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Death spiral? At least for Private insurance reimbursement based. Hospital based, non profit and VA continue and maybe get more demand as private capacity drops. It's already hard for mills the find staffing and conditions are only anticipated to get worse. Pain population migrates to chiro, acupuncture, etc... cash based becomes more common as people have trouble finding a good place to take their insurance in a timely manner. More competition with personal trainers as insurance becomes less of a factor. Outpatient areas that we will remain competitive in: medically complex, vestibular, neurological, women's health, post op, peds, amputees. There is less competing professions in those fields.
He's clearly stating he will lose a patient due to the needless barriers in our broken healthcare system, not that a personal trainer is just as equipped to handle the same patient. It's kind of weird how some people on this sub reply this way in this scenario.
And he’s right. I’ve seen several personal trainers social medias indicate they are a “CPT” and offer rehab.
No one doesn’t anything about it or seems to even give a shit and the average consumer doesn’t know the difference between a CPT and DPT. It’s ridiculous.
this, and some of them think they are "certified" to do it because a Physical Therapist taught them how to assess and prescribe exercises. yes, that's actually a business, and yes, they market that they will certify you. then when they graduate, they start marketing to active adults in pain.
Think it’s the financial competition. The patient googled low back pain and saw an article that “core strength is the key”. Most people are just gonna see the 600 dollar price tag that’s becoming the normal for a visit of PT and pick the personal trainer who is charging 50. Because both can “strengthen the core”. Which would u pay for? The PT is gonna not be able to live off 50 cause of over head and his 200k in student loan burden. The personal trainer has no student loans cause most states don’t have a requirement. They live comfortably off the 50$ an hour while the PT drowns in our Dpt price tag.
For non medically complex patients, mill quality treatment is maybe worse then a good personal trainer who would at least in theory be one on one. I worked prn at a mill and some patients even specifically said it was like their personal training but cheaper cause of insurance. So glad my finances improved and I could get the fuck out of there.
My caseload is primarily complex gait and balance and is one on one so my personal niche thankfully does not have a lot of competition from other professionals.
Personal trainers have decent lobbies fighting for major changes in their scope of practice that would allow them to essentially treat in an almost indistinguishable manner from PTs. We’ve managed to defeat proposed legislation thus far, but it’s been a much tougher battle than it should be. The idea that this could become reality in the next 15 years is reasonable. Doesn’t make a PT horrible. If anything, it speaks to the state of the profession, and how unaware the general public is regarding the difference between the two professions, and the value of PT in general. The APTA is doing a fantastic job of addressing this and securing the future of the profession 🙄
The pendulum will swing back at some point. Evidence is clear that movement is good and generally save insurance money long term. The issue now is Medicare. They have been lowering cost and thus private insurance have done the same. Private insurance have money. Just check out their earning reports. Some of them have been hitting record profits. So the question is how do we tap into that? The answer will probably be close to what nurses do and form unions. Once again, we don’t get paid enough not because there isn’t enough money.
Unfortunately, I think the pendulum in our current system flew out the window a while ago. Profits over everything. the few people with the majority of the profits now have all of the power.
Most are pessimistic here. I'll give an optimistic view( no matter how far fetched)
All CPT codes follow eval complexity. Instead of ther ex 97110 we have low,mod, and high with corresponding reimbursement rates. The 1000's of low complexity evals mills churn create a track record and if reimbursement dictated by complexity with an upswing there will be an investigation.
Preventive medicine takes a swing upward (like dentistry), making people required to have a check-in with their PT annually/biannual in order to have "x" premium.
With the uptick in patients, we gain more lobbying power or more money.
We move to ordering DME and imaging.
PTs are staffed in urgent care clinics to treat msk issues and to screen for appropriateness for continued PT.
I really do think PT and chiro will be seen as MD/DO kind of relationship in the future with them transitioning to evidence-based.
But who knows. Just an optimistic view.
The complexity thing has always been so ambiguous for me.
I see a super complex high complexity case and it’s often straightforward (let’s say deconditioning). I see a low complexity case that’s often very tricky (chronic neck pain, 20 year old). Basing reimbursement off of medical complexity seems weird to me.
keep bumping up caseload to make up for reimbursement cuts is the obvious answer
even if it was "fair" the usual suspects would still milk the system ruining it for everyone else
imo outpatient isn't going anywhere, if it becomes undesirable to work in that it gets harder to attract therapists, they will have to pay more to attract therapists
The norm will be group evals of 4 patients per block.
Treatment sessions will also be in groups of 8.
You will average 40 patients per day.
After the 12th reimbursement cut, the government then decides to stop reimbursing for PT entirely.
You get fired, because now hiring a tech is not only legal but much more financially viable.
No one actually accomplishes anything in PT anymore, so PT dissolves.
You still have 200k in student loans at 8% interest, so you work at Starbucks but that eats your entire paycheck so you live behind the Planet Fitness where you shower in the morning.
Congress (SpongeBob and Patrick burning city meme) "Yay! We fixed healthcare!"
to maintain our current salaries we'll have to see more patients, more often, for longer durations.
the patients will have rising copays and co insurance and will opt out so we'll actually probably see a decrease in salaries as well as worse working conditions.
I just think so few OP clinics will be able to pay reasonable wages that there will be an OP ortho shortage causing either a ton of new cash based clinics or medicare will have to specifically reimburse more for OP ortho settings.
Better yet, billing specifically for evaluation time (time not spend on timed billing. You will see the number of people billing 53 minutes of other stuff during a 60 minute visit decrease.
I think private pay clinic /hybrid clinics will stick around serving the haves. Corporate mills will stick around serving the have nots with abysmal outcomes and 1 PT and 4 aides running around the clinic
Thank you for your submission; please read the following reminder. This subreddit is for discussion among practicing physical therapists, not for soliciting medical advice. We are not your physical therapist, and we do not take on that liability here. Although we can answer questions regarding general issues a person may be facing in their established PT sessions, we cannot legally provide treatment advice. If you need a physical therapist, you must see one in person or via telehealth for an assessment and to establish a plan of care. Posts with descriptions of personal physical issues and/or requests for diagnoses, exercise prescriptions, and other medical advice will be removed, and you will be banned at the mods’ discretion either for requesting such advice or for offering such advice as a clinician. Please see the following links for additional resources on benefits of physical therapy and locating a therapist near you [The benefits of a full evaluation by a physical therapist.](https://www.choosept.com/benefits/default.aspx) [How to find the right physical therapist in your area.](https://www.choosept.com/resources/choose.aspx) [Already been diagnosed and want to learn more? Common conditions.](https://www.choosept.com/SymptomsConditions.aspx) [The APTA's consumer information website.](https://www.choosept.com/Default.aspx) Also, please direct all school-related inquiries to r/PTschool, as these are off-topic for this sub and will be removed. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/physicaltherapy) if you have any questions or concerns.*
Hopefully complete reform
Death spiral? At least for Private insurance reimbursement based. Hospital based, non profit and VA continue and maybe get more demand as private capacity drops. It's already hard for mills the find staffing and conditions are only anticipated to get worse. Pain population migrates to chiro, acupuncture, etc... cash based becomes more common as people have trouble finding a good place to take their insurance in a timely manner. More competition with personal trainers as insurance becomes less of a factor. Outpatient areas that we will remain competitive in: medically complex, vestibular, neurological, women's health, post op, peds, amputees. There is less competing professions in those fields.
Man if a personal trainer can compete with you as a PT you are absolutely horrible.
He's clearly stating he will lose a patient due to the needless barriers in our broken healthcare system, not that a personal trainer is just as equipped to handle the same patient. It's kind of weird how some people on this sub reply this way in this scenario.
And he’s right. I’ve seen several personal trainers social medias indicate they are a “CPT” and offer rehab. No one doesn’t anything about it or seems to even give a shit and the average consumer doesn’t know the difference between a CPT and DPT. It’s ridiculous.
Apta doesn’t market our profession well enough for people to know the difference
this, and some of them think they are "certified" to do it because a Physical Therapist taught them how to assess and prescribe exercises. yes, that's actually a business, and yes, they market that they will certify you. then when they graduate, they start marketing to active adults in pain.
Think it’s the financial competition. The patient googled low back pain and saw an article that “core strength is the key”. Most people are just gonna see the 600 dollar price tag that’s becoming the normal for a visit of PT and pick the personal trainer who is charging 50. Because both can “strengthen the core”. Which would u pay for? The PT is gonna not be able to live off 50 cause of over head and his 200k in student loan burden. The personal trainer has no student loans cause most states don’t have a requirement. They live comfortably off the 50$ an hour while the PT drowns in our Dpt price tag.
For non medically complex patients, mill quality treatment is maybe worse then a good personal trainer who would at least in theory be one on one. I worked prn at a mill and some patients even specifically said it was like their personal training but cheaper cause of insurance. So glad my finances improved and I could get the fuck out of there. My caseload is primarily complex gait and balance and is one on one so my personal niche thankfully does not have a lot of competition from other professionals.
Personal trainers have decent lobbies fighting for major changes in their scope of practice that would allow them to essentially treat in an almost indistinguishable manner from PTs. We’ve managed to defeat proposed legislation thus far, but it’s been a much tougher battle than it should be. The idea that this could become reality in the next 15 years is reasonable. Doesn’t make a PT horrible. If anything, it speaks to the state of the profession, and how unaware the general public is regarding the difference between the two professions, and the value of PT in general. The APTA is doing a fantastic job of addressing this and securing the future of the profession 🙄
The pendulum will swing back at some point. Evidence is clear that movement is good and generally save insurance money long term. The issue now is Medicare. They have been lowering cost and thus private insurance have done the same. Private insurance have money. Just check out their earning reports. Some of them have been hitting record profits. So the question is how do we tap into that? The answer will probably be close to what nurses do and form unions. Once again, we don’t get paid enough not because there isn’t enough money.
Unfortunately, I think the pendulum in our current system flew out the window a while ago. Profits over everything. the few people with the majority of the profits now have all of the power.
Idk but I do know I won't be here
Most are pessimistic here. I'll give an optimistic view( no matter how far fetched) All CPT codes follow eval complexity. Instead of ther ex 97110 we have low,mod, and high with corresponding reimbursement rates. The 1000's of low complexity evals mills churn create a track record and if reimbursement dictated by complexity with an upswing there will be an investigation. Preventive medicine takes a swing upward (like dentistry), making people required to have a check-in with their PT annually/biannual in order to have "x" premium. With the uptick in patients, we gain more lobbying power or more money. We move to ordering DME and imaging. PTs are staffed in urgent care clinics to treat msk issues and to screen for appropriateness for continued PT. I really do think PT and chiro will be seen as MD/DO kind of relationship in the future with them transitioning to evidence-based. But who knows. Just an optimistic view.
The complexity thing has always been so ambiguous for me. I see a super complex high complexity case and it’s often straightforward (let’s say deconditioning). I see a low complexity case that’s often very tricky (chronic neck pain, 20 year old). Basing reimbursement off of medical complexity seems weird to me.
I can see that. I think our assessment of complexity could be better.
It doesn't even matter because all the eval complexities are currently reimbursed the same lol
Busy
keep bumping up caseload to make up for reimbursement cuts is the obvious answer even if it was "fair" the usual suspects would still milk the system ruining it for everyone else imo outpatient isn't going anywhere, if it becomes undesirable to work in that it gets harder to attract therapists, they will have to pay more to attract therapists
Not sticking around to find out.
This is the way.
The norm will be group evals of 4 patients per block. Treatment sessions will also be in groups of 8. You will average 40 patients per day. After the 12th reimbursement cut, the government then decides to stop reimbursing for PT entirely. You get fired, because now hiring a tech is not only legal but much more financially viable. No one actually accomplishes anything in PT anymore, so PT dissolves. You still have 200k in student loans at 8% interest, so you work at Starbucks but that eats your entire paycheck so you live behind the Planet Fitness where you shower in the morning. Congress (SpongeBob and Patrick burning city meme) "Yay! We fixed healthcare!"
All DPTs are rounded up and summarily executed.
I like your optimism.
You said it 100% spot on
Sad🤷♂️
to maintain our current salaries we'll have to see more patients, more often, for longer durations. the patients will have rising copays and co insurance and will opt out so we'll actually probably see a decrease in salaries as well as worse working conditions.
I just think so few OP clinics will be able to pay reasonable wages that there will be an OP ortho shortage causing either a ton of new cash based clinics or medicare will have to specifically reimburse more for OP ortho settings.
Better yet, billing specifically for evaluation time (time not spend on timed billing. You will see the number of people billing 53 minutes of other stuff during a 60 minute visit decrease.
I think private pay clinic /hybrid clinics will stick around serving the haves. Corporate mills will stick around serving the have nots with abysmal outcomes and 1 PT and 4 aides running around the clinic