“I’m going to physical therapy.” Whenever anyone—a friend, a colleague, or even a family member—says this to me, I feel a twinge of disappointment. I know, it sounds crazy coming from me; I am a physical therapist, after all. But that is precisely the reason behind my discontent: I am a physical therapist—a doctorate-level medical professional with the skills and education necessary to diagnose, treat, and coordinate care for my patients. I am not some nameless, faceless provider of a generic ancillary form of treatment known as “physical therapy”; furthermore, the treatment I, as an individual therapist, provide to my patients is a reflection of my unique education, expertise, knowledge, experience, and talent. It is not a mass-producible service.
And yet, when a patient—a healthcare consumer—says he or she is “going to physical therapy,” that is exactly what this entire profession is reduced to: a service. I don’t think I fully grasped the significance behind this seemingly inconsequential choice of phrasing until I attended the Graham Sessions a couple of years ago. There, a fellow attendee pointed out that when physical therapy patients discuss their treatment, they overwhelmingly tend to emphasize the “what” rather than the “who”—that is, they’ll talk about “going to physical therapy” rather than “going to the physical therapist.”
It might not seem like a big deal, but it points to a much larger issue. After all, when someone talks about “going to the dentist” or “going to the doctor” or even—brace for it—“going to the chiropractor,” they are unconsciously linking the value of the service they receive to the person providing it. But, when a person says he or she is “going to physical therapy,” the value shifts to being associated with the service itself—and I am baffled as to why, in the healthcare world, that association seems exclusive to the physical therapy space. You would never hear anyone talk about “going to dentistry” or “going to medicine” or “going to chiropractic.”
It’s hard to pinpoint exactly how—or when—this semantic division developed. But, I’m betting it has a lot to do with the fact that physical therapy came into existence as an extension of physician care—in other words, physicians sent patients to therapy and provided therapists with detailed treatment prescriptions. Thus, the value inherent to clinical expertise has always rested with the referring physician—and the therapist was merely a tool for furnishing the prescribed services. However, as the physical therapy profession evolved, and therapists became better-educated—and more autonomous—providers, the perceived relationship between physicians and therapists remained the same.
On top of all that, not only have we been beholden to a payment system that does not reward quality, but we’ve also—as a community—resisted efforts to introduce quality (i.e., value) as a condition of payment. Thus, our payers have continued to see us as a cost to be reduced, rather than a valuable care option to be leveraged. And until we (1) start operating under a payment system that accounts for value and (2) take control of the data and data-collection tools we use to communicate that value, insurance companies will continue to look for ways to slash our payments. After all, in their eyes, our services are nothing more than a product—and like anyone purchasing a product, they want to pay the lowest price possible.
But, we know better. We know we are not a service; we are not a product; and we certainly are not a commodity. In fact, in cases involving neuromuscular issues, our clinical expertise matches—and often, far exceeds—that of our physician colleagues. And when patients with those issues come to us first, we are not only capable of developing and executing effective care plans, but we also have the ability to do so in a less invasive—and less expensive—manner than most other types of providers. Essentially, we produce better outcomes at a lower cost—and isn’t that the very definition of valuable care?
The problem, of course, is that we haven’t proven that value—at least not at scale. Instead, we’ve:
- kept our outcomes and care cost data in siloes;
- used proprietary tools to track outcomes, thus rendering it meaningless outside of rehab; or
- neglected to track patient outcomes altogether.
There’s no way around it: to prove our value as crucial members of patient care teams—and to shatter the long-held misconception that physical therapy is nothing more than a commodity delivered independent of clinical expertise—we must unite in our outcomes data-collection efforts. Even the practice owners who have implemented outcomes-tracking programs in their clinics often complain that their data holds little influence over insurance behemoths—and that’s simply because, in many cases, big payers want to see big data. More than that—they want to see data they can easily understand, analyze, and compare across the healthcare continuum. That means it’s imperative that we standardize the process through which we collect outcomes data—including the set of tools we use.
So, how do we begin amassing that data? How do we get a large enough portion of the therapy community on the same page with regard to outcomes tracking? Well, it starts with getting the word out—which is precisely why I’ve been so prolific in my outcomes-focused content efforts. I have been beating this drum for quite a while now—and you can rest assured that until the rehab therapy community has established an effective, coordinated outcomes-tracking strategy, that beat will go on.
Whether we like it or not, the era of value-driven health care is upon us. And that means that, like all other healthcare providers, rehab therapists can no longer afford to accept the false presumption that their value is rooted in their interventions. Because as we all know, truly valuable care encompasses so much more than the treatment itself: it’s about how and when the treatment is delivered, the patient’s overall experience in receiving it, and, most importantly, the person providing it.
So, are you with me? Will you join the movement to end the commoditization of our profession? I hope so—because with all hands on deck, I truly believe we’ll see the day when “I’m going to physical therapy” vanishes from our patients’ vernacular, and “I’m going to see my physical therapist” takes its place.