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ADVANCE Perspective: Physical Therapy & Rehab Medicine

Driving the Consumer Marketplace for PT

Published February 11, 2009 6:33 PM by Lisa Lombardo

LAS VEGAS-- As part of the session "Emerging Issues in Medicare, Medicaid and Private Insurance presented Tuesday at CSM 2009, Carmen Elliott, MS, outlined trends in private insurance reimbursement and what PT can do to help itself not lose out in an ever-narrowing window of payment opportunities.

"Consumers are beginning to assume a huge share of the risk for their own health care and providers know it," Elliott said. "They are becoming savvy shoppers for insurance, and they are looking for competitively priced services and quality outcomes."

Conversely, employers are shifting more risks to their employees. More than 60 percent of workers are still covered by health benefits offered by the firm they work for, she said.

Payers are now more likely to raise premiums and reduce medical claims costs where they can. Payers also are emphasizing more consumer-driven products such as high deductible health plans and health savings accounts, she said.

National industry trends show employer-sponsored health insurance is decreasing and that underinsured and uninsured groups are growing.

The result? "The power of consumerism is driving the health care market, especially in this economy," Elliott said. Since they are being asked to pay more out of pocket for their health insurance, consumers will comparison-shop for those who offer the best outcomes for the lowest cost.

There is an impact on physical therapy that the profession must recognize, she said. Opportunities for PT in this economic climate include educating patients on lifestyle changes, contracting directly with employer groups, decreasing reliability with third-party payers if possible, tracking market trend data and payer activity, and stepping up advertising and good marketing.

"Health care is a business whether we like it or not," Elliott said.


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