Physical Therapists Pledge Billions in Savings to Health Reform
At least that is what I am hoping that our national press release will say.
Following in the footsteps of pharma and hospitals, it is time for PT’s to really get our name in the healthcare debate-let’s pledge billions in savings. This political tactic has bode well for the others that have done so.
Pharma has pledged thru supposed price reductions that their savings amounts to $80 billion or less than one-tenth the projected cost of healthcare reform. To put PT in perspective, the outpatient medicare dollar amounts to roughly 3 billion in total or one-two hundred and twentieth of the cost-but let’s not quibble over a few decimal points-in fact, let’s pledge 100% of the last fiscal year’s spending. (side note: PT expenditures are less than 2% of the CMS budget and actually decreased in spending per CMS data-what other provider group had actual decrease in cost to CMS?)
Hospital strategy of $155 billion is a little more crafty. It is a supposed cut in pay and less subsidy for underinsured under the premise that everybody will have health insurance. The point in both pharma and hospitals is that the numbers are purely fictional but represent their “commitment” to healthcare reform. Let’s do the same!
One main tenant of our savings that is unlike the sham estimates of pharma and hospitals, we won’ t won’t pledge thru fee schedule reductions. There isn’t anything to give here and in addition we can’t withstand the 21% forthcoming reduction due to the SGR calculation-neither can other providers. We also will not pledge a hard and fast number-just “billions” but we will provide some logic and rational to our calculations.
I am not a healthcare economist but it would only make sense to engage somebody to pull together some pretty straightforward estimates. Just off the top of my head, I can think of three areas where we can save billions:
-Eliminate conflict of interest in PT. Calculate per CMS data the amount of PT billed either incident to service or by PTPP performed within a physician’s office. Take 80% of that amount figuring that at least 20% of the patients would get referred to a non conflict of interest party. Apparently, the government already has all kinds of data on overutilization in imaging centers that are physician owned—am sure that there is some consistency in the factor of increased referrrals.
-Cost effectiveness. Look at highlighted savings on low back pain by the Virginia Mason’s of the world and extrapolate that to 8.5% of the projected number of patients in the medicare and expanded government system (per previous CMS data 8.5% of the 43 million beneficiaries accessed outpatient PT). This savings estimate ought to include the reduction in direct imaging, pharma, and surgery that would result from using PT’s as primary musculoskeletal screeners. In fact, calculate the incidence between surgery between the military and civilian sector and that should logically point to a method of calculating the difference as that is how the military uses PT’s-as force multipliers due to the fact that there are not enough primary care MD’s and orthos. Cost estimates in knee arthritis, prevention methods for falls and balance can also be made. Let’s also make a plea to our Congress to look no further than the military model as the place to put PT’s as access for musculoskeletal complaints will be a potential bottleneck with the addition of approx 45 million who are currently without insurance.
-Massive changes in fee schedule. Take the entire CPT code system that applies to PT and get rid of it. There are only a few providers left that aren’t in the E&M system and we are one of them. Put us in there and move to a 3 code system that bundles everything together into a patient complexity model that is determined thru PT evaluation and supported by a standardized outcome system that acceptable to PT’s-there are only a few of them out there. Cost savings would be immense as those who drive increased units thru the use of interventions that have zero evidence are eliminated. We could even agree to an episodic case cost within 5 years once bugs and prototypes are worked out. (side note: as I have written many times, it is a lot easier to suggest changes in the CPT system but changing them is altogether different. Even the AMA is being heavily criticized by their own thru Sermo who is calling them the biggest risk to physicians in part due to coding)
As a trade off for saving billions, we of course will have to have significant regulatory changes to include direct access, elimination of plans of care, cap, explicit provider rules (let’s settle on allowing us to use our state practice acts), PQRI (since we will agree to an outcome based complexity model for payment), and the 8 minute rule and coding complexity issues including modifiers would be a thing of the past.
Yes, many will question our savings calculation and like our pharma and hospital counterparts, we will not admit that they are bogus!
Let’s do it!
Thoughts?
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