Ellie Kramer of Woodstock Physical Therapy announced that her facility on Route 212, east of Woodstock, has been taken over by Access Physical Therapy and Wellness, a company that owns over 20 offices and will keep her on as director and physical therapist, along with other staff members. “I wanted to make sure the practice I have built over the course of 30 years remains in the community,” said Kramer. “Access has the same values as I have, treating people hands-on, one-on-one, in 30-minute sessions. We’ll be owned by a bigger company, but the quality will stay the same.”
In New York State, where the reimbursement rate from insurance companies is among the lowest in the nation, Access has had to steer a difficult course to maintain a successful business. In the case of the Woodstock practice, the strategy involved lowering the wages of physical therapists, by an amount Kramer described as “a small drop. But they are providing benefits — health care, 401K — that I was unable to supply.”
For two of the staff members, whose salaries were higher due to their many years of experience, the decrease was not acceptable. Heather Roberts and Christy Keegan left the practice to set up their own offices and declare their independence from the health insurance system. “Most of the people coming to us had co-pays of $50 to $90 a visit,” said Roberts. “Without the overhead of dealing with the massive quantity of paperwork required by insurance companies, I can see people for that amount and still afford to pay my bills and support my family. And people are getting better faster.”
With the ability to schedule 45-minute sessions, Roberts finds, “I go home feeling so much better, knowing I was able to help people instead of wishing I could have done more.”
She doesn’t blame Access for the salary problem. “The bad guy here is the insurance reimbursement. PT reimbursement hasn’t increased in 20 years, so what privat e practices are forced to do — either therapists make less and less money as the cost of living goes up, or they treat a higher volume of patients.”
As an alternative to Access, where 30-minute sessions have been maintained, both women could have considered working at a higher-paying clinic where therapists see more clients by keeping their sessions down to 15 minutes. Often treatments are limited to putting patients “on an ice pack and on a machine,” said Roberts. “When you have 15 minutes, no one evaluates or does hands-on treatment and clinical decision-making. That model sells our profession short.”
Eighteen years ago, Keegan took a job at a Long Island clinic, not knowing she would have see four patients per hour. “You burn out, or you just do the minimum to save your sanity,” she said. “That’s not quality care.”
Before working at the Woodstock office, Roberts had a practice in Phoenicia and took all kinds of insurance. “My practice took off like wildfire,” she recalled. “I had four employees, and I had to work 50 to 60 hours a week to keep it going.” Exhausted by the pace of her work, with little time left for her children, she interviewed at Woodstock and also at a facility that sees four people per hour. “They were going to pay me more and teach me how to do it, but I’ve talked to patients and seen how it works, so I went to Ellie. But there was no prospect of that salary increasing. Do I make way less than when I got out of PT school 23 years ago? Or do I get out of the system? The price of peanut butter has tripled — and I buy a lot of peanut butter.”
Since August, Roberts has rented a space at 28 West, the gym at Route 28 and Maverick Road. Although she is not employed by the gym, she has full access to the workout equipment for her patients. She recently took a training in Milwaukee to be certified as a scoliosis therapist.
Keegan’s office is at Stone Ridge Healing Arts, which also accommodates osteopaths, therapists, and a movement studio with Pilates, yoga, and dance. “Because it’s a wellness center,” said Keegan, “people gravitating toward the place are already trying to take care of themselves. They found I was a good addition.”
It’s difficult to attract patients who already have health insurance, even though the co-pay for most people is comparable to the rates both women are charging. “People pay a lot for insurance,” observed Roberts. “They don’t want to go off and pay for a PT. But our clientele is building. Part of the goal of low overhead is to be accessible. We’re less expensive than a trainer or getting your hair done.”
In the interest of access for all, Roberts has been looking into getting the software required to bill Medicare. “Their reimbursements rates are actually higher than many insurance companies,” she said. “But to bill, you have to have extensive software.” Companies that charge $500 a month for Medicare billing software cannot be accommodated by the low-overhead model. Now she’s investigating a cheaper firm but observed, “The system makes it easier for big companies than for solo practitioners. It’s frustrating.”
When asked why they thought the system had evolved in such a problematic way, Keegan replied, “A lot of people blame Obamacare, but I think it’s the for-profit aspect of health insurance. It should never have been for profit.”
“When I went to my high school reunion,” said Roberts, “my ex-boyfriend mentioned he has houses in Malibu and in Florida. It turned out he’s the CEO of a health insurance company. And here I was, closing my office in Phoenicia.”
Keegan and Roberts emphasized that the Access practice in Woodstock still offers excellent care. Kramer said the two therapists have been replaced by skilled practitioners, one from New York City and the other from California. She added, “Access PT has figured out a business model in this challenging health care climate that is actually successful, which is not easy to do. They treat their staff and clientele well, and pride themselves on a positive workplace culture of great customer service, high quality care, and great rapport among staff members. I would not have chosen to merge with them if it had been otherwise.”
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