Evidence-Based Practice Proposal – Final Paper

5GeriNotes, Vol. 20, No. 2 2013

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When it comes right down to it, we are in a service industry. I had the opportunity recently to spend some time as a clinical mentor to a sales and

marketing group who work to increase referrals to rehabilitation professionals through physician outreach. We talked about why physicians should refer to physical therapy (PT), and about what PT has to offer older adults with some of the most common impairments and chronic conditions. However, I think maybe I got the most out of the meet- ing, because it jolted my neurons out of their usual pathways and got me think- ing about something new. I have spent a lot of time thinking about regulatory affairs lately, with all of the impending Medicare changes: the therapy cap, the Manual Medical Review process, the looming Multiple Procedure Payment Reduction. Clearly the reimbursement system for those of us treating older adults is going to continue to pose chal- lenges to providing clinically excellent care. And these proposed reductions and restrictions are coming into effect in the midst of a major change in who the “older adult” is. The boomers who are becoming Medicare eligible every day are vastly different than the older adults that most of us have treated thus far in our careers in geriatric therapy. These new older adults are super active, and they are going to need therapy for reasons that would make a Medicare auditor’s stomach turn. Imagine trying to find the medical necessity in the abil- ity to walk 18 holes or run a marathon. Anyway, I am going somewhere with all of this. It got me thinking about the likelihood that all of us will need to be- come better sales people ourselves, if we want to continue making a living doing what we love. We will need to convince

insurers that our services impact cost in a positive way (even cut costs through proactive health care) and are worth reimbursing, and convince our patients that what we have to offer is worth writing a check when the insurance company won’t.

I recently read an interview with Lois Vitt, PhD, Founding Director of the Institute for Socio-Financial Studies, who explained that most people fall into one of 4 categories in relation to what they find valuable: Personal-values peo- ple, social-values people, physical-values people, and financial-values people. By looking at what makes each type tick, maybe we can find some insight into how to promote the services we offer:

The personal-values person is the type who is happiest spending on self… the type with custom golf clubs or a closet full of shoes. I think the pitch here is pretty easy. The health and wellness we can deliver is unmatched. Heck, a great exercise prescription can keep you out of the hospital or get you into your skinny jeans! I know patients who started PT after an illness or injury and continued to pay privately long after insurance ben- efits were exhausted, because they loved the way they felt and looked after regular sessions with their physical therapist.

The social-values person is most likely to buy for others. This could ap- ply to our services in a couple of ways. First, when discussing paying for ser- vices with an older adult, we may face resistance, because they want to spend on their children and grandchildren, not themselves. However, what we do can absolutely benefit their families and their savings. Living as independently as possible, for as long as possible means avoiding the costs of hospitalization and institutionalization. It also means the ability to be actively involved with family and friends. We may also market to the social-values inclination of older adults’ families or powers of attorney who may be involved in their health care decisions. The strength, vitality, and in-

creased safety that can result from effec- tive PT intervention are certainly things worth buying for a loved one.

To explain our value to physical-value folks, we can emphasize the way healthy activity engages the senses. Whether it’s hiking, running, swimming, or even cre- ating something pleasing to the senses, like a beautiful garden or a renovated room, we can help ensure that the ability to achieve enjoyment of these experienc- es. My own father recently underwent elective knee surgery and PT to prolong his ability to trail run, an activity that is invaluable to him.

Finally, there are those driven by fi- nancial values, who relish saving, invest- ing, and getting good deals. We might lump insurers into this category, along with many individual spenders. Here we need to demonstrate the pure value of what we do. We need to devote time and energy to further studies demon- strating that effective PT keeps people at home, out of doctors’ offices, hospitals, and skilled nursing facilities. This is the kind of evidence that will appeal to these bottom-line spenders.

Overall, we need to be shaken out of the complacency that patients will be de- livered to our practices and accompanied by generous insurance benefits. Over the next few weeks, pay attention to health care marketing you see around you. You will hear and see ads for hospitals, physi- cian practices, plastic surgeons, sports orthopedic surgery groups, and a few of our peers. Everyone is vying for a piece of the pie. We need to be active partici- pants in the development of health care and reimbursement trends. We need to take pride in our skills and elevate the profile of our profession. This is essential to our growth and financial viability in the years to come.

editOr'S MeSSAGe: SeLLiNG GeriAtriC pt Melanie Sponholz, MSPT, GCS, CCEP, CHC

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