Practical Programs for Providing Pro Bono Services in Your Practice
By Scott C. Spradling
Should we, can we, and how do we provide physical therapy services for those that cannot afford it—whether they are uninsured or underinsured?
The question of “should we” is easily answered in Principle 8A of the American Physical Therapy Association’s (APTA) Code of Ethics, which states: “Physical therapists shall provide pro bono physical therapy services or support organizations that meet the health needs of people who are economically disadvantaged, uninsured, and underinsured.” It is the “can and how” of the question that becomes more difficult to answer.
There are many ways in which a physical therapist and a private practice can provide for or contribute to pro bono physical therapy services. It can be as easy as simply writing a check to a local organization or charity. But that does not really capture the true sense of the principle. I would like to show two different ways that a private practice can develop a pro bono program without having to feel like you are giving away the farm.
The first program example has an indirect financial obligation for the practice. By incorporating principle 8A into your Human Resources/Employment guidelines you can create the “Practitioner Standards for Pro Bono Services.” This standard sets a minimum number of hours annually that each practitioner must donate their services to a health care or community organization of their choice. Since the APTA Principle 8A does not outline specifics in terms of time, a reasonable guideline would be 12 hours annually. These services should be defined as nonreimbursed and noncompensated. The execution of the services remains in the autonomy of the practitioner and should be based on their areas of specialty or interest. For example, if a practitioner is highly into youth athletics, they could volunteer for free sports screenings at an underfunded school or community-sponsored team. There are hundreds of programs and opportunities in almost every city. Practitioners must record their services and hours, much the same way they do for tracking their continuing education. This then would become part of their annual performance criteria, which then becomes objective and measureable and would lend itself toward the consideration of a wage increase or become a metric in determining their bonus or profit share.
The second program example has a direct financial obligation for the practice. Again by incorporating principle 8A into your financial policies and procedures, you can create the “Practice Standards and Guidelines for Pro Bono Services.” This program has a few more factors that need to be considered before implementing. You should have a firm understanding of your practice’s payer mix and average reimbursement as well as your cost per visit. This will help guide you in determining how much you can afford to “give away.” You should also have a general understanding as to the average length of an episode of care. This obviously has many variables based on the severity and intensity of the injury or impairment as well as the patient themselves. However, statistically you should be able to determine the average treatment length for an episode. As an example let us look at 10 weeks (this is based on a 60-minute/once-a-week business model). If your average reimbursement is $100, then the value of that 10-week session is $1,000. That does not seem like much; however, that is not truly the financial impact to the practice. Now you should factor in the cost per visit. If your cost per visit (total expenses divided into total visits in a given period) is $70, then the cost of that 10-week session is $700. This is the true direct financial obligation to the practice. This would be the general standard per practitioner, so if you had 10 practitioners that is a $7,000 annual obligation for your practice. It would now be your duty to determine if the practice can support this obligation in their annual budget. It certainly can be modified up or down based on what the practice (and practice owner(s)) are willing to bear.
The more difficult part of this direct program is: How do you determine who gets the pro bono care? Private practice clinics are not financial institutions, nor should they try to be. However, it is necessary to set standards around the determination of financial hardship. You should enlist the assistance of your practice’s accountant or attorney in helping you draft these standards. It should be simple enough so that the patient does not feel as if they are taking out a second mortgage on their home. You should document proof of uninsured or underinsured coverage. A copy of their paystub or W-2 is perfectly acceptable to ask for and will assist you in understanding their situation. It also does not need to be an all or nothing program. Perhaps the uninsured patient has some means by which they can pay but cannot afford it entirely; you can then establish a sliding scale. This will also allow you to use those unused dollars for another patient, as long as you stay within the financial limits you established. Whichever way you slice it, the guidelines and limits should always be followed—this will ensure you remain fair and equitable across the board for all your patients.
Providing pro bono services does not have to be complicated nor does it mean that your bottom line needs to be wiped out. Establishing practical programs either directly or indirectly enables you to serve a small population of those that otherwise would not have access to care, while still continuing to provide services for your general population.
Scott C. Spradling is a member of the PPS Administrators Council and a certified administrator since 2011. He is the administrator of Movement Systems Physical Therapy in Seattle, Washington, and can be reached at email@example.com.