High Deductibles and higher co-pay plans have forced the consumer to become their own advocate in assessing the best value in medical care. According to research by Kaiser in 2015, the average deductible for people with employer-provided health coverage rose from $303 to$1077 between 2006 and 2015. This means that individuals are paying more for health care and often at the full pre adjusted cost of services until they meet their deductible. In other words, the cost of your medical care pre-deductible is essentially all out of pocket. Making an informed decision on where you choose to use your health care dollars requires an understanding on how insurance reimbursement (to providers) has influenced the services provided by any given physical therapy (PT) business. Now more than ever, decisions on your care are being driven by the bottom line rather than your individual needs.Teasing out which PT providers are patient centered (one on one care) and free from reimbursement influences is important in helping you make the best decision for your PT and other healthcareneeds.
The average reimbursement for physical therapy services in the United States has been on a steady decline for 25+ years. Declining reimbursement challenges the traditional physical therapy model at providing quality service while still achieving a profit. Services provided by physical therapists are billed according to CPT codes. Manual therapy (CPT code 97140) which is supported significantly in the PT literature, is actually reimbursed at one of the lowest amounts, which when combined with 2 or 3 more CPT codes may only allow for a total visit reimbursement at around $55 per (45-60 minute) session.
Traditional physical therapy clinics will make up for these billing short falls by double and triple booking their therapist schedules with 16 to 20+ patients in an average day. Traditional physical therapy companies incentivize clinic directors and therapists to achieve metrics including total visits per week and billing goals. The increase in patient volume within the traditional PT model is causing therapists to burn out quickly because decisions are made on monetary goals rather than patient goals.
Fee for service physical therapy is designed with one major focus- patient centered care. At PT360, each session is one on one with a licensed physical therapist for fifty minutes at a fixed cost per visit that is applied to your out of network deductible. Your therapy sessions are catered to your individual needs and not dictated according to billing codes. Additionally, the fee for service model is designed for personalized care with no overlapping therapy appointments with other clients. The individualized attention you receive lends itself to a quicker recovery with less total time commitment because most goals can be achieved with 1-2 visits per week with a shorter duration of care. Less time in clinic results in savings financially as well as valuable time at home and work.
We value your recovery and your time over insurance CPT codes and corporate PT metrics. Call today to experience the difference at PT360. If you’re interested in experiencing the difference, call our Sandy Springs clinic and set up an initial evaluation at 678-430-8107. If you have any additional questions reach out to me at Dpruszynski@pt360atl.com.
Resources:
- “Among Covered Workers with a General Annual Health Plan Deductible for Single Coverage, Average Deductible, by Plan Type, 2006-2015,” available at:http://kff.org/health-costs/report/2015-employer-health-benefits-survey/view/exhibits/
- https://www.webpt.com/blog/5-ways-affordable-care-act-impacting-physical-therapists/
