Voices from the Industry: How the ACA Has Impacted PTs, OTs, and SLPs

The Patient Protection and Affordable Care Act (PPACA)—most commonly referred to as simply the Affordable Care Act (ACA), or Obamacare—is a federal statute that former President Barack Obama enacted on March 23, 2010, and the Supreme Court upheld on June 28, 2012. According to the US Department of Health and Human Services, the ACA was designed to “make health care more affordable, accessible and of a higher quality, for families, seniors, businesses, and taxpayers alike.” As a result of the program, more than 20 million Americans now have health insurance, and—according to this Los Angeles Sentinel article—some historians believe that Obamacare has been “the president’s greatest accomplishment.”

While fans of the ACA, like secretary Sylvia M. Burwell, sing the program’s praises, others think it’s not all that it’s cracked up to be. In fact, newly inaugurated President Donald Trump spent much of his campaign railing against the ACA and announcing his plans to repeal—and replace—the act. Whether he will actually go through with it remains to be seen, but in the meantime, we thought we’d ask some of our Members how the ACA has impacted their businesses. Here’s what they had to say:

Michelle Underhill

SLP at Northern Colorado Therapy Services, LLC

Michelle Underhill is a speech-language pathologist at Northern Colorado Therapy Services—a practice that specializes in treating patients with Parkinson’s Disease. “We’re in a niche market,” she said. “And our two-therapist practice therapy schedule is full.” While the therapists in her practice mostly treat Medicare patients, they do have a few non-Medicare patients—“as those who are not yet of Medicare age are often paying privately for insurance or paying a portion of employer-directed insurance.” According to Underhill, “these folks typically delay seeking services until they have met their deductible for the year. Then, they limit what they are willing to do therapy-wise due to high copays/co-insurance.”

Northern Colorado Therapy Services has also seen an uptick in the number of patients who have Medicare Advantage plans—which Underhill refers to as “(Dis)Advantage plans”—that cover little to no therapy treatment. As Underhill sees it, “high out of pocket expenses result in people suffering when help is literally right down the street.”

Brian Hartz

PT and Owner of Hartz Physical Therapy

Since the ACA went into effect, Brian Hartz—physical therapist and owner of Hartz Physical Therapy—and his team have spent more time educating their patients about the value of physical therapy as well as patients’ ability to access physical therapists as primary care providers through direct access. “Due to the high copays and deductibles, we’re seeing our patients less,” he said. However, “we’ve found that consumers (patients) are becoming more savvy and researching their options before just following an MD’s recommendation and going to a high-volume POPTs clinic.” In fact, Hartz said that “more potential patients have been coming for a tour and to check the ‘vibe’ of the practice.”

Asia Giuffrida

Office Manager at Gilford Physical Therapy and Spine Center

Asia Giuffrida—office manager at Gilford Physical Therapy and Spine Center—was optimistic about the implementation of the ACA. Unfortunately, though, it didn’t live up to her expectations: “It has definitely had a negative impact on our business,” she said. With high deductibles—and increasing copays and coinsurances—“patients who would normally come twice per week want to come in just once per week to cut costs. Even patients whose plans cover 100% of their PT care (such as Medicare with secondary payers) have become more nervous about the cost of their care—asking me multiple times throughout the course of their treatment how much it’s going to cost them.” This increased worry about costs has produced a “huge influx” of calls. Now, patients “want to pick apart their statements/EOBs piece by piece in order to understand every charge, payment, and adjustment. Not that that in and of itself is bad,” Giuffrida said. “People should know what they’re paying for, and I’m happy to help them understand, but it goes to show how much more concerned and cautious people are about healthcare costs.”

On the upside, Gilford Physical Therapy and Spine Center has seen a lot more Medicaid patients since the implementation of the ACA: “I’m glad to see people who might otherwise have been uninsured getting the care they need,” Giuffrida said. “And these plans actually pay us more than many commercial plans we’re contracted with.” Overall, Giuffrida chalks the ACA up to being just another legislative change: “At the end of the day, just like with every other change the government makes, some benefit and some suffer. As a business, we’ve suffered.”

Donna De Leon

Biller at Endeavor Rehab Center

Donna De Leon—biller at Endeavor Rehab Center—is looking ahead: “We will definitely lose patients due to the new year’s changes,” she said. “Lots of patients are switching—or losing—their current plans because of either high premiums with little to no coverage or their insurance company is being bought out.” In her experience, Leon has found that “some patients believe they automatically have coverage for a service because they have insurance, but that’s not always the case.”

For better or worse, the Affordable Care Act has changed the face of health care in America. With its future hanging in the balance, we want to know: how has this piece of reform legislation impacted you, your patients, and your practice? Tell us in the comment section below.