Bundled Payment Will Require New Solutions

PT practice is changing and much of it comes from external stressors. Especially as we step into new payment models such as bundled payment, we must come up with new solutions. Many physical therapy practices attempt to meet these demands by increasing productivity, driving down costs, and being selective with payers. We must ask ourselves when is it “too much?” When does our quality of care start to be compromised?

This is where we should think about cost shifting vs. cost reduction.

Tim Phillips, PT, spoke at the APTA State Policy and Payment Forum recently about defining our value. As PTs we have value in healthcare through decreased readmissions, infections, adverse events, ER visits, and imaging/testing. We are the experts in fall risk management. We improve patient satisfaction. Tim stated that, “Our ability to target and influence key aspects and predictors of health and physical performance with proven benefit to population health outcomes.”

A research study on occupational health at Virginia Mason showed that 90 percent of low back pain patients are seen by a physical therapist alone and cost of care reduced by 50 percent, MRIs decreased by one-third, only six percent of patients lost time from work, and 95 percent returned to work in the same day. Typical duration of care was reduced from 31 days to 1 day.

One of his studies showed that early access to physical therapy and specialty care management for workers with musculoskeletal injuries had reduced cost for long duration claims >90 days. They had compared the total cost of claims from 2009 from an average $24,696 to $5,749 during their prospective pilot. That is a 77 percent reduction.

Another study looked at PTss in the emergency department for primary setting where an RN refers to PT for musculoskeletal, vertigo or an impaired balance diagnosis. The outcome was decreased admissions, outpatient follow ups, decreased opiates and reduced imaging if the therapist requests it.

These research studies and large scale data show that insurance companies are profiting through cost shifting from reduction in duration of care and total cost of the claim. So the question is why are we losing the battle for payments? The solution lies in looking at large scale data and looking at cost shifting vs. cost reduction. We can all start by contributing data into the Physical Therapy Outcomes Registry www.ptoutcomes.com/

Yes, PT practice is changing but this is an “opportunity to write ourselves into the future of healthcare by demonstrating our value.”  Let’s define our value before someone else does.

Joanne Zazzera
HAPTA Legislative Committee Chair

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>