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Narrator: Welcome to this APTA Podcast. Your APTA membership helps to advance the physical therapy profession by supporting our research and development efforts, including the association's work to improve the long-term sustainability of the profession. The development of APTA's landmark report, "The Economic Value of Physical Therapy in the United States," would not have been possible without the support of our 100,000+ members. APTA is using this report to inform policymakers, payers, employers, and consumers about the significant role and economic value that physical therapy brings to the health care system. The podcast you're about to hear is part of a series that explores the report's general impact as well as describes the findings on individual conditions and treatments. The report uses an economic model to calculate the net benefits to patients and the U.S. health care system of choosing physical therapy over alternative treatments to treat eight different conditions. For all eight conditions – osteoarthritis of the knee, tennis elbow, falls prevention, cancer rehabilitation, carpal tunnel syndrome, vascular claudication, stress urinary incontinence, and acute low back pain – physical therapy was found to have a net economic benefit over the alternative treatment.

Troy: Once again, welcome to this APTA podcast on the economic value of physical therapy United States, a landmark report from the association that shows physical therapies potential to deliver true economic value to patients. The US healthcare system and society as a whole. I'm Troy Elliott and on this podcast it's the second in a series we're producing on the report. If you missed our first one, it's on the development and general findings of the report. You may want to give that a listen for some background, because in this episode we're going to dive into the ways the report's findings can be leveraged in advocacy with federal and state policymakers as well as commercial payers. To do this, I'm joined by APTA staff members and volunteers who can help us understand this report in the context of its use as an advocacy tool. With me today are Cristina Faucheux, a physical therapist and co-owner of Moreau. Physical therapy based in Louisiana and Texas. Christine is also a federal affairs liaison and governmental affairs chair for APTA Louisiana, as well as a governmental affairs liaison for APTA private practice. Also with us today is Janet Shelley. Janet is a PT and Chief Disruption Officer for therapy partner solutions in her roles with APTA, she's an appointee to the APTA, public policy and Advocacy committee, and significantly for this podcast, a Co chair of the physical Therapy value Report, Work group. Christina and Janet are joined by two members of our APTA staff, Chase Kuhn, payment specialist at APTA, and Justin Elliott, Vice President of Government Affairs for the Association. And welcome to you all.  Janet, I'm gonna dive right into it. You helped to lead the group that steered the conceptualization of this report. And you were along for the whole ride as the evidence was gathered and analyzed. So first I'm interested in how you describe this report to others in the profession who might not know about it. So your elevator speech on this and more specifically in terms of advocacy, what are the big picture messages that you think policymakers need to know about this report?

Janet: Thank you, Troy for the opportunity. So physical therapy changes lives for the better, and those changes create a healthier, more productive society.
But for the first time ever, the economic value of physical therapy report quantifies physical therapies potential to deliver true dollar savings to patients in the healthcare system. We all know the clinical effectiveness of physical therapy is well researched and is familiar to policymakers and payers. We know physical therapy produces excellent outcomes, but APTA's new report goes beyond the simple comparison of treatment costs to show how physical therapist services are more cost effective than other courses of care.

Troy: Thanks. Justin, given what Janet just said, I want to turn to you for some insight. And I know we might be treading into scary territory here, but I want you to help us get inside the head of a lawmaker on Capitol Hill.

Justin: Yeah. That is terrifying.

Troy: We don't have to stay there very long, but, but here's what I'm getting at. We can all identify the information just as Janet so wonderfully summarized from this report, that a legislator should know the stuff that we want to communicate, the stuff we want to tell them. But you know, there's another side of this, which is what findings from this report would be attractive to them. You know, what do you think about it would get them to take notice? Or is it more about how you frame it, what it is you think they should know about? And then once you have their attention, how could that translate into advocacy and for what kinds of issues?

Justin: So I think you know first the big picture message to to policymakers is that an investment in physical therapy is an investment in the US healthcare system. You know, this report confirms what we've all known privately, and that is the economic value that physical therapy brings to the table. The value we bring to payment systems and to the healthcare system and then the downstream cost, the the broader economic impact, the quality of life for the patients we serve. And so this kind of confirms everything we we've known and it does so in a way that paints the broad macroeconomic impact that PT has on the healthcare system. I do think that the timing of the release of this report is very good because as folks know, there's been a lot of talk, of course, about how we can have value based payment under Medicare and Medicaid. Of course we have seen year over year cuts to not just physical therapy, but dozens of other providers under the Medicare fee schedule. We've seen a low payment in state Medicaid programs. So the timing of this report is good in terms of supporting our advocacy efforts, both at the federal and state level as well as with large employers and commercial payers. And you know, I think policy, you know, first of this report is an independent, objectively done in report and it is really aimed to inform broader health policy, decision making and policymakers. And you know, again, payers really need to consider the insights in this report so that they can support an advanced policies that support access to coverage of and payment for physical therapist services. I mean, we're going to really maximize the economic value. We need policies that position PTs and that includes policies that would position PTs as entry point providers and ensure beneficiaries have timely access to proven a cost of that cost effective care. But it also means they need to look at things that reduce the paperwork and admin burden. We need PTSsand PTAs spending less time filling out paperwork and more time treating their patients, but I think of all the eight conditions that were modeled that really does show the depth and breadth that PTs and PTAs bring to the healthcare system, and just one example is false prevention. Falls prevention is a huge issue right now under Medicare and the need to expand falls prevention services is is critical and so I think this really does support our efforts that we're working on to include PTs in the welcome-to-Medicare visit and the annual Wellness visit in a falls prevention position. And so I think there's a lot of good stuff in this report that will support a number of our initiatives and issues and bills with payers, with Medicare, Medicaid and legislators.

Troy: And you know you for all the talk at various levels about outcomes based care and value based care, this really hammers home outcomes. This really links outcomes to value in a way that I think is really important for the profession. Christina, I'm going to turn to you and ask you the same kind of question, but in terms of state level advocacy, what do you see in this report that you think legislators would take notice of and what sorts of changes do you think it might help to start?

Cristina: Thank you for inviting me to speak today. As someone who's advocated to advance our profession on Capitol Hill and at the state Capitol, I'm thrilled to have this data that I can use as proof of what I've been saying all year for many years, so on a state level I would say that you can think about pretty much any legislative issue that you have, you can relate this back to the value of PT. So if your state is thinking about running a bill and prior authorization or gold card legislation, improving the state Medicaid fee schedule, direct access for your copay, telehealth or payment parity, again just about any legislative issue that that you're thinking about pursuing, you can leave this data from this report into the conversation. So for example, if the state's having an issue with credentialing with a payer and they decide that they're going run a bill that deals with credentialing, then you want to highlight that not only does the credentialing timeline create a workforce issue, but now you can also highlight that the access issue caused by delaying providers from being able to serve patients who truly need physical therapy services is also costing the health system more.

Troy: Great. And I'm going to stick with you and Justin here for just a minute, because I'm going to shift to regulators, which is related, right, but different also at the same time. What do you think in this report? What's in it for them? And what will they like to hear about?

Justin: So, you know, I think first of all, again with the report it shows again, it paints a macroeconomic picture. And I would, I would start off by saying, you know, APTA has never produced a report like this. And quite frankly, I'm not aware of any other health care association that has done a macroeconomic report on the depth and breadth of as many as conditions that are in this report, that looks not only at the cost of comparison of the interventions, but the quality of life impact. And so I think from a regulatory standpoint, this should have, I would hope, paint a picture that again and investment in physical therapy is an investment in health care and that is why they should look at again some of the regulations and policies that we have on the books that are. But there barriers to care — barriers to access, and regulators should be looking at ways that, again, given the and the impact, the economic impact of these conditions, looking at ways to better position PTs and PTAs, we need to change policies and this report hopefully will move the needle and be a catalyst that will change some of these policies. Again, we want to maximize the economic value. We cannot maximize economic value if there are outdated policies on the books. If we're doing spending more time doing paperwork, then patient care, and quite frankly, if we're not getting paid, the value of the services that we bring to the table.

Troy: And Cristina? I'm thinking what springs to my mind first at the state level is the the ways this is a tool for direct access arguments and improving direct access, and I'm sure there are a host of other regulatory level things at the state level that this can help with too, right?

Cristina: Right. Absolutely. If you're considering even if you have direct access already, but it's a limited direct access, you'll want to use the information from this report to really highlight that physical therapy isn't an expense to the health care system, but truly a cost savings, and why physical therapist should be a primary point of entry to primary carex

Troy: So there's of course another channel for advocacy, and that's the commercial payer world, which is sort of a different animal, but still a key player in all this. Chase, I know you've been looking at this angle. So what kinds of opportunities does this report present when it comes to that world?

Chase: Thanks, Troy. Like you said, it's the same kind of trends that we see in regulation and policymakers that we see with our commercial payers. I think the biggest way that this report informs kind of commercial payers is that it does provide concrete example of how physical therapy not only improves outcomes, but how it frequently does so without increasing costs and it may in fact decrease costs to the healthcare system and in turn those payers who were kind of on the hook for a big portion of the healthcare spending dollars. This report it, it gives us data to prove cost savings. It's a great way to talk to ensures about looking at their own data. You know, here we are showing you that physical therapy saves money. You should look at your numbers, we think you might see the same thing. And so we know this tool will be, or we know that this report will be a great tool in talking with payers who are continuing or adopting policies that limit or block access to effective treatments like physical therapy. And having this data is something that peers will need to answer to. And so we've got to use the info in this report to challenge policies that create these barriers. And I know that my team and APTA will be doing so, but I think it's also really important for individual physical therapists to engage in these efforts, like when they're negotiating contracts with these commercial payers and the more pushback that we're able to give to these disadvantageous kind of boilerplate contracts, the better we position ourselves as a profession in the future. And as mentioned before, I think I think another space at this report can have a huge impact is with self-insured companies, you know, those big companies that provide insurance directly to their employees, they don't have the same profit margins as commercial insurers. So they're really motivated to reduce healthcare spending. They also uniquely care about the things that are highlighted in this report, like missed work, because not only are they paying for the healthcare, but they're also losing money when their workers take time away from their jobs. And so this report really highlights that travel time and miss work and determining the figures for these quality years. And it does a really good job of positioning physical therapy in this space to help with these problems.

Troy: I think you make a really great point about in terms of advocacy about the power of in the commercial space, the power of the individual PT as an advocate with their, with these payers in terms of the way they negotiate their contracts and look carefully at their contracts, because that's where the real, that's where the real power is. It's a whole different kind of arrangement for commercial payers than it is when we're doing advocacy at the governmental regulatory level. It's a different it's a separate conversation that happens with the commercial payers. The individual PT certainly have a lot of, they have maybe more leverage than they realize and they can use their report.

Chase: Absolutely.

Troy: We've been parsing this out in terms of the different types of, you know, on the ground advocacy. But Janet, I wanted to get back up to the 30,000 foot level and ask you to talk a bit about what you think this report reveals in terms of the benefits of physical therapy, not just for patients, because that makes it very obvious, but for the healthcare system overall.

Janet: Well, Troy, simply put, physical therapy, and particularly physical therapy first or as the entry point, as you've heard several times today after an injury or an illness, could save millions of dollars annually to the health care system. And we can accomplish this several ways, preventing expensive medical procedures. Physical therapy is noninvasive. It's a low cost alternative to surgical procedures or other more invasive treatments. For example, physical therapy can help individuals with musculoskeletal injury issues or injuries avoid surgery by improving their condition with exercise or manual therapy. By providing the need for surgery, the health care system obviously will save a substantial amount of money. We can also can prevent hospital readmissions if physical therapy becomes involved with patients who are recovering from surgery, injury or illness. We are instrumental, we know, in reducing the risk of those readmissions, which are costly both to the healthcare system and to the patient where you can reduce medication expenses. Physical therapy can help patients manage their pain, improve their condition without the need for long term medication. We can also help manage chronic conditions such as diabetes, cardiovascular disease, arthritis. We can help the patients maintain a functional abilities, their mobility. All of that will overall lower the health care costs associated with these conditions. And last, physical therapists also can improve long term health and wellness. With prevention, we can focus on improving their overall health by maintaining healthy lifestyles, being active, all the things that contribute to those chronic conditions that that increase the burden on the healthcare cost.

Troy: Let me follow up by asking you to zero in on the chronic condition piece of what you're saying here because as we know the numbers just keep going up in terms of burden, in terms of healthcare costs burden both in the United States and worldwide. So talk to me a little more about the chronic condition end of it.

Janet: Well, for example, a patient has arthritis, has pain and stiffness, and experiences functional difficulties. By engaging with their physical therapists, they can strengthen muscles around joints. They can learn how to manage their pain. They can be taught safe transfers procedures. Again, further limiting their risk for additional injury.

Troy: And I know that PTs know this. I mean, this is PT 101, but that's the kind of argument that you need to bring to policymakers and payers. Those are the kind of messages need to be delivered because they reflect costs, right?

Janet: Exactly. And in today's current structure, oftentimes the copay for physical therapy is far more than even to see a primary care physician or to obtain a medication that could be addictive. So we need to flip that script and we need to have the lower barrier to see the physical therapist to hopefully avoid those additional cost.

Troy: We're gonna wrap up here and I want to thank you all for being here, but I've got a couple more questions for you, Justin. First, what are your thoughts on how members can leverage this report in their own outreach efforts? I think Christina talked a little bit about that and so did and so did Chase. And then I suppose this is really pretty much related, but how is APTA supporting members in sharing this report with policymakers?

Justin: Well, great question, because first I would say if folks have not been have not visited the website yet, go to valueofpt.com and on that website we not only have the full technical report, but we also have a couple of summary papers, executive summaries including a summary paper aimed specifically at policymakers and a summary paper aimed specifically at payers. We also have videos on that website, one aimed at consumers and one again aimed at payers and policymakers. And these are tools and resources that members can utilize in their day-to-day practice to educate consumers and promote their practice or other practice setting as to why they should choose physical therapy. There are these other advocacy tools that can be utilized to support efforts at the state level as well as federal level and communicating to policymakers about this report and why it is important and why it is time for change. There are also some really cool infographics that individuals can download and co-brand with their clinic logo that they can then share with patients and consumers to really promote the value of physical therapy. And so I think there's going be even more resources as we go along. This wasn't just a one and done rollout — this is something that's going to be part of our conversation for the next several years. And so over the weeks and months ahead, we're going to add resources to this website so that members can continually have new tools in their toolbox to utilize to promote themselves, to promote the physical therapy profession, and hopefully be agents of change to address some of the concerns and stresses we have right now.

Troy: Bottom line, look for more to come. Well, thanks Janet, Christina, Chase, and Justin for giving us insight on how we can put this report into action. Listeners you can count on hearing a lot more about this report along just about every APTA communications channel, and there's a lot out there, so please stay informed. It's an easy thing to do by simply following us on social media — Facebook, X, Instagram, and LinkedIn, as well as by way of our APTA weekly emails which arrive in your inbox every Wednesday. We'll be sharing news about the report as well as other information critical to the profession. And of course, it's all free to members.  And don't forget to be on the lookout for the other two podcasts in this series—our first episode that provides the general overview that I mentioned earlier, and the third part of our series which focuses on leveraging the findings of the report with consumers. Thanks for listening.

Narrator: APTA's landmark report, "The Economic Value of Physical Therapy in the United States," would not have been possible without the support of our members. If you're not an APTA member, visit APTA.org to learn more about the value of membership. You can also read the report and find resources to promote the value of physical therapy at ValueofPT.com. Make sure you're also following APTA on Facebook, the platform X (formerly known as Twitter), and Instagram to join us in informing consumers, policymakers, payers, and employers about the significant role and economic value that physical therapist services bring to the health care system.