Barking Up the Wrong Tree

By Terry C. Brown, PT, DPT

Recently I was traveling by air, which is something I do a lot of as your president. Flying is an experience that has gone from a luxury seat with concierge service to something short of a cattle car minus the electric prods. Nevertheless, this particular trip was greatly improved by a free upgrade to first class. As I settled into my new seat I was amazed that my pelvis did not have to deform when sitting down and my knees were actually free of patellar compression. Feeling quite smug, I began to watch the boarding passengers to determine who would share my row. Surely the way things were going it would be either the Dalai Lama or a Victoria’s Secret model. Lo and behold a middle-aged businessman sat down and I was returned to reality. He introduced himself and settled in as we prepared for takeoff.

“What is it you do?” he asked as we became airborne. I’m not sure about you, but this question always stops me momentarily as I consider the direction I should take. Should I be the “clinical” physical therapist and educate him on what we do, or the “president” and educate him on the value of private practice? As this particular trip was to DC to work on payment reform, I chose the “president” role. “Well, I am a physical therapist and happen to be the president of the Private Practice Section of APTA.” We proceeded to discuss my reason for traveling to DC as I explained payment reform as it related to physical therapy and our efforts to influence the Centers for Medicare & Medicaid (CMS). It was obvious that this gentleman was well versed in what I was talking about by the questions he asked and comments he made.

My turn: “What is it you do, sir?” I asked.

“I’m a health care economist based in DC, working for a think tank,” he replied. Now things got interesting!

We continued to talk, and I extolled the value of physical therapy and the difficulty we have in getting paid for what we do. He asked more questions about what evidence we had that supported our value. I gushed with data from the McMillian study, Low back pain (LBP) data, and the Iowa study, among others. “The issue,” I continued, “is that CMS doesn’t seem to be moved by our data; they just seem interested in cutting the cost of physical therapy without considering the overall cost of health care. Isn’t it obvious that savings would occur with increased utilization of physical therapy?”

Smiling, he replied,” You’re barking up the wrong tree.”

Yes, colleagues, we are working with CMS and doing everything we can to offset cuts to reimbursement and educate them on our value. Unfortunately, my airplane friend is correct; this tree is tall and the odds of our bark being heard are minimal. As we continued to talk, we both agreed that the private payer market is where the impact must be made, as that market is receptive to change and open to initiatives that reduce risk and save downstream costs.

This is the direction in which the Private Practice Section (PPS) board of directors and the Payment Policy Committee are moving, looking at bold initiatives to demonstrate our value proposition to those decision makers in the industry. We realize that payment is a regional concern, and we must package a product that can be driven by you our members with the support of PPS and the versatility to adapt to all markets. Quality tools are already available addressing a Comprehensive Care for Joint Replacement (CJR) Collaboration Agreement as well as a model participating provider contract for private practices. Continuing efforts will bring more valuable tools in the near future. Working together as PPS, we will be a force that communicates our value in today’s health care system.


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