Why do PTs feel like they're being forced to see patients at a loss?

Recently, 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.

Now, 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.

But 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, I break down the reasons why practices may consider contracting with a payer. The pros and cons of being "in-network" providers. And how to combat some of the downward pricing pressure in healthcare.

What we cover in this Episode:

-Understanding fee for service reimbursement models
-Why patients still get surprise bills because of the lack of transparency
-How clinicians come to the decision to sign contracts with payers
-The levers that payers have to control costs and profits
-Why value-based care can be difficult for smaller, independent practices
-How value-based care aligns with incentives
-Making the decision to stay in or leave a payer network
-Why we need to think more deeply about the value our treatments and services bring

Full episode note: https://rehabupracticesolutions.com/better-outcomes-152

Learn More: https://rehabupracticesolutions.com
Podcast: https://www.betteroutcomes.show
Get the Book: https://amzn.to/3M2UZ6x
Book a call with me: https://calendly.com/rehabu/discovery
Connect with Me: https://www.rafisalazar.com

If you'd like to learn more about Strata EMR & RCM and achieving a 99.99% reimbursement rate for your PT, OT, or SLP Clinic head over to stratapt.com and book a demo with their team!

Are there times when saying goodbye to team members is the right thing to do?

"I would be a bad boss if I told you to stay here. As much as we love having you on the team, you need to do what's best for you and your family." Over the last few months, I've found myself saying this a couple of different times to team members who were in a place where they felt that a change was necessary. Saying goodbye to team members can be hard. Either for personal reasons or professional reasons.

It's easy to become defensive, or take it personally when a team member approaches you about potentially leaving the team.

Was it something I did as a leader?

What am I doing wrong that they don't want to stay?

Of course, you can explore those questions if you're experiencing a great deal of turnover. But, typically, if it's you, those team members will just leave. There's no discussion; simply a notification: "This is officially my resignation notice". But, if you find yourself in a situation where a team member approaches you about potentially leaving, and you end up in a conversation about priorities, life goals, and continued fit, then I'd venture to say that you're doing just fine as a leader.

I remember approaching a boss several years ago and the conversation basically went like this: "I've been offered this position in an academic program, full benefits, retirement, the works. The problem is, I really love the team here and the work we're doing is meaningful." I'll never forget what my boss said to me: "Rafi, I'm not saying this because I want you gone, but you'd be foolish not to seriously consider the offer." We then had a real discussion about my life priorities, career goals, and how this team fit into that list. Now, I went on to stay with that team until our consulting project was over, but the lesson from that conversation has stuck with me since then. I'm still learning this and working on it myself, but I have come to believe that being a "good leader" is essentially the same as "being a good person". And that starts with looking out for the best interest of those on your team...even if that means that they end up leaving the team for other opportunities or roles. Not every boss I've ever had would have had that conversation with me. But, I'm forever grateful that I've been blessed to have learned from some great leaders over my career who modeled this style of people-first leadership...

I read in a book once that your clients won't remember you in 20 years, but the people who will remember you are the people you worked with, and especially the people you managed or led. If you want to have a real impact in your industry, perhaps a way to do that is by being a good leader to your team, and letting them spread their wings and hopefully they'll create positive waves wherever they end up.

What we cover in this Episode:

• Building a strong work culture that promotes conversations rather than notifications
• Challenges in recruiting and retaining healthcare team members
• How these conversations are different than letting a team member go due to performance issues
• Looking at saying goodbye to team members as a way to continue to build a strong work culture
• Leading in a human way
• A bit of my backstory and career history

Full episode note: https://rehabupracticesolutions.com/better-outcomes-151

Learn More: https://rehabupracticesolutions.com
Podcast: https://www.betteroutcomes.show
Get the Book: https://amzn.to/3M2UZ6x
Book a call with me: https://calendly.com/rehabu/discovery
Connect with Me: https://www.rafisalazar.com

If you'd like to learn more about Strata EMR & RCM and achieving a 99.99% reimbursement rate for your PT, OT, or SLP Clinic head over to stratapt.com and book a demo with their team!

Do people really understand their healthcare bill?

I talk about this all the time on the show, but healthcare is one of the only areas of the economy where the distribution of information is extremely one-sided. What do I mean? I mean that, for the most part, patients receiving care may have a general idea about how much their care will cost, but very few actually have a specific dollar figure upon which to base their decisions. On top of that, unless they are healthcare-trained professionals, they also lack a complete understanding of the treatment options, potential outcomes, and the like. The same holds true for their healthcare bill.

For the most part, people have a general idea of what they need to pay for healthcare services. The problems start to appear when insurance denies claims or treatments require preauthorizations or the like. The resulting bill often comes as a surprise, and can in many cases be rather large. In fact, surprise medical bills have become such a large issue, that the No Surprises Act of 2022 was enacted to try and counter the trend.

This week, I sit down with Frank Lobb, author of The Big Lie in my Healthcare Bill: Why I Don't Owe What My Insurer Fails to Pay". In this book, Frank tackles the topic of insurance denials leading to surprise medical bills.

What we cover in this Episode:

-Who actually pays in healthcare
-How healthcare bills result in true financial burden for patients across the country
-How Insurers structure contracts with providers
-The challenges that come from big healthcare & the push for efficiency
-The Value that Insurers State that they Bring to the Market
-Frank's story of Insurance Denials and Being Unable to Pay out of Pocket for Treatment
-How an Engineer Came to Write a Book About Healthcare Bills

Full episode note: https://rehabupracticesolutions.com/better-outcomes-150

Learn More: https://rehabupracticesolutions.com
Podcast: https://www.betteroutcomes.show
Get the Book: https://amzn.to/3M2UZ6x
Book a call with me: https://calendly.com/rehabu/discovery
Connect with Me: https://www.rafisalazar.com

If you'd like to learn more about Strata EMR & RCM and achieving a 99.99% reimbursement rate for your PT, OT, or SLP Clinic head over to stratapt.com and book a demo with their team!