Is physical therapy focused on long-term health or short-term “fixes?” Short-term treatments (manual therapy) may help us achieve long-term goals but they are not required. Many exercises fall into low-value treatment as well: cookie-cutter exercise programs, low-intensity exercise (that is not targeting fear and anxiety), and postural exercise. Pain scores and functional outcome measures help with determining treatment efficacy in trials and objectifying treatment results for insurers, but they often do not translate to the patient’s goals. Instead of focusing on these measures to determine if we are successful with treatment, let’s look at the patient’s participation in activities meaningful to them. I would rather someone play tennis with tolerable levels of pain than avoid activity, worried they don’t move properly or are at risk of damage and needing surgery. Our area of focus in the clinic messages to the patient what is important. If we emphasize reducing pain and moving “perfectly,” how do you think the patient is going to act when they feel pain outside the clinic? Let’s help patients move more and focus on the long-term results.

We need to be more comfortable talking about finances in physical therapy. Too often, we hide behind insurance and claim it is a front office or billing issue. PTs should be well-versed in how insurance plans work and a patient’s responsibility. Understanding the financial part of PT helps with the value proposition. We can better empathize with patients. We can fight for changes in reimbursement. Student debt is an issue. Reimbursement is an issue. How can we expect to fight for better reimbursement and better pay as a profession if we don’t understand the financial implications of billing practices? This ties directly into clinical quality as well. One of the most valuable indicators of quality is future healthcare utilization. The goal of PT is not short-term pain relief. The goal is to help people live the lives they want to live. Short-term interventions are not a problem, but they are not the solution either. Are we teaching our patients about pain and encouraging movement? Are we delivering high-value services that limit the likelihood of needing future healthcare? We shouldn’t hide from financial conversations. We need more emphasis on the financial implications of PT and the value we bring patients.

This has been on my mind a lot lately. My Centennial project is focused on it (more to come soon), it’s a recurring topic during residency lectures, and it is a focus of all my recent committee meetings. What are your thoughts? How can all members of the profession help? This isn’t just an APTA problem, we all have to work together. Let me know in the comments.