Last week was a momentous one here at WebPT. Not only did it mark our fifth-annual Ascend conference—which we hosted right here in our hometown of Phoenix, a mere stone’s throw away from WebPT HQ—but it also provided numerous opportunities for us (and our friends and Members) to celebrate WebPT’s 10-year anniversary. When one reaches such a milestone, it’s only natural to reflect on the road one took to get there. And to quote APTA President Sharon Dunn during her keynote address at last week’s event, “When you look in the rearview mirror, you can appreciate how far you’ve come.”
Of course, the same can be said about the physical therapy profession as a whole. From its humble beginnings after the first World War to the end of the hard cap on therapy services this past February, our noble profession has a long and proud history that’s worth celebrating. But lately, I’ve grown concerned that perhaps we dwell too much on the past, particularly when it comes to our history with other healthcare stakeholders. However, if we, as a profession, can break free of this tendency, I believe that real, meaningful change is possible.
Our profession has had some major wins.
Take, for instance, the fight for direct access—a battle our profession waged for decades. At times, it seemed like an exercise in futility, and even now, some states only offer limited direct access to therapy services—something the APTA is still fighting to amend. The uphill battle continues to change our way of doing things. However, as Dunn mentioned during her address, nearly 35% of physical therapists in states that actually have unrestricted direct access don’t even use it. But, the fact remains: all 50 states (including Washington, DC) have some form of direct access, and that’s a major weapon in our arsenal. Furthermore, between changes to direct access law and the now-required DPT designation, PTs are fully equipped as the front-line providers we know we can be.
We’ve also faced some serious challenges.
While we’ve certainly come a long way in our quest for autonomy and respect, PTs have also come up against some major barriers in the last couple of decades, particularly in terms of payment. Payers have continually slashed reimbursement rates in an effort to cut costs, and from our standpoint, that’s been a big punch to the gut. After all, the work we do is important and life-changing. And at the end of the day, research shows that physical therapy is far safer and more cost-effective than other treatment options—such as surgery or prescription opioids—making PTs uniquely well-qualified to improve function and chronic pain.
In fact, during his keynote address at Ascend, David Elton, the Senior Vice President of Clinical Programs at OptumHealth, cited the Boston University study titled, “Conservative Therapies for New Onset Low Back Pain and Predictors of Long-Term Opioid Use and Misuse,” which found that 75% to 90% of low back pain patients with episodes of care that began with physical therapy were less likely to have short- or long-term exposure to opioids. In Elton’s words, “The idea that PTs aren’t well positioned to be on the front line of treating back pain doesn’t make sense”—and I couldn’t agree more. Knowing this, the fact that payers still continue to shrink our payments feels like an even bigger affront.
It’s time to re-evaluate our relationships with other healthcare stakeholders.
Before we can overcome these challenges and rise to our full potential as integral members of patient care teams, we must confront and address an uncomfortable truth: while our relationships with insurance payers, physicians, and other healthcare entities have often been rocky, we simply can’t continue to silo ourselves. As health care continues to move toward a more value-centric model, there is growing emphasis on collaboration. Environmental catalysts (e.g., the Affordable Care Act) have sparked significant change at various points throughout our history, and we are in the midst of another one right now with the opioid epidemic. Simply put, we must seize this moment.
When physical therapists and other healthcare stakeholders work together, some pretty amazing things can happen. During a pilot program at Optum, which directed back pain patients to conservative therapies before they saw a primary care provider, the healthcare giant discovered those patients were less likely to seek costly spinal surgery. Furthermore, during the previously mentioned Boston University study—jointly sponsored by the APTA and United Health Care—researchers found that patients are 10% to 25% less likely to see a PT, rather than a primary care provider, if the copay is more than $20 or the deductible is more than $300. With that knowledge in mind, Elton announced that UHC will be adjusting its 2019 benefits packages to waive the copay for the first three physical therapy visits. The end game? Incentivizing and driving a new clinical pathway that puts PT first for patients with low back pain—and ultimately, breaking into the vast population of patients who need a PT, but aren’t finding us. As Elton put it, “[The payer’s] goal is not to create headaches. It’s how to get more patients into your office, let you do what you do, and pay you fairly.”
Mending these relationships will allow us to reach more patients.
Furthermore, as I alluded to above, the fact remains that more than 90% of patients who could benefit from physical therapy services will never receive them. I’ve said it before, and I’ll say it again: that is absolutely tragic. But, if we continue making strides to improve our relationships with payers and referring providers, we can make real progress toward improving that statistic. After all, those sources continue to be two of the biggest gateways to potential patients. And according to Sharon Dunn, “We need to get out of our siloed mentality of sitting in our clinic and waiting for that referral to drop.” Conversely, if we don’t play nice in the sandbox—if we don’t foster positive connections and relationships with other healthcare stakeholders—then we will continue losing patients who could otherwise benefit from our care.
Don’t get me wrong: I’m not suggesting that we shouldn’t reduce our dependence on payers. I’m a strong advocate for diversifying revenue sources through cash-based services and wellness offerings. And I also encourage all physical therapists to take advantage of direct access and market to patients directly; that’s just smart business. But payers aren’t going away anytime soon, and most of us can’t afford to completely ignore them.
I know it’s easy to view payers as the enemy. But we can’t allow ourselves to dwell on past negative experiences. I know for many therapists—myself included—the proof will be in the pudding. But if we are willing to look at our position through a fresh lens, we can see that what we want for our patients and what they want for patients isn’t all that different. At the end of the day, we both strive to provide patients with the best care for the lowest cost. When that is the end result, everybody wins. But, the only way we will get to that place of mutual understanding is by building partnerships and relationships. We must be open to collaborating—and to sharing data. And there is no better time to do that than the present. There is a moment right in front of us ripe for the seizing, but to see it, we have to quit looking in the rearview mirror.