The Collaboration Generation: How New Grads Will Usher PT into the Era of Value-Based Care

December 18th, 2018 in  Allied Health
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When we first enter the physical therapy profession as new graduates, listening, remaining humble, and taking in as much information as possible is crucial to our success. But even if you’re new to the game, it doesn’t mean you don’t have the power to make an impact. In fact, you may even have more power than a burned-out PT who’s simply going through the motions. Between constantly battling payers for better reimbursement rates and fighting tooth and nail for physician referrals, longtime physical therapists often become pretty jaded about the future of the profession.

According to data cited in the 2018 State of Rehab Therapy report, the longer a therapist is in a role, the less happy they are with the direction rehab therapy is heading—and the more the therapist agrees that they used to enjoy the role much more which is why I believe new grads are the key to a new era of value-based care.

As someone who has been a PT for more than two decades, I understand why many of my contemporaries feel this way. However, I also see ample opportunity for the PT community to grow and progress—and for PTs to further establish ourselves as valuable first-line care providers. That, of course, will require a shift in thinking—particularly with respect to our relationships with other healthcare stakeholders. And I think fresh PTs will be integral to spurring that movement.

Payers and PTs have a messy history.

As I mentioned, I understand why many physical therapists feel the way they do—especially when it comes to insurance providers. You don’t have to be in the profession for very long—or at all, really—to know that insurance payers are notoriously difficult to work with. (And on top of that, according to the aforementioned State of Rehab Therapy report, payers are one of the biggest barriers to accessing patients and providing effective care.) Historically, there’s been a unique strain affecting the dynamic between payers and physical therapists, and as a result, many PTs feel somewhat defeated—resigning themselves to being overworked, underpaid, and at the mercy of insurance payers’ corporate greed.

It’s an attitude you will undoubtedly encounter once you start working with more tenured providers, and I strongly caution you to not get wrapped up in the negativity. After all, the future our profession hinges on collaborating with other healthcare stakeholders—including payers and physicians. Your attitude will set the tone for the early years of your career, and more importantly, your enthusiasm and energy can fuel the evolution of the profession and help keep it in step with the industry-wide movement toward value-based care.

Data drives payer decisions.

That said, attitude and energy alone won’t be the only impetus for change. PTs are on the precipice of a major shift in our relationship with payers—one that could seriously impact how payers set their rates for our services. But before we get into that, we must first understand how payers set their rates.

In short, it’s all about data. Everything—reimbursement rates, coverage decisions, and policies—hinges on cold, hard facts. That means a payer’s coverage decisions will depend on whatever data is accessible. But, the data points most payers have—which primarily focus on cost and utilization—only paint a half-finished picture. This data doesn’t typically factor in outcomes or patient satisfaction, which means payers ultimately have a very narrow understanding of the true ROI of physical therapy. Without knowing what the results of PT intervention may be—or having a way to measure those results—it’s only natural they wouldn’t invest more than they need to. That’s just smart business.

There’s change on the horizon.

However, there’s been a noticeable shift lately, and it’s one that—if we can keep the momentum going—could have a profound impact on the way payers view PT services. First, as healthcare spending continues to rise, payers are putting more emphasis on developing sustainable cost-cutting strategies. That means prioritizing the delivery of less expensive—and often, less invasive—treatments. At the same time, the ongoing opioid epidemic has put major pressure on payers to promote prescription drug alternatives, which brings me to my next point.

And if we want to create a new culture around pain management—one that promotes movement, rather than medication, as the first course of action—then we can’t afford to maintain the status quo.

This past September, my company hosted its fifth annual Ascend conference, where about 500 industry professionals gathered for two days to learn about and discuss the changes and challenges facing our profession. Keynote speakers included major industry players such as the APTA’s Sharon Dunn and ESPN’s Stephania Bell. On the data front, though, one keynote address stood out in particular: David Elton of OptumHealth took to the stage to discuss Optum’s recent study on the efficacy of physical therapy (and other conservative therapies) in combating the opioid epidemic.

A PT-first approach could be key to fighting the opioid crisis.

During the yet-to-be-published study conducted by Boston University—which was co-sponsored by Optum and the APTA—researchers found that only a third of eligible patients received conservative treatments (i.e., physical therapy or chiropractic care) as a first option instead of surgery or prescription meds. However, low back pain patients who were sent to conservative therapies first were “75% to 90% less likely to have short or long-term exposure to opioids.”

Those are powerful numbers—which begs the question: why aren’t more patients turning to conservative treatments as opposed to prescription painkillers? Well, the study addressed that, too, finding that patients are “10% to 25% less likely to see a PT, rather than a primary care provider, if their copay is more than $20 or deductible is more than $300.” In other words, patient-consumers—just like consumers in any other market—are drawn to the most cost-effective care options. And as you may know, PT copays and deductibles are often much higher compared to those associated with other care disciplines, due in part to our specialist designation.

Payers are starting to take notice.

So, now what? Fortunately, Optum/UHC has already enacted some meaningful changes based on this data. Per Elton, “starting in 2019, UHC will adjust its benefits packages to waive the copay and/or deductibles for each beneficiary’s first three physical therapy visits.” He went on to explain that reimbursement rates could also potentially increase based on patient outcomes. And sure, UHC is only one payer, but it happens to be one of the largest payers in the country. So, it stands to reason that if UHC makes these changes, other payers could follow suit.

We must remain vocal for the sake of value-based care.

Unfortunately, despite the data being present—and despite one of the largest payers in the country taking steps to make PT more accessible to its beneficiaries—this information has still been met with skepticism from PTs who point to UHC’s long history of low reimbursement rates. (Even during Elton’s address, several attendees expressed this sentiment directly to him). And while I agree that we should be cautiously optimistic, I believe UHC’s changes represent a huge move in the right direction. And if we want to create a new culture around pain management—one that promotes movement, rather than medication, as the first course of action—then we can’t afford to maintain the status quo.

This is truly a pivotal moment for PTs, and there’s never been a better time to enter the profession. Physical therapy is a safe, effective, and financially-friendly alternative to painkillers when it comes to treating chronic pain—and we have the data to back it up. If we want our profession to thrive as we move into the future, we must be vocal about our role in ending the opioid crisis and supporting a value-driven healthcare system—and we must diligently educate our peers, patients, payers, and other healthcare stakeholders.

New grads especially have a lot to learn (you can check out our list of market the value of PT directly to the patients who need us—and to do everything we can to spread the word about the benefits of a PT-first, value-based care approach. After all, the more exposure we create, the more opportunity we'll have to help create clinical pathways—and insurance plans—that support that approach.

Physical therapy is an incredible profession, and I believe your decision to join the PT community is a great one. But, I won’t lie to you: the modern healthcare environment presents us with a lot of challenges. To meet the challenges of the future, though, we first must let go of the past—and I’m counting on the next generation of therapists to help us do just that.