Fee-For-Service Physical Therapy Improves Outcomes and Reduces Cost

In November 2019, the Center for Medicare & Medicaid Services (CMS) announced another upcoming decrease in the 2020 physician fee schedule ,which determines reimbursements rates for healthcare services. In this new roll out, physical therapists where one of twenty-six specialties to face reimbursement reductions. Beginning in 2021, all physical therapy services billed to CMS will see an 8% reimbursement cut. (1) While this drastic federal cut may seem irrelevant to the realm of private insurance, most carriers set their rates based on Medicare’s fee schedule, leaving many physical therapy clinics fearful of more to come.

While this burden may seem to only rest on the provider, these cuts directly affect the quality of care provided by practitioners. Given the $100,000 to $225,000 student loan debt that most recent physical therapy graduates face from investing in 7+ years of education, the financial stress to make ends meet and keep a clinic running becomes greater. (2,3)  To compensate, many clinics will over-book their schedules to see more patients. Physical therapists are now working longer hours, relying on support staff (physical therapy assistants or rehabilitation techs), and booking 2-4 patients per hour by overlapping multiple patient treatments to increase volume. This model then only permits, on average, 15 minutes of one-on-one time between patient and provider. Despite the higher patient volume, many clinics are also starting to pay their staff less. This disparity then trickles down to the patient’s care by reducing the time spent with each patient individually, overpacking clinics, and the use of generic treatment programs leading to slower patient outcomes and burnt out clinicians. (4,5)

If we zoom out further, we can see how this financial burden also becomes greater to the patient. Individuals are being forced into high deductible plans with already high monthly premiums. While CMS states a physical therapist doesn’t require a medical referral to evaluate and treat a patient, they do require that patients be under care of a physician for the condition. Therefore, while a patient has a right to direct access of physical therapy care, most insurance companies will not reimburse for these services without a physician’s referral on file. As such, this policy increases the patient’s cost of care as they must then see and pay multiple provider before accessing the care they need. This effectively makes physical therapists unable to act as a first-line providers for neuromusculoskeletal conditions, as the profession is intended. By remaining out-of-network with these carriers, fee-for-service physical therapy clinics can offer a wider range of services for patients including fitness screens, prevention and maintenance treatment, or dry needling services, all of which insurers do not reimburse for. (6)

While most physicals therapists enter the field in hopes to provide compassionate and exceptional care to each patient suffering from pain and disability, our current healthcare system rewards providers who cut corners. This ultimately harms quality of care, patient’s experience, and the integrity of the profession. My fee-for-service model permits me to spend more time with each individual, collaborate with them, and determine the most cost-effective care during our one-on-one treatment session. Collectively, this allows us to achieve the best outcomes and quickest results for you, the patient, not your insurance company. 

The Math:

In a 2018 study published in Journal of Orthopaedic & Sports Physical Therapy data was collected for 603 patients seeking care for neck or low back pain. Of the 276 patients who chose direct access care versus medically-referred care had “significantly fewer” physical therapy sessions and days in care. The average cost per direct access patient was $260 less for physical therapy, $169 less for radiology, and $53 less in “other costs” like medications compared with those who accessed physical therapy after physician’s referral. Total cost savings for the entire direct access group equaled $400,000. (6)

Average patient co-pay: $25-$75 ($50 on avg. for “specialty” providers)

Average number of visits per patient in typical outpatient physical therapy clinic: 12 visits (at 2-3 visits/wk)

Average total co-pay cost of care: $600

**These costs will then be magnified if you have a high deductible plan, have run out of covered visits for the allotted year, or have been denied further PT care by your insurance carrier.

Contact me today to schedule an appointment and see how you can save time, save money, and heal more effectively with DeStefano Physical Therapy and Wellness.

References:

1. Final 2020 Fee Schedule: CMS Relents on PTA Differential System for 2020; P... (n.d.). Retrieved June 26, 2020, from http://www.apta.org/PTinMotion/News/2019/11/04/PFSFinalRule/

2. Jette, D. U. (2016). Physical therapist student loan debt. Physical therapy, 96(11), 1685-1688. 

3. Debt and the DPT: What Went Wrong? • Posts by EIM: Evidence In Motion. (2020, January 13). Retrieved from https://evidenceinmotion.com/debt-and-the-dpt-what-went-wrong/

4. APTA to CMS: Proposed 8% Cut is 'Arbitrary' and Puts Patients at Risk. (n.d.). Retrieved from https://www.apta.org/news/2019/09/27/apta-to-cms-proposed-8-cut-is-arbitrary-and-puts-patients-at-risk

5. Balancing Act: How Many Patients Should a PT See in a Day? (2019, October 15). Retrieved from https://www.webpt.com/blog/post/balancing-act-how-many-patients-should-a-pt-see-in-a-day/

6. Denninger TR, Cook CE, Chapman CG, McHenry T, Thigpen CA. The Influence of Patient Choice of First Provider on Costs and Outcomes: Analysis From a Physical Therapy Patient Registry. J Orthop Sports Phys Ther. 2018;48(2):63-71. doi:10.2519/jospt.2018.7423https://evidenceinmotion.com/debt-and-the-dpt-what-went-wrong/