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Toni Talks about PT Today

The Reimbursement Paradox

Published September 23, 2015 5:43 PM by Toni Patt

I wish someone could explain this to me. The baby boomers are aging. Each year, millions more of them will become eligible for Medicare. Instead of increasing funding to cover everyone at current levels, the government is decreasing the funding. Everyone will still get funding but with less coverage.

As physical therapists, we know the aging population will need our services. Years ago we talked about the job security that would come with the aging of the baby boomers. It was simple math. More older people means more people will need therapy. It didn't happen.

Yes, there are more people on Medicare. Yes, they need therapy. But Medicare went managed care. Patients still need therapy but fewer visits are approved. There might be more patients but they're on caseload for less time. Combine that with ever-decreasing reimbursement and we find ourselves struggling.

This is true of outpatient, inpatient and skilled nursing. Patients who used to stay 90 days at a SNF now stay 20 days or less. Inpatient rehab stays are under two weeks. Outpatient and home health patients might get scripts for three times a week for four weeks but it doesn't happen.

How is this better? No one is getting adequate therapy. Why cut reimbursement? Why not leave it at the same levels? You would have more people getting less therapy but it would have been more than they get now. Demand is not driving this equation. In every other industry, increased demand means more products or services.

In healthcare we are asked to do more with less, in less time and be paid less money to do so. Less is not more. I don't understand.

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Regarding the "reimbursement paradox" article. Yeah, it's pretty (fill in the blank) sad when a seasoned PT, cannot maintain ANY hours working (SERVING I might add), in a skilled facility where she actually enjoys the work and gets verbal affirmation by her patients (& nurses at times!), thanks to whatever CRAZY "forces that be". So now I'm NOT in the skilled nsg setting, no, I travel 6  times the distance for a different setting (which I'm gifted in and enjoy as well, thank you very much!;)

A HUGE "thank and God bless you" Toni, for your blog.  It's been reassuring (to put it mildly) and a blessing you'll never know to this 26 year PT veteran, AND I keep going!!!

liz moore May 7, 2016 7:47 AM
greer SC

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