Guest guest Posted February 7, 2012 Report Share Posted February 7, 2012 At  the risk of angering someone, my reply is STOP ADAPTING!! At this rate, we will adapt ourselves right out of the profession.  I admit that initially there was areas that needed to be scrutinized and cost contained, but at this point,  any more reductions, regulations, or arbitrary denials to the services we provide our patients either hurt them, us or both.  We keep hearing that we need to keep the cost of health care down, that it is out of control, and we keep hearing third party payors cry that any increases in payments to the providers will drive up the cost of insurance and make it even less affordable,  but despite decreasing reimbursements, higher co-pays, and less coverage, has anyone seen their insurance premiums decrease? Has any CEO of any insurer taken a pay cut, no raise or no bonus in the past 10 -15 years? I can think of a few different solutions to the problems which we face, and I'm pretty sure that I'm not that special, but as long as we have the status quo, and we keep allowing ourselves to be led to the slaughter, there is no incentive for anything to change. So, I will say it one more time, we need to stop adapting, and instead regain our footing and determine our own fate if this profession is to survive. It is not up to only the APTA, it is up to everyone of us out there to educate our friends, family, patients, co-workers, other professionals, legislators, and anyone else we come in contact with. But, most of all, we need to draw a line in the sand, and not compromise anymore. Ok, I'm done preaching... Bernice Small, PT Freehold, NJ From:duane blau To: PTManager Sent: Monday, February 6, 2012 8:41 PM Subject: Re: Future of OPPT  Todd, I went to a continuing ed course a couple of years back given by Arnie Cisneros, the president of Home Health Strategic Management. He pointed out some interesting facts that may be applicable to the OPPT industry. Every time that to government would increase restrictions on HH therapy and revenues, therapists would always fear that the profession would not survive. Perhaps no other segment has been more regulated and restricted more than the HH therapy industry. Each time these restrictions are enforced, therapists have learned to adapt and change the way they do business. Increasing efficiency and decreasing costs, and yes, decreasing the amount of care. But insurance and therapy companies can still show that they can still achieve good outcomes with less. We will have to adapt and make the necessary changes in how we practice. We should also increase our support of the APTA to continue to fight the good fight. Duane Mesa, AZ. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 7, 2012 Report Share Posted February 7, 2012 Bernice--I have been in private practise for now 25 years and yes, I agree to you: DO NOT ADAPT. In Calif, where our local gov reps are most corrupt, we have been fighting to get Direct Access and ban POPTS. So far we are in a loosing battle. Hopefully before I retire or stop working, I would like to see both issues won by PTs. We need to stay united if not, ins companies and MDs will make us non-existent! Hiten Dave' PT > At the risk of angering someone, my reply is STOP ADAPTING!! At this rate, > we will adapt ourselves right out of the profession. I admit that initially > there was areas that needed to be scrutinized and cost contained, but at > this point, any more reductions, regulations, or arbitrary denials to the > services we provide our patients either hurt them, us or both. We keep > hearing that we need to keep the cost of health care down, that it is out of > control, and we keep hearing third party payors cry that any increases in > payments to the providers will drive up the cost of insurance and make it > even less affordable, but despite decreasing reimbursements, higher > co-pays, and less coverage, has anyone seen their insurance premiums > decrease? Has any CEO of any insurer taken a pay cut, no raise or no bonus > in the past 10 -15 years? > > I can think of a few different solutions to the problems which we face, and > I'm pretty sure that I'm not that special, but as long as we have the status > quo, and we keep allowing ourselves to be led to the slaughter, there is no > incentive for anything to change. So, I will say it one more time, we need > to stop adapting, and instead regain our footing and determine our own fate > if this profession is to survive. > > It is not up to only the APTA, it is up to everyone of us out there to > educate our friends, family, patients, co-workers, other professionals, > legislators, and anyone else we come in contact with. But, most of all, we > need to draw a line in the sand, and not compromise anymore. > > Ok, I'm done preaching... > > Bernice Small, PT > Freehold, NJ > > > From:duane blau > To: PTManager > Sent: Monday, February 6, 2012 8:41 PM > Subject: Re: Future of OPPT > > > > Todd, > I went to a continuing ed course a couple of years back given by Arnie > Cisneros, the president of Home Health Strategic Management. He pointed out > some interesting facts that may be applicable to the OPPT industry. Every > time that to government would increase restrictions on HH therapy and > revenues, therapists would always fear that the profession would not > survive. Perhaps no other segment has been more regulated and restricted > more than the HH therapy industry. Each time these restrictions are > enforced, therapists have learned to adapt and change the way they do > business. Increasing efficiency and decreasing costs, and yes, decreasing > the amount of care. But insurance and therapy companies can still show that > they can still achieve good outcomes with less. > > We will have to adapt and make the necessary changes in how we practice. We > should also increase our support of the APTA to continue to fight the good > fight. > > Duane > Mesa, AZ. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 7, 2012 Report Share Posted February 7, 2012 Bernice--I have been in private practise for now 25 years and yes, I agree to you: DO NOT ADAPT. In Calif, where our local gov reps are most corrupt, we have been fighting to get Direct Access and ban POPTS. So far we are in a loosing battle. Hopefully before I retire or stop working, I would like to see both issues won by PTs. We need to stay united if not, ins companies and MDs will make us non-existent! Hiten Dave' PT > At the risk of angering someone, my reply is STOP ADAPTING!! At this rate, > we will adapt ourselves right out of the profession. I admit that initially > there was areas that needed to be scrutinized and cost contained, but at > this point, any more reductions, regulations, or arbitrary denials to the > services we provide our patients either hurt them, us or both. We keep > hearing that we need to keep the cost of health care down, that it is out of > control, and we keep hearing third party payors cry that any increases in > payments to the providers will drive up the cost of insurance and make it > even less affordable, but despite decreasing reimbursements, higher > co-pays, and less coverage, has anyone seen their insurance premiums > decrease? Has any CEO of any insurer taken a pay cut, no raise or no bonus > in the past 10 -15 years? > > I can think of a few different solutions to the problems which we face, and > I'm pretty sure that I'm not that special, but as long as we have the status > quo, and we keep allowing ourselves to be led to the slaughter, there is no > incentive for anything to change. So, I will say it one more time, we need > to stop adapting, and instead regain our footing and determine our own fate > if this profession is to survive. > > It is not up to only the APTA, it is up to everyone of us out there to > educate our friends, family, patients, co-workers, other professionals, > legislators, and anyone else we come in contact with. But, most of all, we > need to draw a line in the sand, and not compromise anymore. > > Ok, I'm done preaching... > > Bernice Small, PT > Freehold, NJ > > > From:duane blau > To: PTManager > Sent: Monday, February 6, 2012 8:41 PM > Subject: Re: Future of OPPT > > > > Todd, > I went to a continuing ed course a couple of years back given by Arnie > Cisneros, the president of Home Health Strategic Management. He pointed out > some interesting facts that may be applicable to the OPPT industry. Every > time that to government would increase restrictions on HH therapy and > revenues, therapists would always fear that the profession would not > survive. Perhaps no other segment has been more regulated and restricted > more than the HH therapy industry. Each time these restrictions are > enforced, therapists have learned to adapt and change the way they do > business. Increasing efficiency and decreasing costs, and yes, decreasing > the amount of care. But insurance and therapy companies can still show that > they can still achieve good outcomes with less. > > We will have to adapt and make the necessary changes in how we practice. We > should also increase our support of the APTA to continue to fight the good > fight. > > Duane > Mesa, AZ. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 7, 2012 Report Share Posted February 7, 2012 Bernice--I have been in private practise for now 25 years and yes, I agree to you: DO NOT ADAPT. In Calif, where our local gov reps are most corrupt, we have been fighting to get Direct Access and ban POPTS. So far we are in a loosing battle. Hopefully before I retire or stop working, I would like to see both issues won by PTs. We need to stay united if not, ins companies and MDs will make us non-existent! Hiten Dave' PT > At the risk of angering someone, my reply is STOP ADAPTING!! At this rate, > we will adapt ourselves right out of the profession. I admit that initially > there was areas that needed to be scrutinized and cost contained, but at > this point, any more reductions, regulations, or arbitrary denials to the > services we provide our patients either hurt them, us or both. We keep > hearing that we need to keep the cost of health care down, that it is out of > control, and we keep hearing third party payors cry that any increases in > payments to the providers will drive up the cost of insurance and make it > even less affordable, but despite decreasing reimbursements, higher > co-pays, and less coverage, has anyone seen their insurance premiums > decrease? Has any CEO of any insurer taken a pay cut, no raise or no bonus > in the past 10 -15 years? > > I can think of a few different solutions to the problems which we face, and > I'm pretty sure that I'm not that special, but as long as we have the status > quo, and we keep allowing ourselves to be led to the slaughter, there is no > incentive for anything to change. So, I will say it one more time, we need > to stop adapting, and instead regain our footing and determine our own fate > if this profession is to survive. > > It is not up to only the APTA, it is up to everyone of us out there to > educate our friends, family, patients, co-workers, other professionals, > legislators, and anyone else we come in contact with. But, most of all, we > need to draw a line in the sand, and not compromise anymore. > > Ok, I'm done preaching... > > Bernice Small, PT > Freehold, NJ > > > From:duane blau > To: PTManager > Sent: Monday, February 6, 2012 8:41 PM > Subject: Re: Future of OPPT > > > > Todd, > I went to a continuing ed course a couple of years back given by Arnie > Cisneros, the president of Home Health Strategic Management. He pointed out > some interesting facts that may be applicable to the OPPT industry. Every > time that to government would increase restrictions on HH therapy and > revenues, therapists would always fear that the profession would not > survive. Perhaps no other segment has been more regulated and restricted > more than the HH therapy industry. Each time these restrictions are > enforced, therapists have learned to adapt and change the way they do > business. Increasing efficiency and decreasing costs, and yes, decreasing > the amount of care. But insurance and therapy companies can still show that > they can still achieve good outcomes with less. > > We will have to adapt and make the necessary changes in how we practice. We > should also increase our support of the APTA to continue to fight the good > fight. > > Duane > Mesa, AZ. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 7, 2012 Report Share Posted February 7, 2012 Regarding this: " We keep hearing that we need to keep the cost of health care down, that it is out of control, and we keep hearing third party payors cry that any increases in payments to the providers will drive up the cost of insurance and make it even less affordable, but despite decreasing reimbursements, higher co-pays, and less coverage, has anyone seen their insurance premiums decrease? Has any CEO of any insurer taken a pay cut, no raise or no bonus in the past 10 -15 years? " Now I am no fan of meddling bureaucracies, nor of medical insurance (which is not by any reasonable definition " insurance " anyway, since we encourage its use for regular, ongoing expenses rather than for significant, catastrophic events---the equivalent of expecting one's fire insurance to pay for painting the house) nor of the practices that obfuscate the practical value of bureaucracy and insurance. But to lay this entire mess at the feet of rule-makers and payors is simply unhelpful. We mustn't forget that for decades medical care has been increasing in cost faster (really much faster) than the rate of inflation, and that utilization has been similarly increasing (on a per capita basis!). (Does anyone expect insurance rates to decrease under those conditions?) Current estimates suggest that medical care now consumes over 17% of GDP. If it continues to grow at its current rate it will certainly bankrupt us (just as effectively as will the crushing, private and government debt we seem unable to stop accumulating). Just this past Tuesday the CBO released an economic report predicting that the cost of government health care programs will more than double in the next 10 years. (Private programs are on the same trajectory.) Graph that particular hockey stick folks, and you will see why it is folly to expect that tomorrow will look anything like today, and why providers expecting to extract even more money out of this rapidly failing system are in for a very rude awakening. Who is at fault? There is plenty of blame to go around, and as usual, all the players (legislators, bureaucrats, payers, providers, and patients) are far more interested in pointing the finger than in introspection. To me, the " most fundamental " problem is that we are too sick---way too sick. Medical care has failed at keeping us healthy (and why should it, when we are paid to treat rather than prevent problems?) and your average Joe is apparently unable to discover solutions outside of the doctor's office. So on it goes. Believe what you want about the cause, the bare reality is that when the descending graph line of worsening health crosses the ascending graph line of medical care costs, we are essentially out of gas. Some have made a good argument that those lines crossed years ago, and the crash was merely delayed---by debt. Dave Milano, PT Rehabilitation Director Laurel Health System ________________________________ From: PTManager [mailto:PTManager ] On Behalf Of Bernice Small Sent: Tuesday, February 07, 2012 11:11 AM To: PTManager Subject: Re: Re: Future of OPPT At the risk of angering someone, my reply is STOP ADAPTING!! At this rate, we will adapt ourselves right out of the profession. I admit that initially there was areas that needed to be scrutinized and cost contained, but at this point, any more reductions, regulations, or arbitrary denials to the services we provide our patients either hurt them, us or both. We keep hearing that we need to keep the cost of health care down, that it is out of control, and we keep hearing third party payors cry that any increases in payments to the providers will drive up the cost of insurance and make it even less affordable, but despite decreasing reimbursements, higher co-pays, and less coverage, has anyone seen their insurance premiums decrease? Has any CEO of any insurer taken a pay cut, no raise or no bonus in the past 10 -15 years? I can think of a few different solutions to the problems which we face, and I'm pretty sure that I'm not that special, but as long as we have the status quo, and we keep allowing ourselves to be led to the slaughter, there is no incentive for anything to change. So, I will say it one more time, we need to stop adapting, and instead regain our footing and determine our own fate if this profession is to survive. It is not up to only the APTA, it is up to everyone of us out there to educate our friends, family, patients, co-workers, other professionals, legislators, and anyone else we come in contact with. But, most of all, we need to draw a line in the sand, and not compromise anymore. Ok, I'm done preaching... Bernice Small, PT Freehold, NJ From:duane blau <duaneblau@...<mailto:duaneblau%40yahoo.com>> To: PTManager <mailto:PTManager%40yahoogroups.com> Sent: Monday, February 6, 2012 8:41 PM Subject: Re: Future of OPPT Todd, I went to a continuing ed course a couple of years back given by Arnie Cisneros, the president of Home Health Strategic Management. He pointed out some interesting facts that may be applicable to the OPPT industry. Every time that to government would increase restrictions on HH therapy and revenues, therapists would always fear that the profession would not survive. Perhaps no other segment has been more regulated and restricted more than the HH therapy industry. Each time these restrictions are enforced, therapists have learned to adapt and change the way they do business. Increasing efficiency and decreasing costs, and yes, decreasing the amount of care. But insurance and therapy companies can still show that they can still achieve good outcomes with less. We will have to adapt and make the necessary changes in how we practice. We should also increase our support of the APTA to continue to fight the good fight. Duane Mesa, AZ. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 7, 2012 Report Share Posted February 7, 2012 Regarding this: " We keep hearing that we need to keep the cost of health care down, that it is out of control, and we keep hearing third party payors cry that any increases in payments to the providers will drive up the cost of insurance and make it even less affordable, but despite decreasing reimbursements, higher co-pays, and less coverage, has anyone seen their insurance premiums decrease? Has any CEO of any insurer taken a pay cut, no raise or no bonus in the past 10 -15 years? " Now I am no fan of meddling bureaucracies, nor of medical insurance (which is not by any reasonable definition " insurance " anyway, since we encourage its use for regular, ongoing expenses rather than for significant, catastrophic events---the equivalent of expecting one's fire insurance to pay for painting the house) nor of the practices that obfuscate the practical value of bureaucracy and insurance. But to lay this entire mess at the feet of rule-makers and payors is simply unhelpful. We mustn't forget that for decades medical care has been increasing in cost faster (really much faster) than the rate of inflation, and that utilization has been similarly increasing (on a per capita basis!). (Does anyone expect insurance rates to decrease under those conditions?) Current estimates suggest that medical care now consumes over 17% of GDP. If it continues to grow at its current rate it will certainly bankrupt us (just as effectively as will the crushing, private and government debt we seem unable to stop accumulating). Just this past Tuesday the CBO released an economic report predicting that the cost of government health care programs will more than double in the next 10 years. (Private programs are on the same trajectory.) Graph that particular hockey stick folks, and you will see why it is folly to expect that tomorrow will look anything like today, and why providers expecting to extract even more money out of this rapidly failing system are in for a very rude awakening. Who is at fault? There is plenty of blame to go around, and as usual, all the players (legislators, bureaucrats, payers, providers, and patients) are far more interested in pointing the finger than in introspection. To me, the " most fundamental " problem is that we are too sick---way too sick. Medical care has failed at keeping us healthy (and why should it, when we are paid to treat rather than prevent problems?) and your average Joe is apparently unable to discover solutions outside of the doctor's office. So on it goes. Believe what you want about the cause, the bare reality is that when the descending graph line of worsening health crosses the ascending graph line of medical care costs, we are essentially out of gas. Some have made a good argument that those lines crossed years ago, and the crash was merely delayed---by debt. Dave Milano, PT Rehabilitation Director Laurel Health System ________________________________ From: PTManager [mailto:PTManager ] On Behalf Of Bernice Small Sent: Tuesday, February 07, 2012 11:11 AM To: PTManager Subject: Re: Re: Future of OPPT At the risk of angering someone, my reply is STOP ADAPTING!! At this rate, we will adapt ourselves right out of the profession. I admit that initially there was areas that needed to be scrutinized and cost contained, but at this point, any more reductions, regulations, or arbitrary denials to the services we provide our patients either hurt them, us or both. We keep hearing that we need to keep the cost of health care down, that it is out of control, and we keep hearing third party payors cry that any increases in payments to the providers will drive up the cost of insurance and make it even less affordable, but despite decreasing reimbursements, higher co-pays, and less coverage, has anyone seen their insurance premiums decrease? Has any CEO of any insurer taken a pay cut, no raise or no bonus in the past 10 -15 years? I can think of a few different solutions to the problems which we face, and I'm pretty sure that I'm not that special, but as long as we have the status quo, and we keep allowing ourselves to be led to the slaughter, there is no incentive for anything to change. So, I will say it one more time, we need to stop adapting, and instead regain our footing and determine our own fate if this profession is to survive. It is not up to only the APTA, it is up to everyone of us out there to educate our friends, family, patients, co-workers, other professionals, legislators, and anyone else we come in contact with. But, most of all, we need to draw a line in the sand, and not compromise anymore. Ok, I'm done preaching... Bernice Small, PT Freehold, NJ From:duane blau <duaneblau@...<mailto:duaneblau%40yahoo.com>> To: PTManager <mailto:PTManager%40yahoogroups.com> Sent: Monday, February 6, 2012 8:41 PM Subject: Re: Future of OPPT Todd, I went to a continuing ed course a couple of years back given by Arnie Cisneros, the president of Home Health Strategic Management. He pointed out some interesting facts that may be applicable to the OPPT industry. Every time that to government would increase restrictions on HH therapy and revenues, therapists would always fear that the profession would not survive. Perhaps no other segment has been more regulated and restricted more than the HH therapy industry. Each time these restrictions are enforced, therapists have learned to adapt and change the way they do business. Increasing efficiency and decreasing costs, and yes, decreasing the amount of care. But insurance and therapy companies can still show that they can still achieve good outcomes with less. We will have to adapt and make the necessary changes in how we practice. We should also increase our support of the APTA to continue to fight the good fight. Duane Mesa, AZ. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 8, 2012 Report Share Posted February 8, 2012 Dear Group, The math is simple. The cycle is coming. Actuaries explain to us that a deleveraging financial economy of debt deflation can only lead to a Japanese-style deflation spiral. Economists agree that deflation is much more painful to swallow than inflation. The developed nations (the West and Europe) are in a serious downward debt spiral...currently led by Europe. In this increasingly globalized world, the developing eastern nations led by China are flush with tremendous labor capacity (over a billion ready and able to make gadgets for you straight from China, a country 4x the size of USA). This will put HUGE downward pressure on US and European wage income. Falling wages for developed economies coupled with rising wages for developing econimies. This is in the NOW and the FUTURE. Debt/Deflation Downward Spiral: Retirees and Pensions will be exhausting SS/ Medicare and Govt Pension Funds ----> massive taxes on the working class----> less discretionary income----> falling asset prices----> falling wage income----> decreased tax receipts----> More Gov't Borrowing ----> UNKNOWN CLIFF European Central Banks and the US Federal Reserve are resisting this deleveraging/deflation using opposite rules of economics. Europe is implementing Austerity to curb the debt spiral while the USA is implementingan opposite method called " quantitative easing " or printing money by giving it to banks at 0%. It is expected that banks will lend to you and me and make a 3-5% profit margin over 0%. Japan tried the later for 20 years and it did nothing to stop prices and wages falling for over 2 decades. THE DEMAND FOR DEBT IS TOO LOW. Who is going to buy that baby-boomer's 5500 sqft. home on Long Island when they are empty nestors left with 25k in yearly real-estate taxes? Your 30 year college-debt paying son making 65k per year? How will this effect Physical Therapy? I think it's much easier to just make Pizza and still earn over 200k a year in cash income. Meli Bayside, NY Re: Future of OPPT Todd, I went to a continuing ed course a couple of years back given by Arnie Cisneros, the president of Home Health Strategic Management. He pointed out some interesting facts that may be applicable to the OPPT industry. Every time that to government would increase restrictions on HH therapy and revenues, therapists would always fear that the profession would not survive. Perhaps no other segment has been more regulated and restricted more than the HH therapy industry. Each time these restrictions are enforced, therapists have learned to adapt and change the way they do business. Increasing efficiency and decreasing costs, and yes, decreasing the amount of care. But insurance and therapy companies can still show that they can still achieve good outcomes with less. We will have to adapt and make the necessary changes in how we practice. We should also increase our support of the APTA to continue to fight the good fight. Duane Mesa, AZ. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 8, 2012 Report Share Posted February 8, 2012 Dear Group, The math is simple. The cycle is coming. Actuaries explain to us that a deleveraging financial economy of debt deflation can only lead to a Japanese-style deflation spiral. Economists agree that deflation is much more painful to swallow than inflation. The developed nations (the West and Europe) are in a serious downward debt spiral...currently led by Europe. In this increasingly globalized world, the developing eastern nations led by China are flush with tremendous labor capacity (over a billion ready and able to make gadgets for you straight from China, a country 4x the size of USA). This will put HUGE downward pressure on US and European wage income. Falling wages for developed economies coupled with rising wages for developing econimies. This is in the NOW and the FUTURE. Debt/Deflation Downward Spiral: Retirees and Pensions will be exhausting SS/ Medicare and Govt Pension Funds ----> massive taxes on the working class----> less discretionary income----> falling asset prices----> falling wage income----> decreased tax receipts----> More Gov't Borrowing ----> UNKNOWN CLIFF European Central Banks and the US Federal Reserve are resisting this deleveraging/deflation using opposite rules of economics. Europe is implementing Austerity to curb the debt spiral while the USA is implementingan opposite method called " quantitative easing " or printing money by giving it to banks at 0%. It is expected that banks will lend to you and me and make a 3-5% profit margin over 0%. Japan tried the later for 20 years and it did nothing to stop prices and wages falling for over 2 decades. THE DEMAND FOR DEBT IS TOO LOW. Who is going to buy that baby-boomer's 5500 sqft. home on Long Island when they are empty nestors left with 25k in yearly real-estate taxes? Your 30 year college-debt paying son making 65k per year? How will this effect Physical Therapy? I think it's much easier to just make Pizza and still earn over 200k a year in cash income. Meli Bayside, NY Re: Future of OPPT Todd, I went to a continuing ed course a couple of years back given by Arnie Cisneros, the president of Home Health Strategic Management. He pointed out some interesting facts that may be applicable to the OPPT industry. Every time that to government would increase restrictions on HH therapy and revenues, therapists would always fear that the profession would not survive. Perhaps no other segment has been more regulated and restricted more than the HH therapy industry. Each time these restrictions are enforced, therapists have learned to adapt and change the way they do business. Increasing efficiency and decreasing costs, and yes, decreasing the amount of care. But insurance and therapy companies can still show that they can still achieve good outcomes with less. We will have to adapt and make the necessary changes in how we practice. We should also increase our support of the APTA to continue to fight the good fight. Duane Mesa, AZ. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2012 Report Share Posted February 9, 2012 Joe, I think we live in the USA, the land where you can sell ice to an Eskimo. Seriously, it's all about marketing, networking and a combination of creating a demand for your product and some deceit. Take Starbucks Coffee. Their coffee is horrible. Rated as the worst coffee by many surveys, consumer reporting and the like. How do they pull it off? It's not about the coffee. It's about the experience! Their target market is the yuppie 18-29 and 53-60 age group.....the ones most willing to overspend! Paying more makes one feel better combined with the atmosphere of SS appliances and kitchen sounds of metallic spoons and fancy grinders in the background. It all comes together to make a brand that works today as it has for the past 8-10 years. Will it work in 15 years? I dont think so. (DD makes better coffee at a better price point). Blockbuster video was great 20 years ago but dead today. Why? They didn't evolve and Netflix did. In the end, the world is becoming increasingly more transparent due to Internet & social media. All industries (factory farms, financial engineering, healthcare, etc..) are becoming exposed for what they truly are. Take Wall Street and the financial industry: The largest shake-up is taking place in financial engineering. Transparency is KILLING wall street and people's trust in financial products is at an all time low. So how is wall street evolving? High Frequency Trading putting pensions and retirees in a casino blender creating more risk of an even larger financial crisis in the future (sorry about going off on tangent here). In the end, I think PT mills will die out and boutique practices that give the costumer that " experience " will prevail. Americans will pay for an experience but expecting insurance to pay for it?.....don't hold your breath. As Mr Milano explained, " expecting one's fire insurance to pay for painting the house " . Meli Bayside, NY Isn't Clint Eastwood the man? America returning to the 50's-style exporter! I think we're closer to being Heartbreak Ridge. Re: Future of OPPT > > Todd, > I went to a continuing ed course a couple of years back given by Arnie Cisneros, the president of Home Health Strategic Management. He pointed out some interesting facts that may be applicable to the OPPT industry. Every time that to government would increase restrictions on HH therapy and revenues, therapists would always fear that the profession would not survive. Perhaps no other segment has been more regulated and restricted more than the HH therapy industry. Each time these restrictions are enforced, therapists have learned to adapt and change the way they do business. Increasing efficiency and decreasing costs, and yes, decreasing the amount of care. But insurance and therapy companies can still show that they can still achieve good outcomes with less. > > We will have to adapt and make the necessary changes in how we practice. We should also increase our support of the APTA to continue to fight the good fight. > > Duane > Mesa, AZ. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2012 Report Share Posted February 9, 2012 Joe, I think we live in the USA, the land where you can sell ice to an Eskimo. Seriously, it's all about marketing, networking and a combination of creating a demand for your product and some deceit. Take Starbucks Coffee. Their coffee is horrible. Rated as the worst coffee by many surveys, consumer reporting and the like. How do they pull it off? It's not about the coffee. It's about the experience! Their target market is the yuppie 18-29 and 53-60 age group.....the ones most willing to overspend! Paying more makes one feel better combined with the atmosphere of SS appliances and kitchen sounds of metallic spoons and fancy grinders in the background. It all comes together to make a brand that works today as it has for the past 8-10 years. Will it work in 15 years? I dont think so. (DD makes better coffee at a better price point). Blockbuster video was great 20 years ago but dead today. Why? They didn't evolve and Netflix did. In the end, the world is becoming increasingly more transparent due to Internet & social media. All industries (factory farms, financial engineering, healthcare, etc..) are becoming exposed for what they truly are. Take Wall Street and the financial industry: The largest shake-up is taking place in financial engineering. Transparency is KILLING wall street and people's trust in financial products is at an all time low. So how is wall street evolving? High Frequency Trading putting pensions and retirees in a casino blender creating more risk of an even larger financial crisis in the future (sorry about going off on tangent here). In the end, I think PT mills will die out and boutique practices that give the costumer that " experience " will prevail. Americans will pay for an experience but expecting insurance to pay for it?.....don't hold your breath. As Mr Milano explained, " expecting one's fire insurance to pay for painting the house " . Meli Bayside, NY Isn't Clint Eastwood the man? America returning to the 50's-style exporter! I think we're closer to being Heartbreak Ridge. Re: Future of OPPT > > Todd, > I went to a continuing ed course a couple of years back given by Arnie Cisneros, the president of Home Health Strategic Management. He pointed out some interesting facts that may be applicable to the OPPT industry. Every time that to government would increase restrictions on HH therapy and revenues, therapists would always fear that the profession would not survive. Perhaps no other segment has been more regulated and restricted more than the HH therapy industry. Each time these restrictions are enforced, therapists have learned to adapt and change the way they do business. Increasing efficiency and decreasing costs, and yes, decreasing the amount of care. But insurance and therapy companies can still show that they can still achieve good outcomes with less. > > We will have to adapt and make the necessary changes in how we practice. We should also increase our support of the APTA to continue to fight the good fight. > > Duane > Mesa, AZ. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2012 Report Share Posted February 9, 2012 Hi everyone, I know a lot of folks are at CSM and this may not be heard by all but I have to speak out. I am tired of the doom and gloom AND I am tired a discussion that hasn't once focused on the patient. At its root healthcare is and always will be about caring for people. Ask me if things are harder than 10 years ago and I would say firmly NO. I have more tools from equipment to outcomes tools and more research evidence than ever before to guide what I do and allow me options for care that are successful and repeatable. Patients/clients are receiving care that, even when limited by insurance, is still way better than I ever could have imagined 24 year ago when I started PT school. In addition, I have opportunities outside of traditional PT care to establish a business model with from fitness to wellness to women's health. 25 years ago a majority of PT practices survived only by contracting with home health or SNF's because the reimbursement was much worse than it was today. What is harder is to use physical therapy purely as a business to get wealthy but you know what - that's not what this profession is all about. I am about profit as much as any American business person and agree that we have too many regulations but at the same time my motivation is not profit but treating patients. Every day I am thankful for the opportunity to make a difference in people's lives. Yes, maybe our profession will become a profession that we cannot make a huge profit any more but does that diminish it or what we do day in and day out as healthcare professionals? I don't think so and I would bet many other colleagues would agree. Ask yourself if you would still be in the profession if you could only earn what teachers make in your area. Would you still be in the profession? I know plenty of PT's that would because patient care and making a difference in people's lives is the most important thing to them as it is to me. I am sorry to vent but this discussion thread was balanced in one direction and I could not let it go on without speaking up for those of us with a quite different view of our profession. M.Howell, P.T., M.P.T. IPTA Payment Specialist Meridian, Idaho thowell@... This email and any files transmitted with it may contain PRIVILEGED or CONFIDENTIAL information and may be read or used only by the intended recipient. If you are not the intended recipient of the email or any of its attachments, please be advised that you have received this email in error and that any use, dissemination, distribution, forwarding, printing or copying of this email or any attached files is strictly prohibited. If you have received this email in error, please immediately purge it and all attachments and notify the sender by reply email. From: PTManager [mailto:PTManager ] On Behalf Of Joe Sent: Thursday, February 09, 2012 10:57 AM To: PTManager Subject: Re: Future of OPPT , Just as I was begining to feel a little better about the country following the Clint Eastwood Superbowl commercial. Guess I should go back to my previous plan of stocking up on bullets and food. Seriously though regarding our profesion, I believe each generation of PT's would say that things are harder now than they were 10 years ago and that they will continue to get harder. I think this is unlikely to change. Joe Ruzich, PT > > > > > Dear Group, > > The math is simple. The cycle is coming. Actuaries explain to us that a deleveraging financial economy of debt deflation can only lead to a Japanese-style deflation spiral. Economists agree that deflation is much more painful to swallow than inflation. The developed nations (the West and Europe) are in a serious downward debt spiral...currently led by Europe. In this increasingly globalized world, the developing eastern nations led by China are flush with tremendous labor capacity (over a billion ready and able to make gadgets for you straight from China, a country 4x the size of USA). This will put HUGE downward pressure on US and European wage income. Falling wages for developed economies coupled with rising wages for developing econimies. This is in the NOW and the FUTURE. > > Debt/Deflation Downward Spiral: > > Retirees and Pensions will be exhausting SS/ Medicare and Govt Pension Funds ----> massive taxes on the working class----> less discretionary income----> falling asset prices----> falling wage income----> decreased tax receipts----> More Gov't Borrowing ----> UNKNOWN CLIFF > > > European Central Banks and the US Federal Reserve are resisting this deleveraging/deflation using opposite rules of economics. > > Europe is implementing Austerity to curb the debt spiral while the USA is implementingan opposite method called " quantitative easing " or printing money by giving it to banks at 0%. It is expected that banks will lend to you and me and make a 3-5% profit margin over 0%. > Japan tried the later for 20 years and it did nothing to stop prices and wages falling for over 2 decades. THE DEMAND FOR DEBT IS TOO LOW. > Who is going to buy that baby-boomer's 5500 sqft. home on Long Island when they are empty nestors left with 25k in yearly real-estate taxes? Your 30 year college-debt paying son making 65k per year? > > How will this effect Physical Therapy? I think it's much easier to just make Pizza and still earn over 200k a year in cash income. > > Meli > Bayside, NY > > > > > Re: Future of OPPT > > Todd, > I went to a continuing ed course a couple of years back given by Arnie Cisneros, the president of Home Health Strategic Management. He pointed out some interesting facts that may be applicable to the OPPT industry. Every time that to government would increase restrictions on HH therapy and revenues, therapists would always fear that the profession would not survive. Perhaps no other segment has been more regulated and restricted more than the HH therapy industry. Each time these restrictions are enforced, therapists have learned to adapt and change the way they do business. Increasing efficiency and decreasing costs, and yes, decreasing the amount of care. But insurance and therapy companies can still show that they can still achieve good outcomes with less. > > We will have to adapt and make the necessary changes in how we practice. We should also increase our support of the APTA to continue to fight the good fight. > > Duane > Mesa, AZ. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2012 Report Share Posted February 9, 2012 Oh and I forgot to add to the original poster of this thread that by all means go into outpatient PT. There are still plenty of clinics and PT's making boatloads of cash out there while few, despite all the gloom and doom, are going out of business. Are there challenges? Absolutely but no more than in many other professions. The cold reality is that plumbers and other trades with their own business do make more money than we do so consider at root why you are doing what you're doing and if you still want to open an outpatient PT, use all the resources available and recommended in this thread to start off on the right foot. If you go into it with little personal debt, have a good billing person or a very reputable agency, open up in an area of need and with good referral sources, maintain the highest standard of care and supplement your business with other options like fitness, wellness etc then it is highly likely that you will have a successful and profitable practice. To maintain it, learn the business of business - the same things apply- good organization and accounting, good marketing, learn how to compete, be innovative and have courage and you will do fine! M.Howell, P.T., M.P.T. IPTA Payment Specialist Meridian, Idaho thowell@... This email and any files transmitted with it may contain PRIVILEGED or CONFIDENTIAL information and may be read or used only by the intended recipient. If you are not the intended recipient of the email or any of its attachments, please be advised that you have received this email in error and that any use, dissemination, distribution, forwarding, printing or copying of this email or any attached files is strictly prohibited. If you have received this email in error, please immediately purge it and all attachments and notify the sender by reply email. From: PTManager [mailto:PTManager ] On Behalf Of Joe Sent: Thursday, February 09, 2012 10:57 AM To: PTManager Subject: Re: Future of OPPT , Just as I was begining to feel a little better about the country following the Clint Eastwood Superbowl commercial. Guess I should go back to my previous plan of stocking up on bullets and food. Seriously though regarding our profesion, I believe each generation of PT's would say that things are harder now than they were 10 years ago and that they will continue to get harder. I think this is unlikely to change. Joe Ruzich, PT > > > > > Dear Group, > > The math is simple. The cycle is coming. Actuaries explain to us that a deleveraging financial economy of debt deflation can only lead to a Japanese-style deflation spiral. Economists agree that deflation is much more painful to swallow than inflation. The developed nations (the West and Europe) are in a serious downward debt spiral...currently led by Europe. In this increasingly globalized world, the developing eastern nations led by China are flush with tremendous labor capacity (over a billion ready and able to make gadgets for you straight from China, a country 4x the size of USA). This will put HUGE downward pressure on US and European wage income. Falling wages for developed economies coupled with rising wages for developing econimies. This is in the NOW and the FUTURE. > > Debt/Deflation Downward Spiral: > > Retirees and Pensions will be exhausting SS/ Medicare and Govt Pension Funds ----> massive taxes on the working class----> less discretionary income----> falling asset prices----> falling wage income----> decreased tax receipts----> More Gov't Borrowing ----> UNKNOWN CLIFF > > > European Central Banks and the US Federal Reserve are resisting this deleveraging/deflation using opposite rules of economics. > > Europe is implementing Austerity to curb the debt spiral while the USA is implementingan opposite method called " quantitative easing " or printing money by giving it to banks at 0%. It is expected that banks will lend to you and me and make a 3-5% profit margin over 0%. > Japan tried the later for 20 years and it did nothing to stop prices and wages falling for over 2 decades. THE DEMAND FOR DEBT IS TOO LOW. > Who is going to buy that baby-boomer's 5500 sqft. home on Long Island when they are empty nestors left with 25k in yearly real-estate taxes? Your 30 year college-debt paying son making 65k per year? > > How will this effect Physical Therapy? I think it's much easier to just make Pizza and still earn over 200k a year in cash income. > > Meli > Bayside, NY > > > > > Re: Future of OPPT > > Todd, > I went to a continuing ed course a couple of years back given by Arnie Cisneros, the president of Home Health Strategic Management. He pointed out some interesting facts that may be applicable to the OPPT industry. Every time that to government would increase restrictions on HH therapy and revenues, therapists would always fear that the profession would not survive. Perhaps no other segment has been more regulated and restricted more than the HH therapy industry. Each time these restrictions are enforced, therapists have learned to adapt and change the way they do business. Increasing efficiency and decreasing costs, and yes, decreasing the amount of care. But insurance and therapy companies can still show that they can still achieve good outcomes with less. > > We will have to adapt and make the necessary changes in how we practice. We should also increase our support of the APTA to continue to fight the good fight. > > Duane > Mesa, AZ. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 10, 2012 Report Share Posted February 10, 2012 Doom and gloom? Naaah! Discussing bare facts is neither happy nor sad, it just is. Similarly, maintaining a patient focus is contingent not on external, but internal factors. It's about what you do with the realities you are handed. You can shift your focus anywhere you want---on making money, on helping your brethren, or if you're really clever, on both. Certainly predictions that the status quo is unsustainable will be difficult to swallow if you like what you've got right now. But ignoring realities is never a winning strategy, and rarely produces happy endings. If we can reasonably assume that tomorrow is not going to look like today, what good does it do your patients, your neighbors, and your family if you behave as if there is no change in the wind? Personally, I think there's a ripping good chance that we will not have as much money (or stuff) in the future, but who ever said money and stuff are prerequisite to love? Dave Milano, PT Rehabilitation Director Laurel Health System ________________________________ From: PTManager [mailto:PTManager ] On Behalf Of M. Howell PT, MPT Sent: Thursday, February 09, 2012 7:25 PM To: PTManager Subject: RE: Re: Future of OPPT Hi everyone, I know a lot of folks are at CSM and this may not be heard by all but I have to speak out. I am tired of the doom and gloom AND I am tired a discussion that hasn't once focused on the patient. At its root healthcare is and always will be about caring for people. Ask me if things are harder than 10 years ago and I would say firmly NO. I have more tools from equipment to outcomes tools and more research evidence than ever before to guide what I do and allow me options for care that are successful and repeatable. Patients/clients are receiving care that, even when limited by insurance, is still way better than I ever could have imagined 24 year ago when I started PT school. In addition, I have opportunities outside of traditional PT care to establish a business model with from fitness to wellness to women's health. 25 years ago a majority of PT practices survived only by contracting with home health or SNF's because the reimbursement was much worse than it was today. What is harder is to use physical therapy purely as a business to get wealthy but you know what - that's not what this profession is all about. I am about profit as much as any American business person and agree that we have too many regulations but at the same time my motivation is not profit but treating patients. Every day I am thankful for the opportunity to make a difference in people's lives. Yes, maybe our profession will become a profession that we cannot make a huge profit any more but does that diminish it or what we do day in and day out as healthcare professionals? I don't think so and I would bet many other colleagues would agree. Ask yourself if you would still be in the profession if you could only earn what teachers make in your area. Would you still be in the profession? I know plenty of PT's that would because patient care and making a difference in people's lives is the most important thing to them as it is to me. I am sorry to vent but this discussion thread was balanced in one direction and I could not let it go on without speaking up for those of us with a quite different view of our profession. M.Howell, P.T., M.P.T. IPTA Payment Specialist Meridian, Idaho <mailto:thowell@...<mailto:thowell%40fiberpipe.net>> thowell@...<mailto:thowell%40fiberpipe.net> This email and any files transmitted with it may contain PRIVILEGED or CONFIDENTIAL information and may be read or used only by the intended recipient. If you are not the intended recipient of the email or any of its attachments, please be advised that you have received this email in error and that any use, dissemination, distribution, forwarding, printing or copying of this email or any attached files is strictly prohibited. If you have received this email in error, please immediately purge it and all attachments and notify the sender by reply email. From: PTManager <mailto:PTManager%40yahoogroups.com> [mailto:PTManager <mailto:PTManager%40yahoogroups.com>] On Behalf Of Joe Sent: Thursday, February 09, 2012 10:57 AM To: PTManager <mailto:PTManager%40yahoogroups.com> Subject: Re: Future of OPPT , Just as I was begining to feel a little better about the country following the Clint Eastwood Superbowl commercial. Guess I should go back to my previous plan of stocking up on bullets and food. Seriously though regarding our profesion, I believe each generation of PT's would say that things are harder now than they were 10 years ago and that they will continue to get harder. I think this is unlikely to change. Joe Ruzich, PT > > > > > Dear Group, > > The math is simple. The cycle is coming. Actuaries explain to us that a deleveraging financial economy of debt deflation can only lead to a Japanese-style deflation spiral. Economists agree that deflation is much more painful to swallow than inflation. The developed nations (the West and Europe) are in a serious downward debt spiral...currently led by Europe. In this increasingly globalized world, the developing eastern nations led by China are flush with tremendous labor capacity (over a billion ready and able to make gadgets for you straight from China, a country 4x the size of USA). This will put HUGE downward pressure on US and European wage income. Falling wages for developed economies coupled with rising wages for developing econimies. This is in the NOW and the FUTURE. > > Debt/Deflation Downward Spiral: > > Retirees and Pensions will be exhausting SS/ Medicare and Govt Pension Funds ----> massive taxes on the working class----> less discretionary income----> falling asset prices----> falling wage income----> decreased tax receipts----> More Gov't Borrowing ----> UNKNOWN CLIFF > > > European Central Banks and the US Federal Reserve are resisting this deleveraging/deflation using opposite rules of economics. > > Europe is implementing Austerity to curb the debt spiral while the USA is implementingan opposite method called " quantitative easing " or printing money by giving it to banks at 0%. It is expected that banks will lend to you and me and make a 3-5% profit margin over 0%. > Japan tried the later for 20 years and it did nothing to stop prices and wages falling for over 2 decades. THE DEMAND FOR DEBT IS TOO LOW. > Who is going to buy that baby-boomer's 5500 sqft. home on Long Island when they are empty nestors left with 25k in yearly real-estate taxes? Your 30 year college-debt paying son making 65k per year? > > How will this effect Physical Therapy? I think it's much easier to just make Pizza and still earn over 200k a year in cash income. > > Meli > Bayside, NY > > > > > Re: Future of OPPT > > Todd, > I went to a continuing ed course a couple of years back given by Arnie Cisneros, the president of Home Health Strategic Management. He pointed out some interesting facts that may be applicable to the OPPT industry. Every time that to government would increase restrictions on HH therapy and revenues, therapists would always fear that the profession would not survive. Perhaps no other segment has been more regulated and restricted more than the HH therapy industry. Each time these restrictions are enforced, therapists have learned to adapt and change the way they do business. Increasing efficiency and decreasing costs, and yes, decreasing the amount of care. But insurance and therapy companies can still show that they can still achieve good outcomes with less. > > We will have to adapt and make the necessary changes in how we practice. We should also increase our support of the APTA to continue to fight the good fight. > > Duane > Mesa, AZ. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 10, 2012 Report Share Posted February 10, 2012 Hi everyone, I know a lot of folks are at CSM and this may not be heard by all but I have to speak out. I am tired of the doom and gloom AND I am tired a discussion that hasn't once focused on the patient. Tom, If you remember, the original question was about the future of OPPT and helping someone with making a decision as to whether or not he should open a clinic of his own. The probable reason the discussion didn't focus on the patient because that wasn't the question. I think we're all professionals here and with professionals, it should be a given that the patient is held in the highest regard so there's no need to assume any sort of moral high ground. At its root healthcare is and always will be about caring for people. Ask me if things are harder than 10 years ago and I would say firmly NO. I would disagree with the latter statement based on the simple realities of mathematics and economics. See my brief discussion at the end. I have more tools from equipment to outcomes tools and more research evidence than ever before to guide what I do and allow me options for care that are successful and repeatable. Patients/clients are receiving care that, even when limited by insurance, is still way better than I ever could have imagined 24 year ago when I started PT school. Again, the question wasn't about clinical care. One should hope and expect that the quality of clinical care improves over time just as virtually every other field of endeavor for the betterment of the human race has been improving over time. One could also effectively argue that improvement in quality of care has probably come about more from clinical creativity and innovation than from any particular piece of equipment, outcome tool, or even research. The clinical skills that have improved our ability to help patients as compared to 35 years ago when I started PT school have come about more from innovative individuals and their creativity with regards to new treatment concepts and methodologies rather than from any particular piece or group of prospective research. In addition, I have opportunities outside of traditional PT care to establish a business model with from fitness to wellness to women's health. Those opportunities have always existed. The first place I worked 33 years ago was one of the first joint ventures in the country between a fitness center, PTs, other medical professionals, and a college with significant overlap and interdependence of services. 25 years ago a majority of PT practices survived only by contracting with home health or SNF's because the reimbursement was much worse than it was today. This statement is unequivocally incorrect. Having experience both on the East Coast and West Coast as well as travelling around much of the country teaching, I can assure you, from first hand experience, that the majority of PT practices were NOT involved with home health or SNFs. Also, reimbursement was definitely NOT worse than today when measured in real, not nominal, dollar terms. Based on starting salaries in 1979 vs. starting salaries in 2012 and the average reimbusement per session, today's therapist has to treat almost TWICE as many patients to make the same income in real dollar terms. What is harder is to use physical therapy purely as a business to get wealthy but you know what - that's not what this profession is all about. The truth being told, very few PTs get wealthy. The Pat Croces are few and far between. But PTs would like to enjoy an income commensurate with their education, expertise, and effort and that goal is becoming increasingly challenging to achieve. I am about profit as much as any American business person and agree that we have too many regulations but at the same time my motivation is not profit but treating patients. Every day I am thankful for the opportunity to make a difference in people's lives. Here's where I agree with you. We are blessed to be in such a profession. Yes, maybe our profession will become a profession that we cannot make a huge profit any more but does that diminish it or what we do day in and day out as healthcare professionals? Of course not and no one said it did. I don't think so and I would bet many other colleagues would agree. Ask yourself if you would still be in the profession if you could only earn what teachers make in your area. Would you still be in the profession? I know plenty of PT's that would because patient care and making a difference in people's lives is the most important thing to them as it is to me. Here's where I agree with Bernice Small. At what point do you say, " Enough is enough. " Just how low are you willing to see reimbursement go? While an idealistic, Mother Theresa-like dedication to the profession is wonderful to aspire to from a theoretical standpoint, if you can't put food on the table and fuel in your tank, pay your mortgage, send your kids to college, and provide for a reasonable retirement and Meli's theoretical pizza parlor can, I wonder if making a difference in people's lives would be more important to you than providing for your family. I am sorry to vent but this discussion thread was balanced in one direction and I could not let it go on without speaking up for those of us with a quite different view of our profession. I often wish I could return to a viewpoint such as yours and unlearn what I learned. But while the truth is painful, it's undeniable and once you've taken the red pill, there's no going back. Like it or not, my naivete of yesterday is gone forever. Here's the math and economics of the situation. It's not doom and gloom. It's reality, notwithstanding the massive pre-election MOPE (Management of Perspective Economics) propaganda campaign that is trying to convince Americans that the economy is coming back, when in fact, it is doing the opposite. http://www.jsmineset.com/2012/02/08/dollar-and-america-on-the-road-to-ruin/ The US and Europe are in a downward economic decline in which standards of living will fall ... at best. The reasons are manifold but the reading the classic tome, Tragedy & Hope, written by Bill Clinton's mentor, Carroll Quigley, will give you some insight. Here's a brief glance: http://www.youtube.com/watch?v=H_CemfucArU It is all part of a " level the playing field " doctrine and this country (and you and I as middle class citizens) are in the process of being " leveled " (like an atomic bomb leveled Hiroshima, only in very slow motion). PT, being a middle class profession, is being " leveled " as well, not due to any specific targeting but simply as a result of being swept along in the events of this economic tsunami. As a consequence, it will become progressively more difficult to earn a living wage from it. But because of our normalcy biases and because the principle of gradualism is being used to cause the baseline to shift in a time frame that is generally beneath our level of awareness, many folks such as yourself just don't seem to see it (like you didn't see the drop in reimbusement levels in real dollar terms). That's the macro picture. I could spend literally days laying out the details but others such as Martenson, Damon Vrabel, and Duane have done it before me. The micro picture is something that I've described before on this board. PT reimbursement is steadily being whittled away. PT market share is also being whittled away by everyone from massage therapists to personal trainers to ATCs to alternative practitioners to . what have you. Schools are producing new PTs faster than old PT s are dying off or retiring, meaning the share of the pie for each PT is shrinking in this regard as well. Educational costs for PTs are steadily climbing, faster in fact than almost any other expense out there and faster than most measures of inflation. The fixed costs of running a practice are steadily climbing as well. In aggregate, these factors dictate that PT s will be working more and more for less and less and having to pay more and more for the privilege of doing so. The end result is unsustainable in the long term, given the present course of events. That being said, IF the PT considering entering private practice understands the multiple and growing risks involved and still wants to take the leap anyway and has the head, heart, and hands to demonstrate caring, compassionate, and competent (HIGHLY competent) care, I say, " Go for it " . Just don't think it'll be a cakewalk. , PT, OCS Marquette, MI Re: Future of OPPT > > Todd, > I went to a continuing ed course a couple of years back given by Arnie Cisneros, the president of Home Health Strategic Management. He pointed out some interesting facts that may be applicable to the OPPT industry. Every time that to government would increase restrictions on HH therapy and revenues, therapists would always fear that the profession would not survive. Perhaps no other segment has been more regulated and restricted more than the HH therapy industry. Each time these restrictions are enforced, therapists have learned to adapt and change the way they do business. Increasing efficiency and decreasing costs, and yes, decreasing the amount of care. But insurance and therapy companies can still show that they can still achieve good outcomes with less. > > We will have to adapt and make the necessary changes in how we practice. We should also increase our support of the APTA to continue to fight the good fight. > > Duane > Mesa, AZ. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2012 Report Share Posted February 11, 2012 Tim, Medical care is anything but a market-based industry. Free markets do indeed flow as you describe (with pricing as the language of invitation and response, AKA supply and demand), but healthcare pricing (and utilization patterning and even the very definition of healthcare) is buttoned up tighter than a corset by a host of seriously powerful non-market forces like laws variously requiring or prohibiting specific care patterns, third-party payors and their rules, government regulators, coding systems, licensing and certification requirements, and yes, providers bellying up to the third-party feed trough. All stand between the customer and his personal wishes, making healthcare not a free market at all, but a completely manipulated market. To presume a pattern of customer demand or to make service value assessments based on transactions in this tightly controlled system is self-deceiving and/or symptomatic of a very narrow viewpoint. Perhaps the only true market sign in healthcare today suggests that actual demand for traditional medical care is far less than this manipulated market has caused to be purchased. Why else would Americans be spending tens of billions of out-of-pocket dollars every year for alternative healthcare after they have already paid billions in mandated payments (insurance premiums, taxes for government programs, co-pays, and deductibles) for allopathic care? The big question for all those who claim to be truly patient focused ought to be, " How many of us would be in business if the care we provide were all paid for privately? " Dave Milano, PT Rehabilitation Director Laurel Health System ________________________________________ From: PTManager [PTManager ] On Behalf Of Tim [timrichpt@...] Sent: Saturday, February 11, 2012 3:51 PM To: PTManager Subject: Re: Future of OPPT I really enjoyed this thread but I'd like you all to widen your gaze a bit for this next post... The beauty of a market-based industry is that there should be answers to problems for each set of consumers: price-insensitive consumers are willing to pay higher prices for extended 1-on-1 attention, pampering, " trendy " treatments like lasers or kinesiotaping, etc. This could be describing the boutique PT practice. More price sensitive consumers will not accept the out-of-pocket cost and are willing to accept dovetailed appointment slots, " group " PT treatments, intermittent bouts of 1-on-1 and supervised thermal modalities, etc. Think WalMart vs. Neiman Marcus. Neither is " bad " . Nor, is either reflective of the " value " of the merchandise. An $8 WalMart wristwatch that costs $50 at Neiman Marcus is NOT a good value to me. We shouldn't disparage our brother and sister physical therapists who bust their butt every day trying to treat 15-20 patients under Fee-for-Service as " low quality " if their patients are happy and getting better. Neither should we assume that the boutique therapist in Island, Florida who is able to charge $75 cash money per 1-on-1 session is necessarily " high quality " if her patients aren't happy and getting better. Going forward, the high-volume PT practices (the " mills " described above) will NOT DECREASE. They will increase. High productivity is the future. The future is already here - its just not evenly distributed. But, the boutique PT practice will ALSO increase. In response to the consumers' demand. There are still a few unnecessary federal regulatory barriers to unfettered access to the boutique PT practice but I'm confident that their future is bright, too. Tim , PT www.PhysicalTherapyDiagnosis.com > > , > > I dont care for Starbucks coffee much either, I do however appreciate their marketing genius and wish that I had picked up some stock in the early days. Yes high frequency trading makes it harder for the small guy, however it is still quite possible to make money in the market, I have been and I'm no Warren Buffett. I think the same will appy to PT. I agree that things will be moving toward " boutique " practices and the mills will die. I never felt they should be around anyway. This would be a good thing for patient care, which as pointed out is really the most improtant issue. > > , > Thanks for the positive sentiments. > > Joe Ruzich, PT > Peublo, CO > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2012 Report Share Posted February 12, 2012 This thread regarding our future is interesting. We in America are experiencing a leveling of lifestyle and standard of living as our average incomes drop. We as a country have enjoyed an obese lifestyle for decades; this is no longer sustainable as third world countries assimilate our previously held production capacity. Our wealth distribution has been increasingly concentrated in a small percentage of the population as corporations placed profit over employees and CEO incomes soared. Most people are tight for money but some can afford cash treatment. Healthcare became widely available and folks expected good care with little out of pocket expense. Providers milked the system with services neither necessary nor ethical, enjoying high incomes (a business model still being practiced by large corporate owned practices and POPs in particular). Now as the proverbial stool hits the fan and we have the ability to analyze efficacy of treatments two things are happening. We are getting less income per patient visit / copays have escalated and Medicare / insurance companies are looking at research relative to the way healthcare is being practiced. This is resulting in the end of the fee for service model. Thus the implementation of ICD 10 codes, ACOs, and other modes of reimbursement. We as a profession are moving forward with research that establishes PT as musculoskeletal experts with the ability to decrease costs through " early access " . An important position for us to assume as these changes unfold is one of advocacy: in our community and at the state / national levels. Being a contributing member of our APTA and its sections is imperative. Our ongoing research is fantastic, what do the chiros have to back them up? People want to know what they are getting for their healthcare dollars and as the boomers age they are picky about who treats them. The fact that many physician groups are supplementing their income (as much as 25%) through POPS damages our profession for a number of reasons however it helps to protect our reimbursement since they have a stronger lobbying force than we do. This is a wonderful profession; I did not make it into PT school the first time around. After designing and building furniture for 14 years I was ready to knuckle down and make my dream of being a PT happen. Now I have my own practice and could not be more satisfied. I started the practice for less than $70K, bought used equipment, and worked per diem until patient volume increased. I have used marketing skills developed from years of doing craft shows to sell my services. Working very hard, long hours, for maybe half the income I now enjoy allows me to chuckle when I hear a gloom and doom outlook. People need our services, THE BUSINESS IS OUT THERE! We have to work harder to establish ourselves: as the ones to go to / the PT place that is enjoyable / the ones that are always learning / the clinic where they know my name and who I am. Maybe some PTs need to try some other way of making a living or visit a third world country to appreciate what we have and should learn to " LIVE LEAN " . Kai Pedersen PT South Mountain Physical Therapy Wernersville, PA Our services as PTs are more efficacious and in demand than ever and our income per patient visit is dropping. _____ From: PTManager [mailto:PTManager ] On Behalf Of Tim Sent: Saturday, February 11, 2012 3:51 PM To: PTManager Subject: Re: Future of OPPT I really enjoyed this thread but I'd like you all to widen your gaze a bit for this next post... The beauty of a market-based industry is that there should be answers to problems for each set of consumers: price-insensitive consumers are willing to pay higher prices for extended 1-on-1 attention, pampering, " trendy " treatments like lasers or kinesiotaping, etc. This could be describing the boutique PT practice. More price sensitive consumers will not accept the out-of-pocket cost and are willing to accept dovetailed appointment slots, " group " PT treatments, intermittent bouts of 1-on-1 and supervised thermal modalities, etc. Think WalMart vs. Neiman Marcus. Neither is " bad " . Nor, is either reflective of the " value " of the merchandise. An $8 WalMart wristwatch that costs $50 at Neiman Marcus is NOT a good value to me. We shouldn't disparage our brother and sister physical therapists who bust their butt every day trying to treat 15-20 patients under Fee-for-Service as " low quality " if their patients are happy and getting better. Neither should we assume that the boutique therapist in Island, Florida who is able to charge $75 cash money per 1-on-1 session is necessarily " high quality " if her patients aren't happy and getting better. Going forward, the high-volume PT practices (the " mills " described above) will NOT DECREASE. They will increase. High productivity is the future. The future is already here - its just not evenly distributed. But, the boutique PT practice will ALSO increase. In response to the consumers' demand. There are still a few unnecessary federal regulatory barriers to unfettered access to the boutique PT practice but I'm confident that their future is bright, too. Tim , PT www.PhysicalTherapyDiagnosis.com > > , > > I dont care for Starbucks coffee much either, I do however appreciate their marketing genius and wish that I had picked up some stock in the early days. Yes high frequency trading makes it harder for the small guy, however it is still quite possible to make money in the market, I have been and I'm no Warren Buffett. I think the same will appy to PT. I agree that things will be moving toward " boutique " practices and the mills will die. I never felt they should be around anyway. This would be a good thing for patient care, which as pointed out is really the most improtant issue. > > , > Thanks for the positive sentiments. > > Joe Ruzich, PT > Peublo, CO > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 15, 2012 Report Share Posted February 15, 2012 " This is a wonderful profession; I did not make it into PT school the first time around. After designing and building furniture for 14 years I was ready to knuckle down and make my dream of being a PT happen. Now I have my own practice and could not be more satisfied. I started the practice for less than $70K, bought used equipment, and worked per diem until patient volume increased. I have used marketing skills developed from years of doing craft shows to sell my services. Working very hard, long hours, for maybe half the income I now enjoy allows me to chuckle when I hear a gloom and doom outlook. People need our services, THE BUSINESS IS OUT THERE! We have to work harder to establish ourselves: as the ones to go to / the PT place that is enjoyable / the ones that are always learning / the clinic where they know my name and who I am. Maybe some PTs need to try some other way of making a living or visit a third world country to appreciate what we have and should learn to " LIVE LEAN " . " Kai, Glad to hear of your success and your fulfillment of your life's dream. Indeed, being the best that we can be and having our patients benefit from that is part of what this profession is all about. I can identify with your statements since I too, started my first practice (and my present one) on a shoestring (of far less than 70K). As I like to say, it is the head (knowledge and reasoning ability), heart (compassionate and caring attitude), and hands (clinical skills) that make our services desirable, effective, and valuable, not our facility or our equipment. I've remained as busy as I want to be throughout my career because of paying attention to those things and I hope to remain so in the future. However, I'm also a realist and recognize that you, me, or anyone else is only one small, vulnerable step away from a drastically altered situation. All it takes is one hospital/corporate healthcare system, one major insurer (like BCBS), one government entity (or law or executive order), or one combination of the above (which we are increasingly seeing develop) to institute exclusive care contracts or some other exclusionary situation to shut us out of the system and life would immediately become much more challenging. While you could contest such actions legally either as an individual or as a group, in this game and in this society, increasingly the deepest and most connected pockets win. Notice the virtually complete absence of any prosecution related to the Great Financial Crisis by the SEC, CFTC, or other regulatory agencies. During the savings and loan debacle of the 1980s, we had at least a thousand FBI agents investigating and aggressively prosecuting the situation. The latest count by Black is that we have a small fraction of that number of FBI agents investigating our present GFC which is orders of magnitude greater in size ... and they're largely twiddling their thumbs since even those cases brought forward have been stonewalled by Holder, for various political reasons. Obviously then, the question you have to ask yourself is, could you survive on an exclusively cash pay basis? On a broader level, changes are occurring in 2012 which will probably accelerate post-presidential election through approximately 2015 that are unprecedented historically, on both a national and a global scale. But for having the reserve currency of the world as well as the world's most powerful military to enforce our will, we would be Greece. And we may yet become Greece ... after the other European dominoes fall. Whether deflation or inflation will come is not yet certain. Deflation would crush everything in its path so the Fed seems to be opting for inflation. In a hyperinflationary scenario, which we are increasingly heading towards if Obama's 3.8 trillion dollar proposed budget is any indication, food and energy expenses will consume a progressively larger proportion of our disposable income ... 70-90% in fact, if past history is any indication. Ask yourself how much people will be willing to spend on PT in such a scenario. Ask yourself how essential physical therapy services were considered to be in Weimar Germany, in Argentina, in Zimbabwe, etc? Or in the Great Depression? Then ask yourself if you think you'd still be chuckling. Living lean will not be a choice as it is now. It will be thrust upon us, unrelentingly. Right now, we are one of the few countries where the poor people are obese. That obesity epidemic may be solved in short order. This is the potential scenario I keep in mind when planning for the future. Only the resilient, nimble, and well prepared will rise to meet the challenge. The rest will be devastated. You never know ... those furniture making skills may come in handy again.;-) , PT, OCS Re: Future of OPPT I really enjoyed this thread but I'd like you all to widen your gaze a bit for this next post... The beauty of a market-based industry is that there should be answers to problems for each set of consumers: price-insensitive consumers are willing to pay higher prices for extended 1-on-1 attention, pampering, " trendy " treatments like lasers or kinesiotaping, etc. This could be describing the boutique PT practice. More price sensitive consumers will not accept the out-of-pocket cost and are willing to accept dovetailed appointment slots, " group " PT treatments, intermittent bouts of 1-on-1 and supervised thermal modalities, etc. Think WalMart vs. Neiman Marcus. Neither is " bad " . Nor, is either reflective of the " value " of the merchandise. An $8 WalMart wristwatch that costs $50 at Neiman Marcus is NOT a good value to me. We shouldn't disparage our brother and sister physical therapists who bust their butt every day trying to treat 15-20 patients under Fee-for-Service as " low quality " if their patients are happy and getting better. Neither should we assume that the boutique therapist in Island, Florida who is able to charge $75 cash money per 1-on-1 session is necessarily " high quality " if her patients aren't happy and getting better. Going forward, the high-volume PT practices (the " mills " described above) will NOT DECREASE. They will increase. High productivity is the future. The future is already here - its just not evenly distributed. But, the boutique PT practice will ALSO increase. In response to the consumers' demand. There are still a few unnecessary federal regulatory barriers to unfettered access to the boutique PT practice but I'm confident that their future is bright, too. Tim , PT www.PhysicalTherapyDiagnosis.com > > , > > I dont care for Starbucks coffee much either, I do however appreciate their marketing genius and wish that I had picked up some stock in the early days. Yes high frequency trading makes it harder for the small guy, however it is still quite possible to make money in the market, I have been and I'm no Warren Buffett. I think the same will appy to PT. I agree that things will be moving toward " boutique " practices and the mills will die. I never felt they should be around anyway. This would be a good thing for patient care, which as pointed out is really the most improtant issue. > > , > Thanks for the positive sentiments. > > Joe Ruzich, PT > Peublo, CO > > Quote Link to comment Share on other sites More sharing options...
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