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PT and the Greater Good

Goodbye Fee for Service!

Published March 5, 2013 10:48 AM by Dean Metz

For most of my professional life, except when I worked in the NHS in England, either I was paid on a fee-for-service basis or the employer I worked for was reimbursed that way. Essentially, "make a visit, get paid" was the way it worked. That's a very expensive way to do things and one that promotes a practice of visiting more rather than figuring out how to achieve outcomes with fewer visits.

PTs aren't the only ones who get paid this way. This week, doctors are being shoved into the spotlight with a bunch of media attention from Time magazine, to Politico website and even New York state is advocating an end to this practice of reimbursement as evidenced in this report from Robert Wood Johnson Foundation.

If this is gaining so much momentum in the MD arena, I'd be willing to bet that it will affect how we are reimbursed as well. Are we as a profession ready for that? I know that in homecare this will take an attitude shift to accomplish. What about private practices? Will this make the therapy cap seem like the "good old days?"

Last week my colleague ADVANCE blogger, Janey Goude, advocated for advancing health maintenance and prevention rather than sick care. I've gone into the arena of public health with the same idea. Is the profession ready to move from mainly rehabilitative tertiary prevention to preventive primary prevention? We have an opportunity to be leaders in the health revolution. Let's not waste it.


In an earlier post, you mentioned physical therapists could choose to look at the coming changes in medical care as an opportunity to reposition, shifting focus to prevention.

Makes me wonder how our society got the focus off of wellness in the first place.

You make a good point. Reimbursement for visits doesn't give an incentive for fewer visits, but for more. Our health care rewards financially for more visits and more prescription refills. The medical system has incentive to keep patients coming back, not to get them well.

Janey Goude March 7, 2013 9:22 PM
Lexington SC

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About this Blog

    Dean Metz
    Occupation: Staff Development Specialist
    Setting: New York, NY – Newcastle Upon Tyne, Great Britain
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