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Founder Letter: The Cost-Shifting Conundrum: How to Combat High Patient Copays

Here are three strategies for PTs, OTs, and SLPs to combat high patient copays without becoming combatant with payers.

Heidi Jannenga
5 min read
August 6, 2019
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In our 2019 State of Rehab Therapy survey, 80% of respondents cited payer requirements as the top reason their organizations require physician referrals as a condition of treatment (even in states with unrestricted direct access). Additionally, high copays and coinsurances were by far the top-ranked regulatory issue in terms of impact to the physical therapy industry and profession. In other words, as it stands, the insurance industry (and its propensity to shift costs onto patients) isn’t making it easy for us as rehab therapists—or the people we serve. 

That said, I still don’t believe that insurance companies are the enemy—or that we benefit from an “us vs. them” perspective. After all, we both (ostensibly) want the same thing—positive outcomes for our patients at reasonable costs—even if we don’t see eye to eye on how to achieve that objective. Thus, the best action we can take is one that unifies us (as much as possible) and builds the foundation for a mutually beneficial relationship that meets our respective needs—and the needs of our patients. To that end, here are three strategies for combating high patient copays (without becoming combatant with payers, tempting as that may be):

1. Leverage data to demonstrate the value of rehab therapy. 

While this is more of a long-term play, it’s one of the most high-value strategies we can employ. That’s because rehab therapy is unquestionably effective, lower cost, and low risk. Thus, it’s a practically perfect solution to the opioid epidemic our country is currently facing. Providers, payers, and patients are all more open than ever to safe therapeutic interventions—the kind that qualified rehab therapists provide—even if it takes longer than more convenient, yet possibly lethal, medications. 

So, what’s standing in our way to becoming the go-to solution for musculoskeletal pain and injury? Our industry’s lack of objective data. We absolutely must collectively track outcomes data and use it to reinforce our value as individual providers and practices—and as a profession. As it stands, nearly 22% of organizations—or a little more than one in five—do not collect or track patient-reported outcomes (according to our survey). Of those that do, only 17.6% use that data to support their negotiations with payers. Yet, that is the only way we’re going to move the needle with payers and other providers and establish ourselves—once and for all—as care coordinators who deserve higher reimbursements and more extensive coverage from patient insurance plans. Bonus: Use your data wisely (i.e., to market to providers and patients—as well as negotiate with payers), and it may even garner you better referral relationships, more direct access patients, and more favorable insurance contracts, leading directly to improved revenue.

Data in Action

Don’t believe it’s possible to effect wide-scale change with data? In a study conducted by Boston University and jointly sponsored by UHC/Optum and the APTA, researchers found that patients were more likely to choose conservative first-line treatments such as rehab therapy (which aligns with clinical guidelines) when they had lower levels of cost-sharing (e.g., lower copays and deductibles). While this may not seem like groundbreaking information, having the objective data made it possible for UHC to implement a new policy to waive copays and deductibles for a beneficiary’s first three physical therapy sessions. The last I heard from David Elton—Senior Vice President of Clinical Programs at Optum—the payer is also considering improving reimbursement rates for physical therapists based on patient outcomes. Boom. This is a wonderful first step, and it likely won’t be the last. As I wrote here, “if the results of this study were significant enough to convince one of the nation’s largest payers to make physical therapy more accessible to its beneficiaries, it’s reasonable to conclude that other major payers will take notice—and potentially follow suit.” But we can’t just sit on our laurels and wait. Instead, we’ve got to: 

  • Leverage this data in our conversations with payers and other providers; 
  • Collect and use our own outcomes data to support the value of our services; and 
  • Advocate for more large-scale studies that will demonstrably prove our effectiveness as first-line providers.

2. Provide exceptional service.

One of the best ways to combat high copays—and to continue attracting patients, even those who have to pay a lot out of pocket to see you—is to provide unparalleled service. In other words, give your patients an experience—and results—that they can’t receive elsewhere. Of course, that starts with the obvious—exceptional, evidence-based patient care and outcomes—but it also extends into the less obvious, like: 

  • Individualized attention and wonderful rapport;
  • A unified, positive, palpable company culture;
  • An open channel for communication between appointments;
  • A top-notch, multimedia home exercise program that encourages compliance;
  • Opportunities to provide feedback—and have that feedback acted upon;
  • Streamlined processes and operations (e.g., those that result in minimal wait times for appointments); 
  • Seamless billing and collection practices (e..g, multiple methods for paying and no surprises, which I’ll expand on in a moment); and 
  • Small touches, like complimentary water, soothing music, chilled towels, and personalized birthday cards.

Patients as Patient-Consumers

A few years ago, WebPT CEO Nancy Ham and I hosted a webinar about serving patients with high-deductible health plans—and thus, high out-of-pocket healthcare costs. In it, we discussed how today’s patients are much more like consumers, which means they want to feel like they are receiving commensurate value for the amount they’re paying. And who can blame them? That’s why the patient experience—which encompasses everything from the first interaction a patient has with your clinic to the last—now matters more than ever before. As a helpful exercise, put yourself in your patients’ shoes and traverse their journey with your practice. Are there interactions or touchpoints that need shoring up? Or big gaps where patients may feel overlooked? That’s where I’d recommend starting to ensure the service you’re providing is truly exceptional. (Good news: There are exceptional software solutions you can leverage to maximize the impact of your touchpoints and thus, improve the patient experience without creating extra hours of work for you or your staff.) 

3. Be upfront with patients—about the value of your services and the cost.

Conversations about financials can be personal and challenging, but there is no room for beating around the bush when it comes to the cost of healthcare services. After all, surprising a patient with a bill he or she didn’t expect is a sure-fire way to lose that patient—and earn a scathing review. Instead, I recommend verifying patient eligibility within 72 hours of booking a new patient appointment (ideally, before the patient arrives for his or her first session) and then, based on the information you garner from the payer, communicating to the patient his or her financial responsibility. Whatever you do, don’t wait to discuss the cost of treatment until your patient completes a visit and you send out a bill; rather, set clear expectations from the beginning and get patient buy-in to the treatment process. This will help ensure that copays and coinsurances—even high ones—don’t interfere with your patients completing their plans of care and ultimately, meeting their goals.

This might take some practice, but the best thing we can do is communicate the cost of our services with confidence—fully owning and expressing our value. If we’re timid, hesitant, or apologetic, our patients are much less likely to believe in our ability to serve them well. Think about it this way: Patients have few qualms about paying athletic trainers and massage therapists—most likely because those providers have no qualms about charging clients directly, and they’re clear about their value proposition. 

Online Reputation

You can even start communicating your value to prospective patients before they ever set foot in your office (and thus, mitigate high-copay sticker shock) via an active, professional online presence complete with stellar patient reviews (i.e., social proof that you’re worth the cost). But, how do you generate overwhelmingly positive reviews? Assuming that you’re already providing unparalleled service as discussed above, all you should have to do is ask. Just be sure you’re only asking the patients who you know are loyal to your practice, because even one negative review can turn off a potential patient. To do that, implement Net Promoter Score® (NPS) tracking®. This super-simple metric is extremely easy to digitize—which means you’ll be able to avoid the most problematic biases associated with traditional satisfaction surveys—and provides actionable insights into specific patient issues and trends. Not only can you use it to address those specific issues and trends quickly—thereby improving the patient experience and hopefully retaining any peeved patients—but you can leverage your already-loyal patients to be brand ambassadors, singing your praises both offline and online.

As with everything in life, our attitude matters—and that’s especially true when we come up against challenges or perceived obstacles. Right now, payers’ prohibitive policies and limited perspective on our value are preventing many patients from seeking our care and experiencing the benefits. But that doesn’t have to be the case forever—and we’re already seeing small shifts that may soon lead to bigger ones. So, the question is: How else can we show up to ensure things are moving in the right direction? I’d love to hear your thoughts. Please share in the comment section below.


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