One of the many “push backs” I get from PT’s, is the effect of higher co-pays that patients have encountered in physical therapy visits which result in less visits. Many therapists have stated that this has had a significant impact on their practice. I am sure that their analysis is correct but does the drop out (less visits) have an impact on outcome?
Before I attempt to go there, let me first state emphatically that I believe co-pays are a barometer of your practice. If patients don’t see the value that they are obtaining from their PT experience, they are certainly much more likely not to come back. A physical therapy referral is unfortunately an ambiguous one. Patient’s know what to expect when they get a referral for an X-ray, lab, or pharmacy. Research reveals that they are not quite sure what to expect when they get a PT “script”. Not long ago, I even had a patient that went to a pharmacy with one of these scripts (the patient thankfully wasn’t given a generic!). It’s our job to not only shape the expectation for the patient but also to demonstrate the value they are receiving from their encounter with us. If we achieve both of these, despite higher co-pays, they will return certainly for enough visits to achieve a solid outcome. Yes, there are on occaission the patient that has to choose “milk” or “drugs” versus PT but this is more the exception than the rule.
For a historical perspective on this whole “co-pay” notion, one has to appreciate the significance of the RAND Health Insurance Experiment (HIE). In the 70’s, RAND randomly assigned thousands of patients with varying degrees of health insurance co-pays and followed them for five years to try and determine their medical utilization health. The lessons, essentially now the gold standard in private insurance, demonstrate that utilization is altered by degree of co-pay (inversely) but that health outcome was not adversely effected by higher co-pay for the average person (differential effects exist for the sick and poor).
Recently, the HIE has come under some very interesting criticism from John Nyman from the University of Minnesota, that appeared in the Oct 2007 issue of the Journal of Health Politics which outlines some sharp criticism of the HIE and the fact that there were so many volunteer drop outs over the 5 year period (LBP surgery research-are you listening?).
So, back to the question: are higher co-pays impacting your practice? If so, are the drop outs voluntarily based on their amount of co-pay or the value they are getting out of their visit? Are the shorter visits per patient having an impact on the patient outcome? Thats a question that only you and your clinic can accurately answer as great variability exists across the country in amount of co-pays. Lastly, I believe that the unintended consequences of higher co-pays has further propelled one of the biggest misperceptions in our profession-that the role of outpatient PT is to provide a Home Exercise Program. A misperception that we have in fact fueled to a certain extent.
Thoughts and your experiences on any of this is helpful.
