Change is inevitable. Everything must change. Change is the only constant. These commonly used expressions hold some truth, and in considering our profession’s evolution as we celebrate the Centennial, they have got me thinking about our collective future. What will physical therapy look like? What should it look like? What must it look like? There are three potentially very different answers to these questions. We only win if the answer to all three is the same. We only win when we do it together, as a unified association.
We have some existential threats that will shape who and what we become, and we must deal with those threats successfully if we are to thrive. The ones I want to focus on here are value-based payment and diagnosis. I believe these two issues to be key drivers of many other related issues including the worsening student debt-to-income ratio, our lack of workforce diversity, our professional identity, and physical therapists being the providers of choice.
Regarding value-based payment1, we are clearly not thriving on procedure-based, fee-for-service payment models. Payers are not offering substantial increases in payment, even if we demand it. Gone are the days that we will be paid for the volume of service provided, especially when it is not linked to outcomes. I believe that the only way we will be able to see increases in payment is by clearly measuring and demonstrating our value. This requires systematic measurement (and reporting) of outcomes…patient satisfaction, patient-reported outcomes, objectively measured functional performance outcomes, and down-stream cost savings with regard to reduced imaging, surgery, opioid use, emergency department visits, hospitalizations, and specialist consultations. When we demonstrate our value, we have the best chance at increasing payment for our services. Salaries can increase. Student debt-to-income ratios improve. PT school will be more affordable and a more attractive career option to a greater diversity of people. The diversity of our workforce can start to reflect the diversity of the communities we serve.
Regarding diagnosis2,3, I have been following with great interest the ongoing discussion about diagnostic labels and their relevance to not only our professional identity, but also to research and payment policy. There are no easy answers here, and as Dr. Deusinger puts it, this is a “wicked problem.”3 But we must confront it. What makes me cringe is the high probability that a single patient could see 5 PTs and come away with 5 different diagnoses. This is true of all PT clinical settings and specialty areas, but is especially true in the outpatient orthopedic world. Without having a single, unified, data-driven diagnostic classification system that is universally taught in entry-level professional education, we rely upon a continuing education industry to sell competing approaches and certifications to licensed clinicians for how to diagnose and treat patients. Not surprisingly, we can have 5 or more different diagnoses for the same problem in a single patient depending on what treatment approach the clinician “follows” and “believes in.” The path forward is indeed “wicked”, but if we do not develop even some semblance of a research-supported universal classification system, how can we assure payers, policy-makers, and patients that we can consistently and predictably deliver on our brand promise and be the provider of choice?
Predicting the future is difficult. Ignoring history is condemnation. Since 1921 our profession has faced many existential threats and wicked problems. As we reflect on the past 100 years, let’s remember the single constant: It is only as a group of professionals unified by OUR professional association that we have succeeded. The next 100 years will be no different. Here’s to the start of our second centennial!
1 Dianne V. Jewell, Justin D. Moore, Marc S. Goldstein, Delivering the Physical Therapy Value Proposition: A Call to Action, Physical Therapy, Volume 93, Issue 1, 1 January 2013, Pages 104–114, https://doi.org/10.2522/ptj.20120175
2 Shirley Sahrmann, Defining Our Diagnostic Labels Will Help Define Our Movement Expertise and Guide Our Next 100 Years, Physical Therapy, , pzaa196, https://doi.org/10.1093/ptj/pzaa196
3 Susan S Deusinger, PT, PhD, FAPTA, Robert H Deusinger, PT, PhD, Achieving Diagnosis-Based Practice: A Wicked Problem in Physical Therapy. On “Defining Our Diagnostic Labels Will Help Define Our Movement Expertise and Guide Our Next 100 Years” Sahrmann, S. Phys Ther. 2020 https://doi.org/10.1093/ptj/pzaa196, Physical Therapy, , pzab005, https://doi.org/10.1093/ptj/pzab005