{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"The Better Outcomes Show","title":"152: Are PTs Being Forced to See Patients at a Loss? ","html":"","width":"100%","height":180,"duration":1980,"description":"Why do PTs feel like they're being forced to see patients at a loss? \nRecently, I've seen a few articles and social media posts in the physical therapy world discussing the downward pricing pressure (declining reimbursement rates) even while some payers (UHC often is the target here) report profits in the billions of dollars per quarter. And, at first sight, you can totally appreciate where these clinicians and writers are coming from. I mean, why cut payments to providers when your organization is raking in record profits? As many clinicians and practice owners put it: they feel forced to see these patients at a loss because of the declining reimbursement rates.\nNow, the reason for declining rates may vary on paper, but it really comes down to two things: 1) incentives and 2) the reimbursement model for healthcare in the US. And both of those things are tied together. I dedicated a whole chapter in my book about the problems with a fee-for-service model in healthcare, but here are the basics: when clinicians get paid for their time (or the codes they bill), they're incentivized to bill as much as possible, in as little time as possible. Payers, on the other hand, only have two levers to pull to cut costs: 1) deny services altogether (or gait them with authorizations and the like) or 2) pay less for those services. That means that it's only natural that, under that environment, payers will place barriers to the service (preauthorizations, etc.) and reduce their fee schedule (the amount they pay clinicians for those services). And that's why PTs feel the squeeze, or the downward pricing pressure, affecting their practices.\nBut here's one thing that we rarely talk about when it comes to insurance and reimbursement rates: who's forcing us to see these patients at a loss? I mean, UHC isn't storming clinics and coercing them into signing provider contracts. The truth is that contracting is a choice, a choice that many clinics and practices are making. In this episode,...","thumbnail_url":"https://img.transistorcdn.com/TRw7TPxyAwWympKv0xhI25HiRrQGqPAeghmslhuz_bI/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9kODg3/MjI5OGRmYWI3MGFm/MTMwYjI2Mzk3Yjk1/ZDIyNC5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}