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Patient Financial Obligation in Outpatient Therapy

By John Britt, Senior Manager

Outpatient therapy is a recurring service; for example, a routine plan of care is often 12 visits over 30 days. With rising co-pays and deductibles, patients are increasingly choosing less care, meaning less visits, than the therapists are recommending in the plan of care because of financial constraints. Your department needs to be aware of patient financial obligation and the steps your organization can take to ensure patients are receiving the level of care they need.

A Common Patient Financial Obligation Scenario

An Outpatient Physical and Occupational Therapist has just completed the initial evaluation on a patient.

The therapist: “Based on the goals you have and my assessment of your current status, I am going to need to see you three times a week for four weeks.”

The patient: “I have a $50 co-pay so I am not so sure I can do that.”

The therapist is not comfortable talking about the financial aspects of the care. She is empathetic to the patient’s financial position and has a thought process to put him on a home program and he could let me know if that doesn’t work.

She conveys her thoughts to the patient who seems relieved not to be faced with a financial burden. The therapist spends ten more minutes instructing the patient in a home exercise program and educating him on the criteria that would trigger him to contact her again.

The Clinical Outcome

The patient does not receive the optimal level/amount of therapy for their condition. The therapist has spent a lot a time preparing to become a therapist and make informed clinical judgments on the optimal amount of care for patients (projected number of visits based on assessment findings and goals).

The fact that the therapist defaulted to a plan of care that is less than optimal is not meant, by any means, to be an indictment of the therapist’s professionalism or judgement. The facts are that the patient, without some point-of-service alternative, might choose to do nothing based on the financial constraints. The therapist is simply trying to find a reasonable compromise to the patient’s constraints.

Contact Blue about Outpatient Therapy Patient Financial Obligation

Could your organization better address patient financial obligation within your outpatient therapy department? Our team has helped hospitals address these financial barriers that are preventing patients from receiving the full plan of care. Most of our clients experience a range of increased visits of 1-3 per new patient.

Blue & Co., LLC,’s Outpatient Therapy Business Advisory Services provides both Assessment and Implementation Guidance to help hospitals understand their revenue and growth opportunities and facilitate changes in processes and behaviors to achieve them. These engagements are not about FTE reduction.

Contact John Britt or your local Blue & Co. advisor to learn more about Outpatient Therapy Referral Development.

John Britt, Senior Manager
502.992.2598

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