A Publication of WTVP

This initiative to reduce inefficiencies in healthcare will have far-reaching economic effects.

The American Physical Therapy Association (APTA) recently became the first non-physician group to contribute to “Choosing Wisely” ( This campaign, started by the American Board of Internal Medicine in 2012, promotes good medical practice based on real evidence. By contributing, the APTA took a great step, bringing the role of physical therapists forward in the American healthcare landscape. What was stated at the top of the list for the APTA is stunning. In fact, the first sentence alone will have far-reaching economic effects, as the APTA has openly discouraged the use of treatments like hot/cold packs, ultrasound or electrical stimulation.

Evidence Emerging
“There is limited evidence for use of passive physical agents to obtain clinically important outcomes for musculoskeletal conditions… There is emerging evidence that passive physical agents can harm patients.” With this short statement, the APTA openly accepted 20 years worth of evidence by the Quebec Task Force and the American College of Occupational and Environmental Medicine, among others. The evidence is that “passive” treatment has no long-term benefit or outcome effect; the only benefits are temporary relief during the treatment, or briefly after.

Around the turn of the century, Medicare declared it would no longer reimburse for hot/cold compress treatments. Few other payers have followed. Historically, PT business managers have encouraged therapists to include as many justifiable modalities as possible. This was not unethical. It was within the published APTA treatment guidelines. Modalities are major revenue generators—the majority of costs in the $3,000/case average for low back pain. Now, the APTA has publicly stated that previous practice patterns are as useless as parsley on the plate at a country diner.

I fully expect that payer sources will rapidly respond to this, denying payment on physical therapy visits that include passive modalities. This is not just going to affect physical therapists. Chiropractors, orthopedic surgical groups and healthcare systems have used physical therapy services for decades as a steady source of income at a relatively inexpensive cost. It was very easy to justify hiring a PT or PTA. You could easily make back five times the revenue of their employment cost—even better if patients were seeing the therapist three to five days a week.

Rewards for Inefficiency
If we want to honestly discuss a major failure in American healthcare, it’s that we reward inefficiency. We are willing to pay for a new faucet, when a gasket will stop the leak. If a patient with low back pain sees a therapist who works from an exercise/home program-based approach, the symptoms might be resolved for one third of the charges, in half the time. That therapist’s company gets reimbursed much less than the national average. The best, most-efficient PTs in our field are the ones being financially driven out of practice, while less-effective failures thrive. Rewarded inefficiency has now been compounded by the publicly-acknowledged potential for patient harm by the APTA.

The current buzzword in medicine is “evidence-based.” At IWIRC, we think the more appropriate model is “evidence-aware.” It’s a subtle difference. Being evidence-aware requires you to continuously evaluate your business model. The lucrative days of using “experience” evidence to guide treatments are gone for physical therapists. The scientific evidence shows that a dominant revenue source is worthless. How is your company’s “evidence-awareness?” iBi