Each month, Physical Therapy Products aims to deliver the latest product-related information to help you treat your patients and run your businesses successfully. This month, we present our second annual Product Guide issue, in which we strive to represent the entire spectrum of the products and services available to you. Many PTs have told me that, before purchasing certain products, the most important question on their minds is, "Will I be reimbursed for providing treatment using this product?"

With the existing therapy payment caps and the limitations on reimbursement for certain technologies—such as laser therapy modalities—having the funds for purchasing new products can be challenging. From these reimbursement challenges for PTs to the escalating costs of prescription drugs, it seems that our health care system has moved away from sufficiently paying health care providers and caregivers to keeping the money within large insurance and pharmaceutical companies.

I recently read a book that provided an interesting perspective on the health care dilemma. In Economics for Humans, author Julie A. Nelson, PhD, describes what she calls a "crisis in care" within the US health care system.¹ She presents an analysis that digs deeper into our perceptions of why hands-on health care services are often the target for low, or even nonexistent, payment. The basis of Nelson's theory is that our current economic system—the entire marketplace of corporate businesses—has been traditionally viewed as a stoic "machine" in which the ultimate goal is to produce profits, void of any concern for ethics or caring for others. In contrast, health care provider occupations were traditionally viewed as being performed from a strong sense of altruism—consequently, health care providers who sought higher wages and payments for services were thought to be greedy.¹ What Nelson ultimately emphasizes is that society cannot separate "business" from "providing care," because this leaves health care providers deprived of vital economic resources.

She presents, for example, a 2002 study prepared for the Department of Health and Human Services that reported that the turnover rate—fueled by low wages—within the first 3 months for nursing home assistants amounted to almost 100%, putting residents at risk for problems such as bedsores, dehydration, and malnutrition. Nelson also talks about the unceasing shortage of hospital nurses. According to Nelson, hospitals claim that they cannot get enough qualified people, leading them to rely on minimal staffing, mandatory overtime, and nurses recruited from abroad. On the other hand, nurses—and many physicians as well—complain that they no longer have the time to actually observe, talk to, and understand their patients, or to help make them comfortable and relieve their anxieties about medical procedures.¹ Although Nelson doesn't specifically call out the rehabilitation specialty, I think you will find several parallel issues, concerns, and limitations.

What's the answer? You obviously cannot run a successful health care business without prioritizing costs and revenues. In the past, I have spoken with physical therapy practice owners who strictly abide by the "one therapist per patient at a time" rule—I think this is remarkable. However, how successful must your businesses be for this model to be profitable? Where do you cut costs to meet those requirements? Perhaps in the hiring of additional staff, or limiting your purchases of new products and technologies. Is there a realistic "middle ground"? I would love to hear your thoughts on this.

I hope this column provides you with some "food for thought." I also hope you use this issue to find the right products and services that fit both your financial requirements and your caregiving needs.

Arati Murti

Reference

1. Nelson JA. Economics for Humans. Chicago: The University of Chicago Press; 2006.