CSM 2013: PT Autonomy: What the Future Holds Under Health Care Reform
SAN DIEGO--There's a popular saying that goes in this vein: There really is no such thing as luck; it is what you do with the situations you are confronted with that determines your own fate.
PTs who are in private practice or who are contemplating such a venture would be wise to adopt this strategy for the foreseeable future, according to the therapists who spoke at CSM June 23 on "Health Care Reform and Professional Autonomy: The Good, the Bad and the Opportunities."
Making the most of navigating the impending health care insurance law changes can make or break how PTs can practice autonomy, and while many of the new rules seem restrictive, it doesn't have to mean that PTs give up autonomy in their practices altogether. The profession would be best served, autonomy-wise, by seizing the opportunity to rethink how PT as a profession approaches the health care bureaucracy table.
"The Affordable Health Care Act pushes development of new health care models and prevention strategies for chronic diseases and improving public health, which overall is a positive thing," stated speaker Ira Gorman, PT, MSPH. Prevention of chronic conditions is a big opportunity for the PT profession, Gorman stressed. "We're great at that secondary and tertiary care, after the problem has begun," he said. "We should start looking more at primary preventive care; often this is not appreciated and as we know it often is not paid for."
The key is keeping the autonomy of the PT profession respected within the health care bureaucracy, which will end up determining standards of payment and how outcomes are achieved, added Robert Sandstrom, PT, PhD. "Stats show more doctors are joining hospitals and health systems rather than go into private practice. It's an interesting and sobering idea of the effect that added bureaucracy can have on an autonomous profession." At the core is the doctor/clinician-patient relationship that remains valued; could moves toward ACOs and the like put an effective end to this relationship?
"Things like joining ACOs don't have to mean a threat to our autonomy outright, for either physicians or for physical therapists in practice. We can help steer and initiate new payment reforms that give clinicians more flexibility within those [rules]," Gorman said.
Gorman, Sandstrom and Stacey Ziegler, PT, DPT, outlined what they called the "good, the bad and the opportunities" for the PT profession in lieu of the coming changes. The good: the ACA is aimed at adding 32 million more health care consumers nationwide; more patients of baby boomer age-between ages 55-70-are now opting for more and better care options and are a huge patient population; and insurance reforms are beginning to focus on outcomes-oriented accountability and evidence-based practices-areas that are PT's stronghold.
The "bad": the development of an Independent Payment Advisory Commission (IPAC); no payment reprieves for outpatient therapy under the cap and no updates yet on fee schedule cuts; market cuts to home health and some other settings, and more regulatory activism under MPPRs, RAC enrollments and a Corporate Practice of Medicine doctrine.
But with the good and the bad come opportunities, the speakers stressed. PT's role in new models of care can open doors for the profession that were previously closed, particularly in primary care aspects and prevention and wellness initiatives.
"More than 90 percent of health care consumers surveyed have a positive impression of PT," Ziegler said. "We have both opportunities and challenges in front of us in participation in ACOs; we are going to have to come to the table to demonstrate to the public our knowledge, expertise and value as a component of integrated care," she said.
As of now, 300 ACOs are operating within 48 states, she said, so the time is now. "As Thomas Paine once said, we need to lead, follow or get out of the way," she said. "These can either be rules that are happening TO us, or they can be opportunities that present us with taking the mess and finding the message."