Salaries going up when reimbursment changes?

[eamuscatuli]

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Hello everyone,

I was talking to a PT who's been in the field for 20+ years, and she says that when insurance companies start reimbursing PT's for work done without a physician referral, salaries for PT's should go up. I was wondering what your thoughts on this are, and if you feel it will actually happen?

 

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[TheOx777]

I have thought about this much since deciding to pursue a career as a physical therapist. It would seem logical that salaries would go up should reimbursement rates go up, but like the poster above me said the physicians and others may not be interested in this happen. It's a really big mess, and I do not know how the new health care system will affect physical therapists. I do agree with the fact that we need all people(young guns and the old guard) invested in this field to beat the issue to congress and anyone else who is in earshot that physical therapy is an invaluable asset for many people.

 

[josh123]

This is a little off topic but I keep hearing mixed things referrals. I hear from some people a patient can only go to a pt w.o a referral. Then I hear that patients can walk imto a pt office w.o referrals. So I was wondering if referrals were needed.

 

[PTboy]

Hello all,

I have been a PT in WI for 5 years and I would have to strongly disagree. Our hospital is currently transitioning to allowing direct access in our department for patients with certain insurances. However, this process is voluntary for PTs and our department is very split on this. With my current situation I do not want this because we are all salaried PTs who work 45+ hours per week so why would I want to take on more responsibility and get no more time per eval to do it? Direct access would likley benefit PTs in a private practice more than my setting.

Furthermore, we specificially asked if participating in direct access would increase our salary or reimbursement and the director said no. I have a hard enough time avoiding burnout when we are pushed to see more patients in a day and the support staff/Techs are also being cut. Our rehab director has warned us that reimbursement will likley only go down, especially medicare, and this is a growing concern for our hospital/department and this is the reason they consistently give us when they increase our work demands and decrease our support staff and benefit package.

 

[TheOx777]

Hello all,

I have been a PT in WI for 5 years and I would have to strongly disagree. Our hospital is currently transitioning to allowing direct access in our department for patients with certain insurances. However, this process is voluntary for PTs and our department is very split on this. With my current situation I do not want this because we are all salaried PTs who work 45+ hours per week so why would I want to take on more responsibility and get no more time per eval to do it? Direct access would likley benefit PTs in a private practice more than my setting.

Furthermore, we specificially asked if participating in direct access would increase our salary or reimbursement and the director said no. I have a hard enough time avoiding burnout when we are pushed to see more patients in a day and the support staff/Techs are also being cut. Our rehab director has warned us that reimbursement will likley only go down, especially medicare, and this is a growing concern for our hospital/department and this is the reason they consistently give us when they increase our work demands and decrease our support staff and benefit package.

Very interesting points! It is certainly something to think about as it relates to Direct Access. I think many people on this forum(including myself) are either pre-PT or PT students who need to realize that this process is a lot more complicated than it appears. Questions abound!!!😕

 

[MinnDasota]

Salaries won't go up just because of direct access. Although most states allow direct access, not every insurance reimburses for these services, most notably, Medicare. With this, most insurance companies follow Medicare's lead when it comes to reimbursement. With all the cuts in Medicare, reimbursement continues to drop and salaries continue to stay modest. Even if most insurances reimbursed for services performed without a referral, it's unlikely reimbursement will increase because of the above...

Arguably, the most common ways to increase PT salaries are 1) going out of network and charging a flat fee for services...This forces the patient to submit their own claims in which they get reimbursed based on their out of network benefits, if they even have any; 2) increase the amount of patients seen per hour which effectively decreases quality of care; 3) work a second job; or 4) offer additional services to increase overall income for the practice (massage, acupuncture, personal training, nutrition, etc). The above is based on outpatient services as insurance reimbursement is completely different in the hospital setting.

 

[MuscleHead]

Salaries won't go up just because of direct access. Although most states allow direct access, not every insurance reimburses for these services, most notably, Medicare. With this, most insurance companies follow Medicare's lead when it comes to reimbursement. With all the cuts in Medicare, reimbursement continues to drop and salaries continue to stay modest. Even if most insurances reimbursed for services performed without a referral, it's unlikely reimbursement will increase because of the above...

Arguably, the most common ways to increase PT salaries are 1) going out of network and charging a flat fee for services...This forces the patient to submit their own claims in which they get reimbursed based on their out of network benefits, if they even have any; 2) increase the amount of patients seen per hour which effectively decreases quality of care; 3) work a second job; or 4) offer additional services to increase overall income for the practice (massage, acupuncture, personal training, nutrition, etc). The above is based on outpatient services as insurance reimbursement is completely different in the hospital setting.

i dont understand, at all, why physical therapists would want direct access certification if it doesnt translate to more money. increased responsibility and expertise with zero increase in reimbursement sounds like stupid logic to me.

 

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[MinnDasota]

i dont understand, at all, why physical therapists would want direct access certification if it doesnt translate to more money. increased responsibility and expertise with zero increase in reimbursement sounds like stupid logic to me.

Sorry direct access is not a certification. It is not about increased reimbursements or higher salaries either. It's about allowing patients to see someone for a condition/injury without having to wait days or even weeks to see a physician who may ultimately send the patient to PT anyways. Basically, it is another point of entry that could potentially save the patient time or money or both. Now that logic makes sense to me. I'm up for the challenge of the increased responsibility and I don't see anything wrong with enhancing my knowledge and expertise.

 

[MuscleHead]

Sorry direct access is not a certification. It is not about increased reimbursements or higher salaries either. It's about allowing patients to see someone for a condition/injury without having to wait days or even weeks to see a physician who may ultimately send the patient to PT anyways. Basically, it is another point of entry that could potentially save the patient time or money or both. Now that logic makes sense to me. I'm up for the challenge of the increased responsibility and I don't see anything wrong with enhancing my knowledge and expertise.

I'm from PA and in PA you need certification to obtain direct access. Not all PTs in PA can see patients without a referral.

I'm all for saving patients money and time, and also all for increasing my own knowledge and expertise.

Maybe there's something I'm missing about direct access (I'm still a student), but why would you treat patients without a referral if youre not getting paid for it? Are direct access patients (for example those with medicare) paying out of pocket, or is medicare eventually coughing up money? From what has been said in this forum, medicare doesn't reimburse direct access treatment nor do some other insurances.

Being is a PT clearly isn't all about money, but its a job and you need to put food on the table.

 

[MinnDasota]

I'm from PA and in PA you need certification to obtain direct access. Not all PTs in PA can see patients without a referral.

I'm all for saving patients money and time, and also all for increasing my own knowledge and expertise.

Maybe there's something I'm missing about direct access (I'm still a student), but why would you treat patients without a referral if youre not getting paid for it? Are direct access patients (for example those with medicare) paying out of pocket, or is medicare eventually coughing up money? From what has been said in this forum, medicare doesn't reimburse direct access treatment nor do some other insurances.

Being is a PT clearly isn't all about money, but its a job and you need to put food on the table.

I work in CT and NY and both allow direct access (no certification). However, the rule in CT is 6 visits or 1 month (whichever comes first) before you need a script. In NY, it's 10 visits or 1 month before you need a script. Obviously, each state differs.

As stated before, some insurance companies won't reimburse for PT under direct access (such as Medicare). Thus we won't see them without a script as we won't get reimbursed for this. They of course have the option to pay out of pocket. On the other hand, most Medicare patients are already entrenched within the health care system so most already have scripts from their MDs so direct access is not usually an issue. In my experience, it's usually the younger, more active patients that utilize direct access. Also, it seems to benefit the outpatient ortho/sports population most.

Every time, someone calls to schedule an evaluation, our billing dept verifies their insurance and informs the patient what they are liable for (deductibles, co-pays, co-insurance, etc). That is when the patient decides to get services here or elsewhere. When it comes to direct access, we still have to verify insurance which usually takes a day (although I have seen patients the same day). If their insurance doesn't accept direct access, we tell them to get a script before coming in for PT.

 

[lizzo76]

Does anyone have any sense of what people are saying about salaries after "Obamacare" kicks in? I know a LOT of allied health professionals are very worried that salaries will go way down.

 

[MuscleHead]

Does anyone have any sense of what people are saying about salaries after "Obamacare" kicks in? I know a LOT of allied health professionals are very worried that salaries will go way down.

doesnt seem like anyone has a clue.

 

[hefe]

I know they extended the medicare caps temporarily through this year for PT even though they were initially planned to be cut at i think ~20-25%?? last year (forget exact percentage). But I'm not sure what the future holds beyond it. I'm going to look into it, probably in the coming months as I prepare for school.

There may be ways to recoup some costs even if reimbursement is cut a bit. It doesn't seem easy to predict to what extent (if much) salaries will be affected from this side as a student.

 

[jesspt]

i dont understand, at all, why physical therapists would want direct access certification if it doesnt translate to more money. increased responsibility and expertise with zero increase in reimbursement sounds like stupid logic to me.

Well, first off, in regards to money, as long as you verify benefits ahead of time, which most clinics do, that pt. will be coming to you rather than another provider first, ensuring that they are walking in your door, with the $$$ from their pocket and insurance company going to you. Then, the PT can determine whether the pt.'s symptoms are amenable to physical therapy interventions or not, then refer if necessary. If they see another provider first, there is the real possibility that they may never walk through your door. And for some of those pts, physical therapy might be their best option.

In regards to responsibility, well, there's a much smaller difference between direct access and non-direct access than many people think. If an MD/DO/PA/NP sends you a patient with the diagnosis of cervicalgia (neck pain) and they have a history of dizziness and headache, you don't do a cranial nerve screen, take a careful subjective history, etc because you ASSUME the referring provider has done it, you're asking for trouble. If you then perform an intervention that places undo tension/stress on the vertebral artery and the patient has a stroke, guess who loses their license? The MD/DO who probably should have done a cranial nerve screen and a series of vertebral basilar insufficiency tests? Nope. The PT does, because, once a patient walks through your door, you are responsible for their care. That means, if you do something stupid or negligent, you have NO EXTRA protection from litigation just because the patient saw a physician prior to seeing you.