PT and the "New Economy"

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mcap -> PT and the "New Economy" (February 10, 2001 1:28:00 PM)
Group: I am in the middle of reading Robert Reich's new book. It is about the New Economy and the social implications. I am done with the economy part and moving into the implications chapters. In this new economy, as much as anyone can tell......it seems that workers must be flexible and dynamic. Business will face extreme competition from many sources. So, when a company provides a product or service for which there is a market, competitors rush in to do it better. This means that the original business must either improve, innovate with a new product, or cut costs - the most popular choice. This leads to a lot of growth and productivity, but workers, must adapt and shift positions quickly or they will suffer. When their employers need to cut costs - they will go! Healthcare has been insulated from this more than other sectors but it is changing also. Will this affect us? How long before insurance and Hospitals find cheaper ways of providing our services? And, if they don't, how long until the next plan or hospital does. This doesn't have to happen. If PTs had an eye on innovation and methods of delivery that cut costs (beyond just seeing more patients in less time) then we should do well. But I am not sure I see too much innovation going on [IMG]http://www.rehabedge.com/forums/frown.gif[/IMG] PTs mostly seem to be doing as they are told, and in many cases, don't even run their own departments or clinics. I honestly can't say what the future will hold. Perhaps a flood of competant graduates into a tight labor market will spur innovation and further the profession. But in this new economy model, it is difficult to determine how we will fit in. Another problem is that the New Economy seems to reward bright and talented people even more. Many of the brightest PTs might will have to resist the tempation to leave the field for higher compensation. Just some thoughts.....let me know what you think. You guys owe me after not responding to my excellent sitting post [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG]

mcap -> Re: PT and the "New Economy" (February 12, 2001 3:18:00 AM)
SJSJSJSJSJ: If I read your post correctly, it appears that you are lamenting the effect of managed care and third party payers on PT. I would agree that these are important issues but I think we need to think BEYOND them. I think we need to concern ourselves about the effect of the new economy on PT, not managed care. Remember, managed care was a market response to rising health care costs. Before HMOs were adopted wholesale, healthcare costs were rising at rates several times the consumer price index. Employers were feeling the squeeze. After government reform failed, managed care stepped in to tackle the problem. It worked at first and growth rates were slowed. However, it now appears that rates for managed care plans are now rising at unacceptable rates as well. Throughout all of this one must remember that there is a virtually unlimited demand for healthcare and a limited supply. Costs continually have to be cut - and it is often the government that leads the way. The insurance companies often follow medicare. My point is that we will have to prove that our services are benficial and cost effective (we already have to a limited degree but it will require marketing savy and innovation - not just research). The point is that I don't think that we can just unite with doctors or hope insurances will change. How will we make ourselves irreplaceable to insurance?? That is the question we will answer. Because, with the way things have changed, groups that are not irreplaceable are replaced. mcap

Andrew M. Ball, MS, PT -> Re: PT and the "New Economy" (February 12, 2001 5:14:00 AM)
I'd have to agree with mcap. SJ, you and I have talked about this before. We need to divorce insurance as a profession, not embrace it. Look at the most successful clinical doctorates (e.g. Podiatrists, Dentists, etc.) they survive in lieu of insurance relationships, why can't we? We will be squeezed out of the traditional healthcare model, like it or not, there is very little that we do that requires much skill. Why is that? It's because we don't have much research to support that anything we do actually works, and what we do have, most practicing clinicians fail to read. As a result, we look like a bunch of idiots when ATC's, massage therapists, and rehab nurses claim that they can do our job cheaper and faster than we can. It's not about truths SJ, it's about images and beliefs. For the most part, the general public views us as technicians indistinguashable from massage therapists. Despite what our overinflated professional egos may tell us, despite the counltess more hours that we spend learning anatomy, physiology, clinical neurology, etc. When it comes right down to it, there is not much difference in outcomes between the two professions, so why should insurance, or the general public treat us any differently? We as a profession will die if we don't extablish a professional identity. What is it that the physical therapist can do that NO OTHER PROFESSIONAL can do? What makes physical therapy unique? What makes PT . . . well . . . PT? Our future has nothing at all to do with insurance or managed care. In many ways, HMO's have kept the profession alive during a time during which market forces in a free market would have crushed it. Drew

Ron -> Re: PT and the "New Economy" (February 12, 2001 10:19:00 AM)
The economy of PT is no different than the economy of any business that must survive competition. The bottom line is delivery of the product in a way that is consistent with the demands of the purchaser and be of such quality that the purchaser will buy (use) again or tell others to do likewise. If we hold ourselves out to be experts than our product(pt. care) should be exceptional. Exceptional results will earn the respect of your peers (therapists,Mds) but more importantly of your patients ,who in the very end are the ultimate referral source. I have been in this field well over 20 years and have seen many a therapists grow "moldy" for lack of effort to keep thier skills honed and business sense keen. They are hard pressed to offer commentary on "need" for therapy and often stumble for words when questioned on theory and research. Like it or not medicine is a business and like any other business only the strong, innovative, customer friendly and results oriented will survive.

mcap -> Re: PT and the "New Economy" (February 13, 2001 7:52:00 AM)
SJSJSJSJSJ: How was dinner? In response to your posts I will say that I agree with Drew and Ron. You need to look beyond the problem with insurance. Yes insurances pay strict attention to the bottom line and they should streamline the claims process. In some cases it appears that insurances make it so hard that they are hoping people with give up on claims. But this is not the major issue facing us! Insurance is not compeletely ignorant of research and it does factor in. Some research is done in PT but not enough of it has a large sample size and many studies are not randomized and controlled. And I beleive that you are scared to ask yourself the BIG question. Most PTs are. The question is: "Why should insurance pay us for our services?" Yes other professions will face similar challenges. They will have to prove their worth or face extinction. But some groups are more protected than we are. Who is going to do surgery, read an X-ray or prescribe medications other than a physician Who will dispense medications other than a pharmacist? Who are you going to to take care of your teeth - a dentist. It is important to realize that these professions face challenges also. Dentists have hygienists. Pharmacists are being replaced by computer programs and automated dispensing machines. Physicians have competition fron NPs, PAs and a host of "alternative" providers growing in popularity. But they have advantages because of public perception and exclusive privelege to perform certain services. But I think that they have also demonstrated a need for their services. Honestly, how do you justify the widespread use of PT? I am not saying that there aren't amazing PTs out there and I beleive that we do certain things better than anyone else. But from and Insurance, public and political point of view - how is the profession viewed? Why should anyone pay? mcap

mcap -> Re: PT and the "New Economy" (February 14, 2001 5:22:00 AM)
SJSJSJSJSJSJSJSJSJSJSJSJSJSJSJ: Happy V-day!! You state that PT is a covered service and that the CPT codes are considered worthy. I agree. You also contend that since they are covered that payment should be remitted in a timely fashion. I agree once again. But I think the question we are asking you....the one you haven't answered is this: Why do we HAVE to be the ones submitting these codes. They are not exclusive to PT, in fact, I think they fall under rehab medicine. Right now, other groups are fighting for the right to use those codes and bill for them (ATCs, etc). I think that we have the best credentials but will we be able to argue that some other professional can't show someone some exercises and then bill a 97110 to the insurance companies? That is the question. Not whether they should pay but whether they should have to pay us!! I think they should but I don't feel our argument is strong enough.

mcap -> Re: PT and the "New Economy" (February 15, 2001 11:03:00 AM)
SJ: First, I need to tell you about NYC. The taxi drivers often do not know where to go and they are without question, not safe in some cases. There are many, many accidents involving cabs every year. IN regards to the rest of your post I will say this: You are wasting your time trying to convince ME how well we do everything. I beleive that many PTs out there treat patients very, very well and are concientious, intelligent and competant. But there are many out there that simply go through the motions and simply draw a check. Also, think about your cab analogy. Cabs take money directly from their clients. Travelers are free to choose how and why they spend their money and if there are features of value in cabs....they will spend the money. But with health situations there is often a third party payor. So a valid analogy would be if everyone had travel insurance. They would pay a fixed sum every month (mostly through the government or employer) and companies would then reimburse the cabs for services renedered. In this case, the public isn't deciding what is optimal - the companies and the government are. And with these companies and government agencies always concerned about the bottom line they might look closely at the reaserch in the efficacy of taking cabs. They might also factor in how much influence people in the industry have. They would cut payments eventually - am I right!!!!! Take the example of low back pain. The Paris task force recommends exercise for the treatment of low back pain. This can be any exercise, biking, walking, etc. They DON'T recommend specific exercises such as the kind we give in PT. Now the reality of the situation is that I think we have things that work better and I use them all of the time. There is some research but not enough. Eventually insurance might stop paying PT for the treatment of LBP. It doesn't matter how good we are or whether we are right or wrong. It is reality.

Ron -> Re: PT and the "New Economy" (February 16, 2001 6:11:00 AM)
OK, time to add some fuel to the fire. Lets for a moment place our profession in the situation where the insurance company has decided not to pay for our services (really!). Let us also suppose that that the consumer (patient) can make a choice with his/her healthcare dollars and has choices to make on thier cafeteria plan coverage (one of which is PT). Let us also realize that "alternative therapy" techniques are one of the fastest growing segments of "healthcare" payed for by the consumer. In fact in 1997( most recent tabulated data) visits to alternative medicine practioners exceeded visits to all US primary care physicians. Out of pocket payments will exceed $30 billion/year. Lets define(because it is reality) alternative care as massage therapy,personal training and exercise, arthritis programing, health clubs and fitness facilities,Chriopractic,Industrial athletic training facilities, relaxation techniques, biofeedback ect, ect , ect...... Now where does PT fit in?, where do you want to fit in? and what do we need to do about it...? We would be well aware not to place our future in the hands of the insurance industry. Food for thought. "In times of change,learners inherit the earth, while the learned know how to deal with a world that no longer exits"

charanderson -> Re: PT and the "New Economy" (May 16, 2001 4:11:00 PM)
I really liked the last comments that Ron posted. I am a PT and a Feldenkrais Practitioner. If I had to pay out of pocket for a PT or a Feldy, which would I pick? hummm. Well, I know that, with a Feldy I would get one on one individualized sessions with a private practitioner. I would get a session that does not focus on pain, but rather on movement and my skeleton. I would get a person's full attention to the MOI, lifestyle and past histories. The cost would be about 55-100 dollars, expensive, but what would a PT visit cost? And If I didn't like the practitioner I would go to another one, no lengthy admissions or prescription dilemnas. These days, I am not to sure what I would get with a P.T. This is of course not to say that there aren't excellent P.T.'s out there. There are. I have read many posts that indicate this to be true. If I were to go into private practice again, I would want to work like a Feldy (following our Practice Act of course)and market myself as a private PT specializing in Feldenkrais. And I would market myself in the ways that the alternative therapists do. I have heard that many argue for DPT. Isn't it interesting, as Ron said, that the alternative therapies have less credentials and less state certification and pull in as a whole more, annually, than primary phyisicans. I had a discussion recently with an O.T.R. She had been fighting for Lisensure in the State of California, until she wanted to practice privately, Then she appreciated the benefits of the current Ca. law and stopped her action on the political front! Interesting! Charlene [URL=http://www.SmartTiming.com]http://www.SmartTiming.com[/URL]

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