Ask an Expert
Featuring Shirley Sahrmann, PT, PhD, FAPTA
Monday June 8, 2009
Q: How can we improve insurance reimbursement for our services?
Probably the only way reimbursement can improve is if we demonstrate that PT services are cost-effective. That means the patient’s condition is improved or alleviated by physical therapy, while services provided by other practitioners are more costly and possibly less effective in both the short and long term.For example, management of low back pain often requires a visit to the primary care physician, radiological tests, possible referral to an orthopaedic surgeon, and drugs or surgery that involve great costs and may be unnecessary or less effective. Ideally, physical therapy would involve only a few visits, which would include an examination identifying the pain producing movements, instruction in avoiding and correcting the offending movements, instruction in a home exercise program, and modification of non-optimal movement patterns during basic and work activities.Obtaining outcome data means that we can demonstrate treatment cost-effectiveness and consistency in the delivery of care for specific conditions. Unfortunately, physical therapy for patients with low back pain varies widely, and outcome data is all too rarely collected.I am fearful that with escalating medical costs and the problems with the economy, reimbursement for the treatment of conditions that are not life-threatening is going to decrease and not increase. Therefore, I believe we are going to have to undergo a major paradigm shift: we will need to become practitioners that are consulted on a periodic but regular basis throughout life, following the dental business model rather than the physician’s business model.Under this model, the major source of PT reimbursement will be direct or private pay from many individuals on a semiannual or annual basis, spread out over a lifetime, and from periodic, more intensive episodes when an acute problem develops. I believe PT will be more palatable to both third party payers and the public if for the most part costs are contained, and not part of a very expensive and expansive process closely identified with the physician.
Shirley Sahrmann, PT, PhD, FAPTA, is a professor of physical therapy, cell biology and physiology, and neurology at the Washington University School of Medicine in St. Louis. She has received numerous awards, including Washington University’s Distinguished Faculty Award. She is a frequent lecturer, and has served in appointed and elected APTA offices at the national and local level.
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