Importance of Patient Choice

The health care system in Rochester, just like most areas of the country, is undergoing changes in response to health care reform. The hospital systems are consolidating, they are buying physician practices, and Accountable Care Organizations (ACO’s) are being formed. The intent is to create greater accountability among health care providers, and to improve efficiencies within the system. Payment models will change from the current fee-for-service model, and providers will be rewarded for cost effective care and for keeping their patients healthy.

One of the unintended consequences of this consolidation of the hospital systems is the growing phenomenon of self-referral. In other words, as physicians become employed by the hospital, they are given financial incentives to direct all services internally. This is having a major impact on private physical therapy practices, as patients are being steered away from these community-based practices. Some of the tactics that physicians are utilizing in the process are encroaching on the patient’s right to choose their own provider. Even when the patient has an insurance policy that allows for choice, patients are being told that they must receive their services from the physician employer.

Why should health care consumers be concerned about this? Perhaps the greatest concern is that patient are not being directed to the highest quality physical therapy providers. When patients have choice, they get to determine who is the best provider. This is what helps to ensure quality care. Another reason is that physician’s should disclose any financial interest in their referral patterns as a matter of their own code of ethics. People have a right to know why a physician or other provider is referring them to another provider.  

At STAR, we work hard to provide quality health care. Over one-half of our physical therapists have advanced certification in orthopedic practice. We also systematically measure patient outcomes, and compare our performance to like clinics across the country. So if you are told that you have to receive your physical therapy care at a hospital based PT center, ask why? Or if you know that your insurance allows a choice of providers, you can insist on being referred to a community based, quality care center. You have the right to choose.

Marcia Miller Spoto, PT, DC, OCS