17 Nov Do you take insurance?
When I made the decision more than five years ago to leave a traditional physical therapy practice the move represented a last ditch effort to continue in the profession I so adore. I wanted to be a physical therapist (“PT”) since I was eight years old, grew up watching and being mentored by amazing PT’s that were extensively trained and saw the difference that can be made by simply applying qualified eyes, hands and brains to a patient. However, in my first few years in a traditional setting, I was treating up to five patients at a time and spending at least an hour a day justifying the need for my services to an insurance company. I was having success with patients but knew I could do so much more.
What every consumer needs to know is that insurance companies dictate what physical therapy services are worth. Unfortunately, in this city specifically, reimbursements for medical services are relatively low because of the prevalence of consortiums or groups of similar businesses that band together to share the cost of insuring their employees. Insurance companies save these businesses money by providing lower annual premiums to the employer. The reduced cost for the employer gets made up by the employee (in the form of a higher deductible) and by the provider (through a reduction in their reimbursement rate).
By 2014 I had enough. I ventured into the relatively unknown world of fee-for-service healthcare. In that world, I now have an opportunity to apply the skills I learned in my doctoral and postdoctoral training, while working with clients one-on-one. Quickly, I saw that clients were getting better a lot faster, just as I had anticipated.
As an illustration of my point, consider the average number of visits to a traditional physical therapy clinic for the treatment of any single joint dysfunction of 18-20. With a $50 co-payment due at the time of service and 20% co-insurance due within 30 days of service, a patient is looking at an estimated per visit cost of $80 or $2,200 in total per incident.
For $2,200 in aggregate, the typical patient spends roughly 15 minutes with a PT and the remaining time with an aide or assistant (remember, insurance rewards PTs that see more patients at one time). In the fee for service setting, the average number of visits for a single joint incident is 4-6, at an estimated rate of $600 total. Under this paradigm, the cash-based provider is rewarded for people that get better. So, while the idea of spending money up front is scary, the long-term return on investment is much greater because of the quality and delivery of care. Treatment this way is also more efficient, often requiring one visit per week as opposed to 2-3 visits per week in the traditional setting.
In order for me to deliver the unique, medically-justified care that each individual requires, leaving the traditional, insurance-based physical therapy world was a necessity. At Anchor Wellness, interventions including modalities, are based on the PT’s expertise and clinical experience. We are fortunate in the State of Ohio to not require a physician referral which means that a PT is solely responsible for evaluating and treating each individual that walks in the door, including being knowledgeable and responsible to refer out to different providers when indicated.
About the author:
Dr. Sarah Cash Crawford, PT, DPT, COMT, CMTPT, is a physical therapist and certified myofasical trigger point therapist through Myopain Seminars ®, the only certifying body of Trigger Point Dry Needling in the US. Dr. Crawford trained under Jan Dommerholt, PT and founder of Myopain Seminars ®, who worked directly under Drs. Travell and Simmons in his pursuit to bring dry needling to the U.S. Dr. Crawford has been performing Trigger Point Dry Needling the Cincinnati area for over six years and was the first CMTPT in the state of Ohio. She has been a practicing physical therapy for eight years. With a background in neurologic rehabilitation, manual therapy and a specialty in treating chronic pain, Dr. Crawford began studying dry needling to further expand her treatment options to help patients overcome the influence of myofascial restriction. Dr. Crawford is the founder of Anchor Wellness, Inc., an integrative health practice that specializes in physical therapy, pilates and health coaching.