Saturday, January 26, 2008 | 01/26/2008 | Physical therapy clinics feeling the pain

This article which I received via Google Alerts Physical therapy clinics feeling the pain points out a number of the challenges faced by Physical Therapists and particularly those in private practice.  I do have to comment on a couple of comments by Mr. Dave Mason, APTA Vice President of Government Affairs and Reimbursement Advocacy.

Mr. Mason reportedly stated "It is a very competitive marketplace, where payment rates are causing pressures".  This statement is inherently misleading.  It assumes that free market influences are at work in the physical therapy marketplace when nothing could be further from the truth. 

I believe a more correct statement would have been, "It is a very anti-competitive marketplace characterized by laws and regulatory policies which are biased to the advantage of insurers, consolidation of the insurance marketplace, the rise of third party "Organized Delivery" intermediaries who represent multiple insurers and Referral for Profit.

Consolidation of the insurance industry, biased regulation, and the Organized Delivery Entities result in less competition amongst insurers to attract network providers.  Allows insurers to "negotiate" contracts with a "take it or leave it" stance thereby allowing them to reimburse at rates which make practice unsustainable. 

Additionally because of Physical Therapists failure to protect and enforce their ownership of the practice of Physical Therapy, others are employing parasitic business models as reflected in the burgeoning number of referral for profit situations across the country.  Referral for profit eliminates a patient's choice of providers, increases utilization as pointed out by a recent Medicare report and reduces the financial resources available by practicing Physical Therapists to reinvest in the profession by supporting research, their professional Associations and Societies.

I also take issue with Mr. Mason's reported comment "The practice models (therapists) had are not really working now."  This comment whether taken out of context or not I feel reinforces the continuing impression I have that the APTA would rather capitulate to the strong arm tactics of the insurance industry rather than forcefully advocate for a fair and reasonable reimbursement.  The continued focus of the Association on alternative models including "cash based practice" is a prime example of capitulation.  If "cash based practice" is the alternative model I'd ask where this leaves those healthcare consumers who pay premiums and can't afford a "cash based practitioner"  We and our patients deserve better.

How long before we all make a stand to protect and defend our practice and our profession?  I hope soon before it's too late.

As President Kennedy said, "There are risks and costs to action.  But they are far less than the long range risks of comfortable inaction"