How much should insurance dictate quality and results in healthcare?
Now that I am both subscriber and provider, I see that controversy both personally and professionally.
While in my last clinical of physical therapy school, I noticed pressure to push for production. It was not uncommon as a novice physical therapist to see four patients per hour, with possibly only 10 minutes of hands-on time with each. I even recall a clinical instructor encouraging me to hold off on any manual care, instead directing the patient to perform therapeutic exercises for 30 minutes then 15 minutes of an appropriate modality; all of which could be supervised by a physical therapy assistant or technician. My inner struggle began as I saw the tremendous impact that manual therapy had on patients, even if only for 10 minutes.
That frustration lit a fire in me, and was the motivation for my opening a cash-based physical therapy practice nearly six years ago. Insurance companies can influence the type and amount of treatment a therapist provides. In my opinion, this is not a patient-centered modeled of care. I subscribe to the philosophy that manual physical therapy provides the greatest benefit in the least amount of time. Manual therapy, the hands on time between a patient and therapist is often sacrificed in the “insurance model”.
This is primarily why I do not accept insurance, and stand so passionately behind that ideal. I also believe there are tremendous misconceptions about the scope and practice of physical therapy. A great example is my uncle (an orthopedic surgeon) who asked me at a family dinner, “Don’t you just exercise people?” I now laugh thinking of that. Physical therapists are trained in therapeutic and performance exercises, however, that is a very small part of what we do. We are trained as doctors to diagnose anyone who walks in the door, whether to refer out, or resolve the issue with physical therapy.
If you’ve ever “just been exercised”, please seek out a manual physical therapist. It doesn’t have to be me, but I’d surely love to show you how I am reinventing mainstream physical therapy.