Physical therapy is something nearly all Missourians will need at some point in their lives. In order to truly develop a good understanding of what it’s like to practice one of the healing arts in Missouri, it’s best to go “straight to the source” by speaking with a professional in that field. In this piece, OneMissouri speaks with a physical therapist. This professional has had an independent practice for the past 20 years in a small town of about 4,500 residents, situated in the northeastern part of the state.
Physical Therapy: It’s Complicated.
OneMissouri: How would describe physical therapy care in Missouri right now? What word would you use?
PT: In flux. Things are so much different than they were when I first started practicing 20 years ago. It’s so much more complicated than it was when I first started out.
OneMissouri: What do you mean? Complicated in what way?
PT: Well, for one thing, it’s a lot harder for independent operators to make it today. Most physical therapists today choose to join a group or a conglomerate, primarily because they can negotiate higher reimbursements from insurance companies and Medicare. As an independent operator, I have no leverage like that—I have to just accept what an insurance company or what Medicare will pay me. I can tell you that I make a whole lot less money now than when I first started practicing two decades ago. Of course, I didn’t go into this profession for the money, but the reality is that I have to pay for this office and all the equipment that comes with it. I have to pay the utilities and for liability insurance. I used to pay someone to take care of the insurance billing and accounting paperwork, but a few years back I started taking on all that myself. Now I spend an entire day each week just to get caught up on paperwork. The PTs that have joined a group or a corporation don’t have to worry about doing this themselves.
The Reality of Insurance
OneMissouri: Is there anything else that has been a challenge?
PT: Yes—there’s a state law that requires new patients to receive a doctor’s referral before they can receive physical therapy. This means that someone who’s been in a car accident or who has fallen off a ladder has to go to their physician—usually their primary care doctor—to be examined first. Then, if that doctor feels they need physical therapy he or she writes a prescription which the patient then brings to me to schedule an appointment. Of course, their medical insurance has to approve it before it the treatments will be paid for. Then, I start working with that person whose fallen off that ladder—maybe I treat them twice or three times and they start to feel better. That patient may think they’re all healed up and may stop coming. Then, two or three weeks later, maybe a month, they start to feel bad again. But—they can’t just come back to me and resume their treatments. According to the state law, they have to go back to their physician, get another referral, and then start all over as a new patient. It makes no sense and I hope they change it because really, no one wins except maybe the physicians who make some extra money on visits.*
Reimbursements & Paperwork
OneMissouri: You spoke a few minutes ago about insurance reimbursements and paperwork. Could you talk a little more about that, and how things have changed in say, over the past decade?
PT: Sure. For one thing, more people have insurance because of the Affordable Care Act, which is a good thing. But those same people now pay higher premiums, have higher co-pays, and most of the time, higher deductibles. So, while nearly all my patients now have insurance, they tend to conserve on their healthcare. In my case, I see those people less often or for fewer visits because they are keeping an eye on those higher costs.
OneMissouri: So, your patients are paying more for their insurance in most cases. At the risk of being intrusive, are you benefiting from those higher premiums and co-pays?
PT: The short answer is no. While the insurance companies are charging more, those extra dollars aren’t making their way to physical therapists, particularly independent operators like me. Reimbursements have gone down and remained stagnant. Like I said earlier, by having my own little practice, I have zero negotiating power when it comes to reimbursements from insurance companies and Medicare.
In addition to that though, we (physical therapists) have a new cost that we must now incur as part of an ACA mandate. We now have to pay a monthly fee to a cloud hosting service for electronic health records. I understand the need for these records, but at the same time it’s really time consuming and is just another added cost to my overhead.
Cap Per Procedure
OneMissouri: Do you see this getting any better?
PT: No—not really. In fact, it may even get worse. Medicare seems to be moving more and more toward a “cap per procedure” model—where they would only pay a certain amount for a patient’s treatment such as a back surgery—and then once that cap was reached the money stops. This then give hospitals an incentive to move patients through quickly, sending them home early before they’ve had a chance to fully recover. This troubles me.
OneMissouri: With all these challenges, do you think this will have any impact on the number of men and women choosing to become physical therapists in the Show-Me State in the future?
PT: I think we’ve already started to see a decline. For example, in the past 7-10 years, you can no longer get a physical therapy license with just a bachelor’s degree. Now, you have to earn a Doctor of Physical Therapy degree. This requires a whole lot more time and lot more money to get through school—and usually larger student loans to go with it.
OneMissouri: The Occupational Outlook Handbook says physical therapists make about $87,000 per year nationally. In Missouri, it’s lower—slightly over $81,000.
PT: Yeah. And while that may seem like a lot of money to some, it’s really not. Just imagine if your pay had remained nearly the same for the past 10 years or so, and the only thing that had changed was that your costs had gone up. I think a lot of younger people are starting to think long and hard before they choose to go into physical therapy.
*Efforts to pass Missouri legislation that would allow physical therapists to treat patients without a prescription failed during the 2019 session.
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Top Photo Credit: About.com Health