I’ve read a number of diaries here from the perspective of the insured (or uninsured), and most of these stories are pretty compelling and persuasive in pushing for single payer or a public option. But I’d like to share with you the perspective of a provider and why I think a public option would benefit us. I’m a physical therapist currently working in an outpatient orthopedic clinic. The other therapist owns the clinic, and I am a salaried employee. I say this to give full disclosure to the fact that what I will say is only what I am told by the owner and cannot be verified by me. However, I have no reason to doubt his truthfulness.
Our clinic is small, but does fairly well in a competitive market for a relatively small-sized town in Kansas (popn ~ 100,000). As most of you are aware, most insurance plans have changed for the worse, i.e. higher deductibles, higher copays, higher premiums, and less coverage overall. I’m sure some of you may also be aware that reimbursement rates for us providers have also declined as well. You know this because the bill you receive in the mail by us is higher for the same services you would have received in the past. Well those reimbursement rates have obviously negatively affected our business as well. Not only are we receiving less from insurance companies, but it becomes more difficult for our patients to justify the price of therapy needed to get them back to full function.
We are seeing more of our local businesses (like our public schools) going towards insurance companies that only provide a flat-rate of reimbursement regardless of the patient's diagnosis and type of treatment that would be most effective. Companies like United Healthcare, Cigna, and Humana give us a flat-rate reimbursement of around $45-50 per visit, even though therapy may necessitate 2-3x that per visit (in accordance to the charges of CPT codes). Of course we can choose not to accept these insurance plans and be more selective on who we choose to accept, but considering more of our local businesses are moving towards these plans, this would likely be detrimental for our private business.
The best insurance for reimbursement was BCBS of Kansas. However, a very close second was good ol’ Medicare. In fact, out of all the insurance companies that we accept, with the exception of BCBS, Medicare beats them all in reimbursement.
What is also interesting to note is that the owner did show me a spreadsheet comparing productivity between 2008 and 2007. We were nearly 2x busier in 2008, yet when we compared the net income for the business we only made approximately $4,000 more than 2007. And this is despite the overhead costs and salaries being negligible (actually slightly higher in 2008).
So we can continue onward with the current insurance trends, working twice as hard as each year passes in order to break even or make a pittance of a profit (if I work 2x as hard next year than I am this year, I’m going to need some Physical Therapy on my own body!), or the system can change and offer something better to private outpatient businesses like ours. I’m sure there would be a number of pitfalls in a public option plan, and I don’t kid myself that it will be smooth sailing the entire way through it. But if it’s even just mostly similar to the current Medicare rate of reimbursement, well that’s a huge potential for me to treat and help more patients as well as watch our business continue to thrive.