#physicaltherapy Game Changers or Hypocrites?

It’s been a long time since my last blog so excuse the headline! We just started season 2 of Practice Leadership Podcast and the first episode is on PT and Chronic Pain, which is part of a 2 part series called Big Bets.

My experience in 32 plus years in this illustrious profession is that PT’s are big talkers but risk averse. We like to talk in platitudes about the benefits, access, and cost bending of physical therapy, but we are unwilling to back those claims up with action. In fact, we would rather complain about the paucity of data, evidence, and a burdensome regulatory environment. The reality is we have plenty of data and evidence, but we don’t have enough care or action. The regulatory environment does remain oppressive and stifling and, with the impending MIPS, has jumped the shark one too many times for my taste.

As PTs, we claim that patients should be seen first by a PT and early in their episode of care. We claim this will lower cost, provide better outcomes with less surgical rates, and lower utilization of future healthcare visits.  Our claims are backed by several data sources that now include this gem – a visit to a PT first lowers exposure to opioids by 75-90% (remember, 21% of patients exposed to opioids develop on-going problems). Our data support of our contentions are not the problem, our actions and priorities are.

I propose that we clean our own house first, particularly in regards to plan design around our own healthcare coverage. It’s hard to talk about the pathway model of PT first and access of PTs for all things musculoskeletal, when our own insurance policies thwart our claims. A recent presentation by Dave Elton of Optum displayed data that demonstrates, based on a 217k sample, that policies where a PT copay is above $20 dollars or deductibles are above $300, you are less likely to see a PT rather than a PCP (by the way, the average deductible in US is now $1350, with families spending $20K on health insurance).

If you are a PT, how does this jive with your own company’s insurance coverage? If you are a PT that works for a company that is self-insured, does your plan design require you to see a PT first for any musculoskeletal disorder? Do you have any incentives in the form of a lower copay to see a PT than a specialist for low back pain? Geisenger Health Plan put together a PT bundle consisting of 5 physical therapy visits with a single copay (J Pain Res. 2017; 10-1337-1346). Retrospective analysis of claims data found this bundle was associated with 29%-35% short-term reductions in emergency department visits and with a 12-20% reduction in primary care visits after 6 months.

I propose that we have our own campaign, backed and supported by physical therapy companies and our national organizations, that highlight companies that are implementing PT first and early as a primary feature of health insurance coverage. Insurance companies have data that demonstrate this and should be compelled to work with us to legislate and make regulatory changes that support their data through plan design changes.

The ongoing opioid crisis and the significant decreased exposure by patients to them when seen by PTs in an early access role could be a strong facilitator of this change. Perhaps we can enlist a multisite research meta-analysis in a few years that publishes these results and at least promotes them to the Amazon, JP Morgan, and Berkshire venture that is taking aim at the middlemen of healthcare. Self-insureds who are well positioned to be true cost benders should be approached in a more unified manner by our profession with examples, data, and published studies on this PT first and early pathway model – those are actions that would serve us well.  If we collectively work again, PT first and early will become the standard.

And yes, by the way, I am pleased to report that I am part of a company that will be 100% self-insured and on a PT first and early pathway of care model by January 1 with a bundle of PT visits at one copay for all things aches, pains, sprains, and strains. If somebody wants to stray to a PCP or specialist, it will be a heavy copay cost!

Let’s make this bet and back it up with actions, not just words.



2 responses to “#physicaltherapy Game Changers or Hypocrites?

  1. James Gallegro says:

    I love the outside the box thinking – and trying to push a direction of overall PT care planning, instead of individual wins. Loved your comment about the regulatory environment having “.. jumped the shark one too many times for my taste.” Couldn’t agree more. To that end, I think we should hedge our bets as a profession and begin to push for the single payor option – forcing insurance companies to begin to see us organising in a direction that presents a clear existential threat to them. If more professions join the push, maybe they will make more reasonable decisions.

  2. Larry Benz says:

    Thanks James for your reply-as I believe we have to push hard for a single plan design that puts PT First and Early in the pathway of care for all things musculoskeletal

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