Submitted by: Cathy J. Leer, PT, MBA, Director of Physical Therapy Family Physical Therapy Services, Inc. Bedford, NH and Chichester, NH 6036448334
Your Right to Choose Your PT Did you know that you have the right to choose your physical therapist? Consider the following facts: In all but 2 states (Alabama and Indiana) you have the right to make an appointment directly with a physical therapist without a physician’s referral. NH is a “direct access” state, which means that you do not need a referral, even with Medicare, for the first 30 days of treatment. Armed with this information, the next time you need physical therapy, what will you do? How will you choose your PT facility? Some important issues you should consider when making your choice are: geographical location, experience of the therapists, insurance coverage, and ownership of the clinic or facility. Each of these issues has validity when choosing your facility. Location It does not make sense to travel so far that you undo any benefits that PT may have achieved, not to mention the price of fuel. Experience The experience of the PT staff is vital to your success. New graduates, although highly educated, too often don't have the techniques or history of treatment experience behind them to make accurate diagnoses or achieve results in a timely fashion. This is particularly important if you have high deductible, or high coinsurance or copay insurance policies. Insurance Rates Another very important insurance fact that you may not be aware of is that some major insurers actually reimburse hospital facilities at a higher rate than non hospital providers for the same service. In some instances, the rate can be twice as high or more! If you have a capitated benefit or a limited budget, this can dramatically affect your treatment by using up the available funds more quickly, thereby limiting the number of treatments you can receive.
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The sad part is that you can't find this out prior to receiving your treatment. Only after the fact, when you receive the Explanation of Benefits from your insurance company, will you discover that you could have received treatment with a more experienced therapist at half the cost if you had gone to a privately owned practice. That’s like paying for a Cadillac and getting a Chevy. So much for transparency. Facility Ownership and Conflict of Interest Also disturbing is the growing trend for primary care physicians (PCPs) becoming hospital employees, with little say about where their patients are referred. Because the hospitals want the services to stay inhouse for financial incentives, referral coordinators kindly make the appointments at their own facilities. Thinking that the doctor has requested the referral, the patient blindly accepts the appointment, not knowing the true cost of the service NOR the experience of the staff or quality of the service. But hospitalowned clinics aren't the only clinics that have referral incentives. Some physicians have ownership interest in PT clinics as well, which means that they get financial rewards for referring to their clinics. The law requires that these doctors inform you of their ownership interest when making that referral. Have you read the fine print? The Key is Being Informed What does all of this mean to you as a consumer? • You have the right to choose • A physician referral is NOT required (check with your insurance carrier) • Choose an experienced therapist • Verify your coverage and costs at your chosen provider • Ask if your physician has ownership in the clinic and as such gets a "kick back" or some kind of financial reward • Ask if your physician is a hospital employee and if he/she truly has a preference where you receive PT • Ask WHY the physician is sending you to a particular therapist You have the right to choose your PT, just like you choose your surgeon, your auto mechanic, or your hair stylist. It is your health and your CHOICE. ### Cathy Leer, PT, MBA, has been practicing physical therapy for 30 years. As founder and Director of Physical Therapy at Family Physical Therapy Services in Bedford and Chichester, NH, and an advocate for patient care and rights, she has earned the reputation in the local medical community as a therapist who gets Page 2 of 1
results, particularly with difficult cases. She specializes in manual orthopedic physical therapy.
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Published on Apr 4, 2012
You have a right to choose your own PT! Making an informed decision can mean a world of difference in your recovery. This article discusses...