HEALTHCARE
I’ve been a physical therapist (PT) for over 30 years. I chose this profession to help people, like most health care providers. However, my education barely touched on business or economics—Economics 101 was about it. Most healthcare providers aren’t interested in business, which is part of why our healthcare system is in its current state. For years, healthcare providers have focused primarily on patient care while letting commercial insurance companies control decisions on care frequency, costs, and approval. Terms like "deductible," "co-pay," "co-insurance," "out-of-network," and "prior authorization" are now normal parts of our healthcare experience. To make matters worse, Medicare has continually cut benefits and reimbursement rates. Just last week, Congress allowed another 2.8% reduction in the 2025 Medicare fee schedule.
These obstacles negatively impact patients’ ability to receive the care they deserve:
• Administrative Burden: Practices and hospitals face increasing administrative demands, requiring more staff to comply with regulations and secure payment for services rendered.
• Accessibility: Health care providers are spending countless hours on documentation and approval requests, limiting their time with patients and contributing to burnout. As more providers leave the field, accessibility to care becomes more difficult, especially as our population ages and health declines.
• Affordability: High deductibles and co-pays make healthcare increasingly unaffordable. Many patients can't afford recommended treatments, which can lead to worsened health. A mild musculoskeletal issue could require surgery simply because a patient couldn't afford physical therapy.
What Can We Do?
The simplest answer: Be Part of the Solution. The more individuals contribute to change, the faster we can create solutions.
As highlighted in Dr. Madom’s January 23, 2025 blog, start by:
• Understanding your insurance coverage
• Collaborating with your healthcare provider
• Advocating for yourself if care is denied
I’d like to add to that. Recently, I became president of the American Physical Therapy Association of Rhode Island (APTA-RI). Last week, I attended two Rhode Island Senate committee meetings to discuss PT legislation on prior authorization and co-pay parity. Prior to that, I served as the Federal Advocacy Liaison for Rhode Island and attended "Hill Day" in Washington, D.C., where I met with Senators and Representatives to discuss current PT issues. I’m inspired by the support from many of our State and Federal representatives, who are aware of the issues and want to help. So, again, be part of the solution by adding these actions:
• For Providers: If a patient can’t get the care they need due to payer limitations, write to your local representative. Share outcomes and efficiency data to strengthen your case. Encourage your patients to write as well.
• For Patients: If your insurance denies recommended care, send a letter to both the insurance company and your representatives. Your stories help shape legislation that can bring change.
Make the Time
Be part of the solution for responsible, accessible, and affordable healthcare for all.
