would that matter? We are otherwise no different than anyone else. That’s just a matter of scale. I disagree that the American people would never stand for such a thing as single payer healthcare. 35% probably wouldn’t (about the same number that still support Trump), but the rest certainly could, and would.

    With regard to the tired non-sensicle trope of government oppressive overregulation I would just say that if you’re letting government regulation limit your practice with your patients, then I feel very sorry for you. The one thing I would say that is particularly onerous is the lack of Medicare direct access for us. That certainly needs to change.

    John G. Couldn’t agree more.

    1. John Ware, PT says:

      Scandinavia and Canada, despite their recent more liberal immigration policies, are much more culturally homogenous than the US. This has important impacts on lifestyle, which has an important impact on health. Everything from diet to stigma on single-motherhood are strongly influenced by racial, class and regional variability- in other words: cultural differences. The US is unique in this way. And, our population is very large.

      Most likely voters, who are the ones that really matter in terms of public policy, are against a single payer plan based on the most recent poll I could find.http://www.rasmussenreports.com/public_content/archive/health_care_update_archive/april_2014/37_favor_single_payer_health_care_system

      I think you’re in denial if you think government-imposed regulations don’t negatively impact on the ability of clinicians to provide the kind of care they think is best for patients. The amount of time alone that it takes to do home health documentation has a negative impact on care. Or, based on the evidence (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4081747/) has neutral impact on outcomes. I’d argue that doing a lot of unnecessary documentation has a negative impact on the clinician’s job satisfaction and quality of life, which cannot have a positive impact on care provision.

      I’ll provide a concrete example. I went on a ride-along with a PT on a home health visit for a company that I’m going to start doing some PRN work for. The documentation system requires that the PT perform a TUG as part of the PT eval. The PT, however, did not perform a TUG. She spent over an hour in the home with the patient, who’d just had a TKA. She measured AROM, set up the CPM, and did a reasonable job of assessing her gait and mobility. But she did not perform an actual TUG, which is a good test for providing a baseline level of general mobility and fall risk. I’m assuming she inferred a TUG score based on the gait assessment that she did. In other words, she made a number up and entered it into the box- probably sometime the next day because she told me that she doesn’t like to do her documentation in the home because IT TAKES TOO LONG. This PT wants to spend the time in the home interacting with her patients, not an EHR device. I can appreciate that. However, this requires a trade-off. I’m sure different PTs make different trade-offs based on numerous factors but, the question is, WHY SHOULD THEY HAVE TO? Why is home health PT documentation so lacking in efficiency to the point of being onerous? There shouldn’t be so many barriers to providing effective and efficient care for patients. I think many PTs have just become resigned to the fact that “this is the way it is and always will be,” so we put up with crap like this. We’re fooling ourselves if we think having to do a lot of superfluous, government-mandated, process compliance busy-work doesn’t impact our relationship with and therefore care of our patients.

  7. Tim Mondale says:

    I’d say 37% is pretty good poling for a health care plan (Government single payer) that has been consistently vilified by both parties (particularly the republicans) for 30 years. All of them in the back pocket of big pharma, medicine, and private insurance. It’s disgusting that all we can come up with for a rational is government can’t possibly do any thing right. What nonsense.

    We choose to continue spending 17-19 % of our GDP for crappy healthcare only for the fortunate few, and nothing for the rest.

    I just heard an interview with the president of a local community college. She said that 10 years ago the payer mix of state and federal to individual responsibility for higher education was 70-30%. Now 10 years later it’s 30-70. She said there are a lot of competing entities for those state and federal dollars. We are literally not supplying a well trained work force because we have this need to spend so much on healthcare, (helping the rich get richer) for the terrible results we get for only the select few that have good jobs.

    Our “free market” healthcare is crippling us, and we refuse to see it.

    And we’re supposed to believe that regulation is what’s killing us?

    1. John Ware, PT says:

      Two letters: “VA”.

  8. Tim Mondale says:

    Really, that’s your example? Grossly underfund the program because you think no one is looking, and continue to line the pockets of the million/billionaires that sponsor you (Republican Congress), and then blame the program…classic RNC stuff. Good work.

    1. John Ware, PT says:

      Tim, just because you say the VA in unfunded doesn’t make it so. The facts show that VA funding is more than adequate. According to the Office of Management and Budget, VA funding increased nearly three-fold between 2000 and 2012. Even factoring in inflation-adjusted dollars, funding for the VA increased faster than the total number of VA patients and almost double that of VA patients seeking inpatient treatment.

      You still haven’t answered my question: Who came up with the 8-minute rule? Sometimes a big, complicate problem can be boiled down to just a few absolutely indefensible and/or ridiculous facts. I’m presenting facts, and you’re just bloviating and blaming everything on evil Republicans.

      No one’s looking at the VA budget? You do know that the federal budget is public record, right? What’s not being looked at or addressed is the the accountability of corrupt bureaucrats at the VA and throughout our government who misuse and outright steal taxpayer dollars.

  9. Tim Mondale says:

    A) the funding for the VA is not adequate, and any difficulties they have had has little to do with corruption at any level (right wing myth, just like voter fraud). Frankly the VA does a pretty good job with what they have. Of course not everyone is as clearly virtuous as you John.

    You understand why the VA funding has increased don’t you John? That’s right, endless war, and military actions in the middle east. If we’re going to send people to war, we damn well better provide for their health and wellness upon their return, and congress has not adequately done that. Perhaps you want to privatize the VA and block grant that to the states just like Republicans want to do with Medicare. That would be perfect, then we could care for our seniors and veterans as poorly and as we care for the rest of our citizens. Hey but at least it would cost us a lot more money.

    Don’t care about the 8 minute rule. Doesn’t affect my practice in the least. Medicare direct access yes, very important.

  10. John Ware, PT says:

    Tim,
    It’s hard to discuss this with you when you refuse to acknowledge facts. Here’s a link to a politifact article that breaks down the budget increases at the VA up to 2016 (http://www.politifact.com/truth-o-meter/statements/2016/sep/30/barack-obama/barack-obama-says-va-budget-has-risen-85-percent-h/). President Obama, like most Presidents, exaggerated the amount of increased spending for the VA, but by any measure, VA spending- both mandatory and discretionary- has had a very healthy budget increase year over year. Here’s another link to an article at The Federalist (a right-wing news source), which includes a graphical representation (with sources cited) of how spending at the VA has outpaced the number of those accessing medical services from the VA. (http://thefederalist.com/2014/05/30/this-chart-shows-why-the-vas-problems-have-nothing-to-do-with-funding/). So, your argument that increased VA spending is attributable only to more wars and increased services needed for veterans is not true. You’re just repeating a left-wing narrative that doesn’t jive with the facts.

    Whether you care about the 8-minute rule or not is irrelevant. I was making the point that a centralized management apparatus funded by the taxpayers has come up with numerous irrational, to the point of ludicrous, rules to dictate how we practice. We’ve grown accustomed and have figured out how to “work around” these stupid rules so they have minimal impact on daily practice and patient care. But it’s naive to think they don’t have an impact on current PT practice, particularly on the balance sheet. Many of these rules are built into documentation software to provide a real-time audit of many therapist’s time spent with each patient. It costs money to pay software developers, which increases overhead, thereby reduces margins in outpatient settings. Combine that with reduced reimbursement rates and a six-figure debt coming out of an entry-level DPT program, and what you’ve got is an industry facing some serious financial challenges. We may also have some serious man-power shortages in the near future, if we don’t get a handle on the return on investment problem facing new and potential PTs. I’m not recommending either of my teenagers consider PT school. It’s just not a wise investment today. That’s sad.

  11. Liza Tan says:

    Same issue in NYC. More people have insurance but the co-pay, co-insurance and deductible are prohibitive to use the insurance. Do you think we are ready for single payer? Big hospitals here in NE have developed sports medicine and are using ATCs with PTs. If PTs are not seeing the writing on the wall, and insists only PT can do this or that, and claim a stake at healthcare using restrictive board rules, we’ll continue to constrict ourselves.

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