Physical Therapists: Are you worried about the effects of Obamacare?

Discussion in 'Physical Therapy' started by DreMD, Dec 30, 2009.

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  1. DreMD


    Dec 30, 2009
    I am Canadian and we have publicly funded care here - as you may have heard on the anti-Obamacare campaigns lol.

    This is the state of PT in Canada:

    Basically the government pays for health care, so like any business the government realizes that in order to save $ some things need to be cut from public funding.

    So until a few years ago, physical therapy services in Canada were government covered, then the government decided there's no more money and it no longer covers physio, except for the very young and elderly, but not if you have insurance first.

    About 8 years ago, I used to go to physio as a teen following a serious sports injury for about 8 months 4x/week. I was covered by my parents insurance, but the gov also paid for PT so it ended up being like $5 per visit. While there I saw many many patients who would also come daily. Since it was so affordable many people just enjoyed going for tune ups, especially the elderly population. I'm now a physical therapist, and we are lucky to see 15 patients a day. People can't afford it. The government won't pay for it. And big corporations also cut coverage for employees. A typical employee in his 30s has coverage for maybe a max of 30 visits a year. Most have between 15-20 visits, or about a month of therapy.

    With the gov cutting the coverage, hospital PT has also been drastically cut. 99% of the hospitals in Ontario no longer have outpatient clinics, and the typical inpatient PT is responsible for 25-30 beds. There's typically only enough time to see each patient 3x per week.

    Finding a full-time job in a hospital is pretty much nonexistent today. Most of my colleagues are working multiple (2-3 part times) with a mix of private clinic and hospital.

    So with the US government wanting to mimic the Canadian system, I think you guys have something bad coming your way, in my eyes at least. I'm all for equal care and equal opportunity for the poor and underserviced to access health care. However, I really am now starting to understand that private industry is what drives innovation and promotes excellence.

    So what are your opinions of the Obamacare's impact on Physical Therapy in the US?
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  3. lee9786

    lee9786 7+ Year Member

    Feb 3, 2009
    This is something I've been following pretty close. It does have me concerned. I've decided to take a year off of applying to schools because of it. I need to see what is signed into law before I sign onto 100k debt. There's too much uncertainty. There isn't too many healthcare professionals that seem to confident something good is going to come of all this.

    There is a very big problem in the future ahead that needs to be settled. Medicare is not financially stable in it's current state. I see this as a very big issue for PT.

    I'm not a fan of the term "Obamacare." It's associated with a complete government-controlled healthcare system which from what I read isn't the idea. While there are scares that the private insurance industry will collapse under the pressures of a governement option I really don't think it would happen. Look at how much money the current private insurance companies CEOs have been making. Then add the revenue from the thousands of Americans who very shortly look to be required to purchase health insurance. I think they will be just fine. It's the American people I'm worried about.
  4. black


    Sep 24, 2009
    Not worried, if I can't pay my loans off I won't and based off government labor statistics "Employment is expected to grow much faster than average. Job opportunities should be good." which is one reason why I'm going in to the field. I'm wondering if there will be a lawsuit due to lost wages comparing cuts across professions.<br> on another note even without knowing the OP's injury 140 sessions over 8 months seems excessive and to my understanding tune ups have no backing in studies on prevention of problems so there is no reason why people should be going to a PT for a tuneup, that's a belief of chiropractors which also to my understanding isn't backed up in the literature.
  5. truthseeker

    truthseeker Senior Member 10+ Year Member

    Sep 2, 2004
    Worried. I am worried about everything that Obama does. He is trying to remake the USA into the USSA, the united socialist states of america.

    However, If our services are truly valuable, then they are worth paying for. You don't hear people saying that they won't call the plumber to fix their broken toilet because it is necessary. If rehab is necessary, people will find a way to get it. If what we are doing is unnecessary, then good for the people who won't pay, they are making an informed decision.

    If we, as a profession can't demonstrate that we do what we do better than anyone else, AND that it is valuable enough to pay for it, then a pox on us.
  6. FLsurferDPT


    Dec 21, 2009
  7. MotionDoc

    MotionDoc PT/PhD

    Oct 29, 2009
  8. DPT2DO

    DPT2DO 7+ Year Member

    Sep 22, 2008
    New England
    Being a PT in Mass, we have seen some of the state-level changes which may ultimately be implemented nationally. Unfortunately, I think Health Care Reform will ultimately hurt PT.

    As PT's, we are lumped in with medical specialists for insurance purposes. So sometimes a patient with X insurance has a $15 copay for PCP office visit and $25 copay for specialist visit. We are regarded as specialists even though patients will often see us repeatedly for 5, 10, 20 visits, etc, and ultimately they incur a very large cost for this.

    In Mass, we now have ~97% insured, thanks to the bill passed a couple yrs back. Many patients depend on Medicaid, but the state is shunning Medicaid customers towards low cost, highly-subsidized alternatives like NHP, Network Health, BMC, etc etc. Very recently (like the last month), these insurances enacted some changes in their copay structures which do not bode well for our business. Celticare, which will be replacing Network Health, is structured such that a PCP visit involves no copay, specialist visit is $25, and ER visit is $100. You can bet your ***** that beneficiaries of medicaid subsidized insurances are going to shun PT due to the large copay of $25. I'm assuming this was set-up to discourage patients from using specialists, however that's not a problem when we're talking about a one-time consult with a Derm, however it IS a problem when seeing a PT for several visits. Moreover, structures like this are beginning to show up more often, and if we as PT's continue to be grouped with specialists, we will lose patients. Alternatively we could take a hit on the co-pay, but thats not very helpful when the insurance only pays out 30-50% of billed rates anyways.

    I have a feeling this type of insurance structure will be spreading nationally before we know it, and it is our responsibility to demonstrate the necessity of our services and limit the cost to our patients.
  9. lawguil

    lawguil Senior Member 7+ Year Member

    Jun 24, 2004

    I often hypothosize that there is a lot of overtreating occuring in the PT world because it's so accessible. If rehab is needed, people should pay.
    Just like the dentist - most people pay out of pocket....and it is pretty easy to exceed coverage limits.....I believe PT should be an out of pocket expense
  10. Lizarde

    Lizarde 2+ Year Member

    Jan 30, 2009
    Comparing health care to other countries sometimes causes us to think the grass is greener on the other side. Some of the effects of the Canadian healthcare system on PT seems pretty harsh, but most US insurance plans already cap PT visits in a similar way. That is if they even pay for PT at all. I personally have a privately purchased high-deductible HSA (of the kind Bush promoted) and pay out of pocket for almost everything.

    I'm also see nothing wrong with co-pays as it helps patients understand that there is value in what they are receiving. If I'm paying $50 for a PT visit I will probably work harder, pay attentions, and do exercises at home on my own (if appropriate). If it's free and unlimited I'm more likely to be more passive and lazy about it.
    No, not everyone can afford co-pays, but I think the majority can figure out how to budget for their needs if they make it a priority. I currently work as a Pilates instructor and will start DPT school in the fall. I charge ~$60/hr for an hour of Pilates and have people of all income ranges as clients. They see it as an investment in their health and well-being and find a way to fit it in to their budget.

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