Theres a chang happening in the world of healthcare that you should be a part of. Cutout the middleman that is insurance and get the care you deserve directly from the source. $23,000,000,000, Twenty-three billion dollars. That’s the profit united healthcare made in 2024. $71,000,000,000 is the profit the top seven insurance companies had made in that same year. It’s expected that this number has risen year to year with the increased implementation of AI to “improve efficiency” i.e. increase denials and decrease payments. Relative to these record profits, the amount the PT is reimbursed for the skilled services they provide has decreased by 7% since 1999. PT is only one part of the medical field that has been constrained by this extraction of wealth valued over the improvement of health.
PT’s remain motivated and committed to improving the quality of life of our patients and our communities, but the financial realities of the current insurance landscape have forced numerous compromises on the field that have been worse for the clinician and the patient. Most evidently this can be appreciated by the time you actually spend interacting with tour PT directly. For most clinics to stay profitable at the reduced payment they make up for the difference in volume. Instead of 1-on-1 care you will see PT’s working on 2 or even 3-4 patients in a one-hour session. At a prior job I was expected to see between 17-30 patients in an 8-hour shift.
It doesn’t matter how skilled you are, you can only be in one place at one time, and getting 15-30 min of actual time to work on making things better is progressively more inefficient for all. This lose-lose situation worsens the experience for all. The clinicians who’ve spent 6-7 years in higher education to earn their degrees are often reduced to being cogs in the corporate machine. Best case scenario in these “mill” type situations the therapist only gets to use a smaller subset of his/her skills. Or they have to stretch the care plan longer because they only get half the time they need in a session to make a difference.
From the perspective of a person seeking care, it’s hard to know what you’ve been missing out on. PT has been commercialized and standardized by the largest chains of clinics whereby your second week you know the routine and see it with most people that come in the door. Warmup on the bike or treadmill for 10 min, do exercises with the aide or tech for 30 min, get 10-15 min with the PT to update and get some manual therapy, then wrap up with 10-15 min of heat, ice, stim, or the like. There is value to all of these things. But you get so much more out of the quality time with the skilled PT than all the others.
This is why there is a growing trend amongst PT’s myself included have gone away from the insurance-based model. It’s not based on care, research, or skill. It’s based on profit, and line goes up is difficult when there is a time limit. Squeezing more units out of the same hour of time is often unethical, impractical, and lessens the experience for all directly involved. The direct-pay/direct access model of care removes all the handcuffs that come with the sunk-cost fallacy of insurance. In this model it’s you and the PT working together 1-on-1 to analyze your entire situation, needs, and concerns to get you to your best self in the least time.
At a glance people often think that direct care PT is too expensive. This is the wrong way of looking at something as important as your health and quality of life. The average course of PT is 4-6 weeks 2-3 times a week. With copays averaging $25-$55 per session you’re looking at $200-$440 at a minimum, and that’s if you’ve met your deductible. If you haven’t met your deductible, you’re likely paying the same or more than you would with direct care. That’s while getting 15-30min on average time with the person you came to see.
For the price of a massage, a couple dinners out, or a deluxe video game you can make a meaningful positive impact on your quality of life and fitness. Don’t wait, don’t stay in pain for another day. Come to invoke therapy and experience the difference that care centered around you and not a stock price can make.
