This is not my idea but it's worth repeating.
I first read about physical therapists being the 'gatekeeper' for high-volume, high-cost conditions like Lower Back Pain at MyPhysicalTherapySpace.com so I thought I'd use this blog to relay the message.
Let's see if it gets any traction.
You can help also.
Comment on this blog to improve its page rank or send your own ideas to Washington DC. President Obama is looking for a few good ideas here.
The Status Quo
This image is from Better Ways to Pay for Healthcare by the Network for Regional Healthcare Improvement and the Robert Wood Johnson Foundation.This image dichotomizes cost into performance risk and insurance risk.
Medical providers should only have to worry about performance risk.
'Fee for Service' is in yellow - this is the status quo and it is dominated by physicians - good luck getting any traction there.
A Better Way
The 'Episode of Care' is where I think physical therapists would be adept at saving money and improving outcomes.
Presently, the episode of care for all diagnoses is only loosely organized by family physicians and other 'gatekeepers'.
'John' (from MyPhysicalTherapySpace.com) recommends this:
"...President Obama should appoint physical therapists as the nation's designated 'babysitter' for patients with musculoskeletal conditions.The Episode of Care is therefore based entirely on the Medical Model - patients come to us primed with MRIs and X-rays that trumpet their pathology and deflate the restorative power of physical therapy.
In other words, our only role is to shield patients from the black hole of useless (and likely harmful) medical spend(ing)."
Physical therapists could intervene early, using the ICF/biopsychosocial model rather than the medical model.
I make the case for physical therapists manging the care of a lady who can't kneel down in the March 23rd PTD.
The Last Word
The third alternative payment model, Condition Specific Capitation would likely be managed by a large health system or hospital that looked at overall costs.
Can physical therapy show cost reductions for common, high-cost musculoskeletal conditions over an episode-of-care when PTs, instead of physicians, make the initial decisions for patient triage?
If so, then can we take responsibility for ALL the performance risk?