Single Payer Healthcare and Salary of Rehab Professionals

[10ninja]

Hi everyone!

I was wondering what everyone's thoughts are on future salaries of rehab professionals (PT/OT/SLP). This election cycle has given me a lot to ponder and I'm wondering how changes to the healthcare system in the U.S. (such as a modification of Obamacare or the introduction of a single payer system), might affect salaries?

I know that salaries are cyclical. They went down for the rehab professions in the 80's and are back up again today, but I would love to pick everyone's brains

I, by no means, did not enter healthcare to get rich, but I'm hoping for stability given my future student loans.

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[jblil]

I don't think you have to worry about "changes to the healthcare system". We have too many entrenched special-interest groups (e.g., health insurance companies, big pharma) who will fight tooth and nail to preserve their share of the pie. And they have deep pockets to ensure Congress votes the way they want. Although I think a well-run single-payer system would be best for everyone, I don't think it will happen in this country.

What is starting to happen is "capitation", under one form or another. I am currently working in home-health, and the hospital system gets a lump sum for the care of each patient. If it (the hospital system) can hold the costs below the lump sum, it pockets the difference. If not, it has to dip into its own pockets to make up the shortfall. Since Home-health (HH) is less expensive than inpatient or outpatient care, I think HH will see good growth in the next few years. But this growth will attract PTs into the HH setting, and eventually the supply-demand imbalance will lead to lower salaries. How long will it take? I have no idea.

 

[OHIO PT]

I don't think you have to worry about "changes to the healthcare system". We have too many entrenched special-interest groups (e.g., health insurance companies, big pharma) who will fight tooth and nail to preserve their share of the pie. And they have deep pockets to ensure Congress votes the way they want. Although I think a well-run single-payer system would be best for everyone, I don't think it will happen in this country.

What is starting to happen is "capitation", under one form or another. I am currently working in home-health, and the hospital system gets a lump sum for the care of each patient. If it (the hospital system) can hold the costs below the lump sum, it pockets the difference. If not, it has to dip into its own pockets to make up the shortfall. Since Home-health (HH) is less expensive than inpatient or outpatient care, I think HH will see good growth in the next few years. But this growth will attract PTs into the HH setting, and eventually the supply-demand imbalance will lead to lower salaries. How long will it take? I have no idea.

What makes you say HH is cheaper than OP?

Another theory is that people who usually get HH after leaving hospitals and SNFs will go directly to OP and skip HH. I think the requirements to be eligible for HH will be more strictly enforced. Lack of transportation is not actually even an acceptable reason to get HH over OP. If a patient is not truly home bound they will have to start going to OP in the future I believe.

 

[jblil]

What makes you say HH is cheaper than OP?

Generally, overhead. The set-up and operational costs for a HH operation would be lower than those for an OP clinic: no (or little) rent to pay and fixed assets to acquire. My last rotation before graduation was in HH, and it so happened that both my CI and I have MBAs; we had really interesting discussions about the cost structure of HH vs OP while we were riding in the car en route to patients' homes.

 

[OHIO PT]

Generally, overhead. The set-up and operational costs for a HH operation would be lower than those for an OP clinic: no (or little) rent to pay and fixed assets to acquire. My last rotation before graduation was in HH, and it so happened that both my CI and I have MBAs; we had really interesting discussions about the cost structure of HH vs OP while we were riding in the car en route to patients' homes.

Those are only costs to the people who own those companies, I'm not 100% sure but I dont think that translates to the cost to the insurer/patient being lower. I'm pretty sure the cost of a patient getting home health therapy is more expensive than that same patient getting OP therapy. That is the only that matters here in the scenario being discussed with bundled payments.