Cost & The Healthcare Consumer - Part 3
Walmart Vs The Forum Shops
"You get what you pay for." It's a phrase most of us have heard at some point in time.
But what does that phrase mean to you? When you hear or say it, what exactly are you meaning and assuming?
In my mind, there are a few assumptions made by this statement:
"You get what you pay for" -- it isn't 100% true, certainly outliers do exist, but I would say that a majority of the time, this is fairly accurate. After all isn't that what Walmart is all about, offering goods at the lowest possible cost so that they can sell in high volume to make their profit. Compare that model to the high end boutique shops within the Forum Shops at Caesar's Palace. Those of you who live here in Las Vegas, or who have visited and taken the walk through The Forum Shops know what I am talking about. These are very high end, boutique stores that have low inventory and are high priced. This means that they don't have to sell in high volume to make their profit. And think about perception -- certainly many walk through and scoff at the $200+ for a single shirt, but most people connect theses shops as being of high quality and high stature simply due the pricing. It's an interesting paradox of sorts.
The same comparison could be made in car shopping, as buying a Porsche or Ferrari is much different than buying a Ford or a Fiat.
So what's the point?
People generally have preconceived notions of what quality is which impacts their perception of value. Healthcare is no different. There is lots of talk in the physical therapy world about quality measures, about what physical therapists actually do, and what the profession should & should not be focusing on. It is a vast array opinions that generally fails to take into account a few key points:
It is often hard to compare one physical therapist to another, as you are not always comparing apples to apples based on experience, continuing education pursuits, and specialization of the physical therapist in question. To use the Walmart & Forum Shops example, there are many large physical therapy practices here in town. Some are local, others are national chains. The business model is generally the same, use a physical therapist with the help of an assistant and one or more 'Techs' and see a high volume of patients. The numbers generally amount to the PTA seeing thier own case load of 2-3 patients per hour, while the PT sees 3-4 per hour, and the 'Techs' help with set up & break down of modalities (heat, E-stim, US) and supervise the exercise portion of the treatment. The PT does whatever assessment or manual therapies are necessary, and usually amounts to seeing each patient for about 10-15 minutes. This is the Walmart approach to PT.
It's no wonder patients often put little value on physical therapy services when they are delivered in a way that makes the individual one of 4-6 in the same hour, they only see the actual PT 10-15 minutes each visit (hopefully), and they are often finding themselves unsupervised and are simply being told what exercise to do next in the rotation.
Athletes Physiotherapy was founded on the idea that a more individualized approach to treatment can yield improved outcomes and faster turn around, often requiring fewer visits. Why? Because in a model were the patient is seen one-on-one by a physical therapist for an hour or half-hour each visit, we can continually asses & progress, we can differentiate site of pain versus source of pain, we can utilize interventions that make change quickly, and we can educate the patient effectively, and empower them to continue the progression even when not in clinic. This also uses a coaching model, where the therapist is guiding and correcting as necessary to help the patient achieve the desired result, but also internalize the movements being performed to improve their overall body awareness. This model is extremely well suited for athletes & dancers, and is more of a boutique approach to physical therapy. This is The Forum Shops.
As such, there is generally a higher cost of services in the model Athletes Physiotherapy utilizes...or is there? In choosing the way of The Forum Shops, there is a resulting increased cost to maintain a lower volume. The cost of services is not generally higher than that of the Walmart shops, it is just paid up front and received in full. The Walmart PT experience relies on high volume because they are not paid what they charge, the are paid what their insurance contract stipulates. If they sign a contract that pays $70 per visit, and the patient's co-pay is $40, then the insurance company pays them $30. Many of these companies agree to low paying contracts because they make up the difference in....high volume.
But is the cost to the patient really greater? In many cases, it is not. In the current climate of insurance changes and rising deductibles and co-pays, many patients are having to pay out of pocket for much of their treatment. The often have to meet a yearly deductible, pay a per visit co-pay, and pay a percentage of each session (co-insurance, which depending on the plan could vary from 20% to upwards of 50%). There are a few different misconceptions related physical therapy which I've mentioned in earlier posts. We will revisit them here and give an explanation of how the value of physical therapy is clearly not seen or there is just a misconception or assumption that has been made:
As always, food for thought. Agree or Disagree, leave your comments below!
Athletes Physiotherapy - Las Vegas, NV
Thank you for stopping by the Athletes Physiotherapy Blog! Kristopher Bosch founded Athletes Physiotherapy in Las Vegas, NV. He is a Father, physical therapist, athletic trainer, pilates teacher, & perpetual student!
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