I Don't Want Value-Based Reimbursement in Physical Therapy Yet: One PT’S Perspective

In an ideal world, professionals would be paid based on the measurable value of the services they provide. The issue, as we all know, is that healthcare reimbursement is far from an ideal world.

Over the last decade, the phrase “fee-for-service” went from the way most healthcare providers were paid to a phrase inherently tied with the term “overutilization”. Fee-for-service is quickly becoming a curse word; the bane of our existence, a main reason healthcare is broken.

And for good reason: overutilization was, and still is, a huge driver of unnecessary healthcare costs. And, out of the immense frustration with the inefficiencies of care, value-based reimbursement (VBR) was born (or reincarnated, depending on your viewpoint). You see, VBR is going to save us all from the fiery wrath of overutilization, and make us all better clinicians.

But, as lawmakers & lobbyists worked to flesh out the details of VBR, we as rehabilitation professionals felt the sting of neglect once again: we weren’t included as providers that will switch to VBR. Upsetting, indeed.

Upon deep reflection, and after many conversations with people ‘in-the-know’ when it comes to healthcare, I’ve realized something: not being included in initial VBR plans is, very likely, a good thing for our profession.

Wait. Before you rush to judgment, hear me out.

Payors (and providers in many instances) pushed for VBR because healthcare costs were out of control. But where were costs out of control? In settings such as hospitals, where a length of stay costs five to six figures. Even more importantly, hospitals had no incentive to keep patients from coming back in the door a week later. The much needed shift toward VBR in these settings will not only quell overutilization, but it will align the incentives of the patient, the provider, and the payor.

So, the shift to VBR was to decrease overutilization of services, and decrease healthcare costs. So should we feel slighted to not be included in these reforms? Not so fast. Being left on a fee-for-service schedule is a tip-of-the-cap to rehabilitation. It’s the payors saying:

“Yes, healthcare costs are out of control. But, the overutilization and ballooning costs aren’t coming from modalities such as physical therapy. In fact, let’s try to decrease utilization of higher cost modalities, and increase utilization of cost-efficient & effective conservative care.”

We aren’t operating under VBR in physical therapy. And, until all of the inevitable issues are ironed out, I say good!

One huge point I’d like to clarify: just because we aren’t being reimbursed based on outcomes doesn’t mean we shouldn’t be striving for improved efficiency and quality of care. Rather, we should take this opportunity to further validate our profession and continue to prove our efficacy.

In essence, injury rehabilitation is not the problem in healthcare. Rather, it is one of the solutions. We have the ability to provide efficacious treatment at a relatively low cost, which is what VBR is striving to achieve across the healthcare spectrum. Rather than feeling like we’re being left behind in reimbursement reform, we should be welcoming the push for more conservative care with open arms.

Ryan Klepps



Physical Therapist, Membership Chair of APTA of MA, COO & Co-Founder of Strive Labs, Inc.

Somerville, MA http://strivehub.com