Some interesting things:

-Price transparency. Go to www.outofpocket.com. There are over 100,000 prices collected from different sources.  Consumers are allowed to post anonymously for those items that they pay for routine health care including mammograms, MRI’s, lab, and office visits.  CMS data is also “loaded into this site”.  I found little data that mattered in physical therapy. 

Personally, I don’t buy into the price transparency argument as a cure for our health system ills unless all services become elective and cash paying (amongst cosmetic physicians they report that botox is a great example of this as it is viewed by users as a commodity and users price shop constantly). There are some models of insurance where this is occurring somewhatan d the rise in Health Savings Accounts can be be argued to be a form of this.  Perhaps PT will in fact have a “price shopping” component to it.

I would love price transparency amongst payors-like the CMS model where I know based on geography what is reimbursed.  Why, for example, do the sordid payors give one PT clinic $50 per visit and another $35 even if they are across the street with one another?

                                                                                                   

-Medical Group Management Association (MGMA) has reported some data that I believe all PT practices are experiencing-a negative revenue to growth per practice and an increase in cost.  Cardiology, family practice, and OB/GYN are in this “shrinking margin” category.  Ironically, orthopedic practices are experiencing a 2.8 increase in revenue and a 2.3 increase in costs representing one of the few practices that are having very slight margin increase.  MGMA survey data is reaching record highs in voluntary participation (they went to an on-line data collection) with over 38,000 providers participating.  Why don’t we do this in PT?  Why are we so parochial about sharing practice data that can be confidential and result in data power?

Thoughts?

Larry@physicaltherapist.com

Comments

[Derek Dalton SPT]

Transparency is good, but like Larry I don't see cost transparency as an effective means of fixing our healthcare woes.

Maybe I'm missing something, but I also don't see the benefit of bcecoming a commodity. Is price shopping something we want? It seems (despite our efforts to educate) that patients would simply see the PT with the lowest prices.

Come on down, for only $29.99 we'll decrease your pain. Hot pack and e-stim included. Call now for a free ultrasound. If you want manual treatment, that'll cost you $50.

Like I said, I could be totally missing the point. If so, please feel free to add to my education (I'm all for learning).

We need therapist behavior measures and outcome transparency -- not newspaper coupons and price-matching.

[Larry Benz]

Derek: As I stated, I don't think transparency is a good way to cure health ills. To your point, it would further commoditize us-and we are already viewed as a commodity.
Larry

[Rick]

Let's see: A. Revenue decreasing at the hands of third-party payers who have "commoditized" PT
and have little interest or incentive to measure let alone incentivize outcomes.
B. Perverse government reimbursement models which favor SNF and Home Health, helping to drive the manpower shortage.
C. Costs rising, margins marginal...and shrinking.
D. And slim prospects for improving efficiencies because of the well-intended, but foolish rules defining "one-on-one", counting minutes, etc.
I think it's called a "death spiral".
We're not going to change payor behavior fast enough to save us.
Asking United Health to be reasonable just isn't going to work.
Is there hope then for private practice PT?
Larry?

[Mark Schwall, PT]

Larry and Rick you have hit on some critical issues that we as a profession have failed to adequately address. Moreover, I am deeply concerned that it is only going to get worse unless, or until we stand up as a profession and cease capitulating to external pressures and finally confront them. Instead of laying claim to our profession through exclusive ownership of our services and practice, we have allowed our services to be commoditized, along with ourselves, as evidenced by the many “sign on bonuses” advertised in professional and commercial publications. Granted, Physical Therapists are a bit of a Johnny-Come-Lately to the Professional Corps as our practice and unique knowledge base has developed and evolved; but if we are to survive as a profession we have reached a tipping point and must claim ownership of our professional services.
I would proffer that at the heart of all of our issues is our continued failure to adequately address the ownership issue. As my friend Ken Mailly, PT has often stated: Physical Therapy is either a commodity to be bought and sold, or it is a profession to be practiced; it cannot be both. Additionally, it is impossible to control something unless you have ownership of it. As long as we abdicate our responsibilities as professionals and allow others to declare themselves as “stakeholders” of our services, we will continue to flounder and continue to capitulate. Until we all as “professionals” reconcile ourselves to this simple proposition, all other issues cannot be addressed satisfactorily.
It has been my observation, and it is now my opinion, that our Association (APTA) has descended into a typical bureaucratic pattern of existence, which is to solely sustain the bureaucracy and unfortunately it appears to be at the expense of our own principles and ideals. While having a documented & stated position of support for exclusive ownership of our services by Physical Therapists, APTA forms strategic (read financial) relationships with organizations having public and lay shareholders.
Now even the Private Practice Section is looking to amend their mission statement from its current version, which reads:
“The purpose of the section is to foster the growth, economic viability, and business success, of physical therapist-owned physical therapy services provided for the benefit of the public, and to promote exclusive physical therapist ownership of physical therapy services.”
It has been now proposed to read:
“The mission of the American Physical Therapy Association Private Practice Section is to foster the economic viability and professional development of the private practitioner and promote physical therapist ownership and management of physical therapy services through education, legislation, and networking.
One can only deduce from such a proposed change that drops the term “exclusive” that they are now capitulating to the concept that lay and corporate ownership is acceptable and to be promoted. I would submit that this is for the primary purpose of bolstering membership. I would also submit that if this mission change is accepted, they should change the name of the section to something more reflective of this new mission. I would suggest something like the American Physical Therapy Association Anybody with a Dollar in Their Pocket Can Provide Physical Therapy Section.
Rick, you asked “Is there any hope for private practice PT?” and I would respond yes but it is becoming only a glimmer. If we are to save private practice and more importantly remain the profession we and those before us have worked so hard to establish then we have to demonstrate a degree of self respect and quit trying to perpetually wear the white hats and demand what we are due.
You stated that “Asking United Health to be reasonable just isn't going to work.” I wholeheartedly agree. Here in New Jersey our state chapter of APTA has over a number of years attempted to reason with the insurance industry which has only resulted in further diminishment in reimbursement and loss of coverage as evidenced by arbitrary caps, sky rocketing co-pays and unreasonable and capricious visit limitations based solely on the need of insurers and their intermediaries to bolster their bottom lines. This is why it became necessary for a now large group of privately practicing Physical Therapists in New Jersey to form an organization whose sole mission is to advocate on their behalf and has now instigated legislative relief from the monopolistic behaviors of the insurance industry. Ironically the biggest stumbling block in this legislative effort is our own state APTA chapter which is holding fast to their long failed strategy of discussion with the “struggling” insurers.
One has to wonder whether APTA has determined that it is time to abandon third party reimbursement and private practice. I fear that this may indeed be the case as it is the only way to explain the absence of effective advocacy on these issues while simultaneously and strongly advocating a strong shift toward cash based services. While I certainly support the concept of providing certain cash based and wellness based services; as other authors on this blog have noted and I also believe this is not our core mission, competency or “brand” as a profession. I’d also ask where this “cash based” direction will lead us if it leaves all of those who cannot afford the out of pocket expenses that this alternative model of practice would entail. In my experience most of the public believes our services should be covered by the insurers to whom they are paying exorbitant premiums. This “cash based” direction is just one more example of capitulation that threatens to leave millions without affordable access to our services and one that I believe will lead to our ultimate demise as a profession as we now know it. In short and as I see it the time has come to continue to capitulate and die or stand and fight to survive.

[Sean]

Mark,
I just got off the phone with PPS and apparently the proposal to remove "exclusive" has been withdrawn.
I have to disagree with you about the decision to go cash-based as being a capitulation. On the contrary, I believe it is the exact opposite. To capitulate or surrender would be to continue to see patients for below-cost reimbursement; in addition to not making an attempt to negotiate higher rates. Rather as most "cash-based" practices go, they accept cash up front from the patient, print the CMS-1500s, and let the pt file for herself. Therefore choosing not to deal with the ACN's of the world altogether.
I choose not to run my practice this way because I feel it is a step too far in the other direction. When beneficiaries begin to see that their chosen providers are no longer in the provider book, a crossroads will be met. What we can do to help is send a letter to every beneficiary of a rate-cutting insurance company. It would state something along the lines of XYZ has decided to cut our reimbursement to approximately 50% of what it was, making it impossible for our practice to continue seeing its patients. We hope that your premiums have been reduced by a similar percentage. If not, you may want to consider another insurance plan with a provider list to your liking.
Also, I would suggest posting on the Yahoo message boards for each company's stock. Maybe then someone will pay attention.