DO YOU KNOW YOUR RIGHTS?
By Cathy Leer
Did you know that, as a patient, you have the right to choose your Physical Therapist? Did you know that you are not obligated to receive treatment from a specific facility recommended by your doctor or doctor’s office?
Don’t worry if you answered “No” to these questions. You are not alone. Seventy percent of consumers believe that a physician’s order or prescription is required in order to see a physical therapist. In fact, all 50 states allow direct access to a physical therapist which means that you DO NOT NEED A REFERRAL to be evaluated by a physical therapist, AND you have the power to determine which facility is right for you.
What direct access and your right to choose results in:
• Freedom to choose PT’s based upon expertise or specialization, experience, location, or value added services;
• Immediate access to a PT for evaluation and diagnosis without waiting for a doctor’s appointment;
• Immediate access to treatment;
• Quicker healing;
• Decreased secondary problems associated with delayed treatment;
• Maximization of your insurance benefits based upon deductibles, co-pays, and fee structures.
So now that you are aware of your right to choose, how do you make the decision as to which therapist or facility is right for you, especially if you have no basis for judgment? To better inform your decision, it is important to understand some of the economics of physical therapy and why the norm in patient treatment has developed often to the detriment of your body or wallet.
First, most businesses are governed by the bottom line: Profit. Profit is increased either by volume or by pricing. The more patients that are seen, the more billable treatments there are. The more frequently a patient is seen, the more co-pays are collected. Many insurance companies are transitioning from a “fee-for-service” model (where bills are generated based on what a therapist does with you) to a “fixed-rate” model (the rate of reimbursement is the same regardless of what the therapist does with you or for how long). With a fixed rate of reimbursement per treatment, profit is increased with more treatments, not longer treatments. Unfortunately, that means there’s incentive to provide more treatments to the patient, and hence more co-payments. With co-payments rising sometimes to the $50 to $75 range per treatment, this can add up rather quickly.
Another reimbursement consideration to be aware of involves insurance reimbursement to hospital-based outpatient facilities vs. a private PT-owned facility. A hospital-based facility may get paid up to 4 times the amount that a private PT-owned facility gets for the same service. If your insurance benefit for PT is capitated (meaning a limited overall dollar amount), that means the higher costs at a hospital-based facility will eat up your allowed dollar amount 4 times faster than at a private PT-owned clinic. So, not only do you end up paying exorbitant co-pays and deductibles but your PT benefit is effectively one quarter of what it should be if you go to a hospital-based outpatient facility.
Profit can also be increased by decreasing the cost of providing the service by employing new physical therapist/physical therapist assistant graduates, athletic trainers, or unskilled rehabilitation aides, all at lower salaries than experienced physical therapists/physical therapist assistants. Unfortunately, this affects your level of care because of the inherent lack of knowledge or experience. The more training and experience your therapist has, the more efficiently and effectively the therapist can target treatment to your specific needs.
On any given day, there are only so many work hours for a particular PT. So, in order to increase revenue generated by that PT, patients are either double-booked with another patient or group of patients, or the duration of treatments are decreased to accommodate more patients. Very often in this type of environment, treatment is left up to the patient to perform independently or under the supervision of an aide or trainer, and even though it should be billed differently it usually isn’t. Furthermore, if the patient is completing a task on his/her own, it is usually something that can be done at home as part of a home exercise program. So, why are you doing it in the clinic and getting billed for it? Shouldn’t you be receiving care in the form of what you can’t do at home??
Family Physical Therapy Services only employs experienced, licensed Physical Therapists or Physical Therapy Assistants. Most of our treatments are performed in private treatment rooms providing services you can’t perform adequately by yourself at home. Evaluations are 1 hour and follow-up appointments are typically 30-45 minutes. Like any business, we need to make a profit, though maximizing profit is not our primary motivation—getting you better is.