The Discount Isn’t the Deal: What Really Drives Workers’ Comp PT Costs
When payers evaluate a physical therapy program, the conversation usually lands on price. How far below fee schedule? What’s the cost per visit? Those figures are easy to compare in an RFP and easy to report to finance.
The trouble is that price is only one side of the math. Total PT spend on a claim comes down to what each visit costs and how many visits take place. A strong discount can be wiped out quickly if the visit count keeps climbing.
In her new Leaders Speak column for WorkCompWire, ION PT Network Chief Revenue Officer Sara Mulick takes a hard look at how the industry buys physical therapy and why the most important cost driver often goes unexamined.
Where the money actually goes
Sara, who has spent more than two decades in workers’ comp sales leadership, points to the stretch between a worker’s first visit and discharge as the part of the episode where cost variation really lives. It’s also the part claims professionals see least clearly. That’s where a plan of care should adapt to how the patient is responding, and where cases without active oversight can drift into ongoing treatment that isn’t moving recovery forward.
She also shares visit data from a national program that shows why comparing similar cases, rather than looking at averages, reveals the variance that matters.
Speed is no longer a differentiator
The article makes another point payers will want to consider at their next renewal. Fast scheduling and quick time to first appointment were once meaningful ways to tell PT partners apart. Today, nearly every credible vendor clears that bar. Speed still matters, but it has become a baseline expectation rather than a reason to choose one program over another.
Better questions for your next business review
Sara closes with a set of questions payers can bring to their PT partners, focused on outcomes by case type, authorization delays, and how often clinical intervention actually changed the course of care. They aren’t always comfortable questions for vendors, which is exactly why they’re worth asking.
Read the full article
Read “Beyond the Discount: Rethinking the True Cost of Physical Therapy” on WorkCompWire
This column builds on a theme ION COO Anthony Marcket, PT, explored earlier this month. Read his post on moving from PT networks to PT management.