As a physical therapist, I work to help my patients move better and feel better. I help to improve range of motion (ROM), increase muscle strength, and improve functional mobility. I like to think I do a pretty good job at it, too.
Occasionally, the way that I get paid comes up in conversation with my patients. Most often, my patients receive something in the mail from their insurance company called and Explanation of Benefits (EOB). Usually it is a paper with lists of numbers and codes on it that kind of resembles the Rosetta Stone. It takes multiple degrees from some of the finest colleges and universities to figure the thing out. I try to break it down for my patients, but it usually ends up with me telling the patient, "This is what I get paid from your insurance company, and this is what is left over, which you owe me in the form of a copayment."
A lot of times my patients are surprised at how much they have to pay when compared to what their insurance company musy pay. "Is that all you get?" they usually ask.
To be honest, I do allright. I make enough money to have a house, a car, and I get to eat. Plus, my job is pretty rewarding, so it all works out.
Some insurance companies pay me a flat rate per patient. If I treat the patient, I make some money. But some insurance companies that pay me do so by time. If I see a patient for 30 minutes, I get some money. If I spend 45 minutes with my patient, I get more money. And if I spend 60 minutes with my patient, I get even more money.
I find this system extremely backwards. Here is why: I know a physical therapist (or two) who do things to their patients just to have the patient in the clinic for 60 minutes to maximize the payment, regardless of clinical need or outcomes. The system of time based physical therapy encourages some people to do more stuff to the patient just to make a few extra dollars.
Now don't get me wrong. Most doctors, physical therapists, nurses, and other healthcare practitioners are honest and ethical people. I'm just saying that the time based payment system may cause some physical therapists (or doctors, podiatrists, etc.) to head off track, just to make a little more money.
Here is how I see it: Shouldn't I make more money for getting my patients better, faster? Isn't there more value in a physical therapy session where the patient walks out the door in 30 minutes armed with the tools to manage their own problem than the patient who is in PT for 60 minutes? Isn't my expertise worth more than my time?