Episode 1660 - Cash, insurance, or hybrid: where's the magic?

Alan Fredendall // #LeadershipThursday // www.ptonice.com

In today's episode of the PT on ICE Daily Show, ICE Chief Operating Officer Alan Fredendall discusses the current state of the insurance-based healthcare systems, alternative practice styles, and the "magic" behind building a sustainable practice.

Take a listen to the podcast episode or check out the full show notes on our blog at www.ptonice.com/blog.

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EPISODE TRANSCRIPTION

INTRODUCTION Hey everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today's episode, I want to talk to you about VersaLifts. Today's episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of h drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today's show notes to get your VersaLifts today.

ALAN FREDENDALL All right, good morning, PT On ICE Daily Show. Happy Thursday morning, I hope your day is off to a great start. My name is Alan, I'm happy to be your host today. Currently have the pleasure of serving as our Chief Operating Officer here at Ice, and the Division Leader in our Fitness Athlete Division. It is Thursday, it is Leadership Thursday, that means it is also Gut Check Thursday. This week's Gut Check Thursday is another qualifier workout, so it's on the more aggressive end. So we have every four minutes for four sets. You're basically going to go through one workout of the Hero Workout DT. You're going to do 12 deadlifts. You're going to go 9 hang cleans. The caveat this week is that they're hang squat cleans. So they're going to take longer to cycle and they're definitely going to take more out of your legs than the traditional power clean we find in DT. Then you're going to finish with six shoulder to overhead. So for most folks, that's going to be a push jerk. The weight there is 155-105 on the barbell. Ideally, we're finishing one round of that complex in about two minutes. And then in any remaining time in that four-minute window, we're doing as many wall balls as we can. Guys are going to throw a 20-pound ball to a 10-foot target. Ladies, a 14-pound ball to a 9-foot target. The goal of that workout is to get through the barbell and get to the wall balls and accrue some wall balls. Great scores are going to be really anything above 50 reps. Exceeding 100, making your way towards 150 is definitely going to be an exceptional score. Modify the weight on that barbell, modify the reps if you need to make sure that you get off the barbell in about two minutes and that you have time for wall balls. There is no rest between sets, so keep that in mind as well. You probably don't want to be doing wall balls right until the whistle and need to turn and pick up that barbell without a break. You're probably going to want to allow yourself maybe 15 to 20 seconds of rest on the last set of wall balls and then go and pick up that barbell when the clock beeps. So have fun with that one. That's from a qualifier workout for a really awesome competition we have here in Michigan out on the west coast of Michigan out near Grand Rapids called Fresh Coast Fit Fest. Really fun CrossFit workout two day event on the beach. So some of our teams here from our gym at CrossFit and Fenton are going to be doing that. So have fun with that qualifier workout. THE CURRENT STATE OF THE PT INDUSTRY Today what are we talking about? We are talking about cash-based practice, insurance-based practice, or maybe in between what we call a hybrid-based practice, where is the magic? So today I want to make a couple points. I want to really have a candid discussion on insurance and really the physical therapy profession in general. I want to talk about what it means to open a sustainable and ethical practice. I want to talk about the down-low with payment methods and payment amounts as far as how much we get paid. and I want to talk about the concept that I call the golden rule of private practice. So let's start with that discussion on insurance. So Kaiser Foundation back in 2022 published that about 95% of Americans have health insurance. Why do I bring that up? I bring that up because if you only get information from social media, which unfortunately many folks now do, you might have this perception that cash-based therapy, cash-based medicine in general, concierge medicine, has taken off and that if you still accept insurance, you are somehow maybe 100 years behind what's currently happening. and it could not be further from the truth. Most Americans, most consumers have insurance. Again, 95% of people. So certainly while folks are getting more used to maybe their high deductible plan and that they do probably need to pay out of pocket for some or maybe all of their health care, Certainly that's not the case for everybody. In this idea, this mantra on social media that Americans have just rebelled against health insurance and none of them have it anymore and everybody is totally willing to pay cash for everything and you can charge whatever you want is the name of the game could not be further from the truth. In fact, 33% of Americans have Blue Cross Blue Shield PPO insurance which means they carry pretty nice insurance that they probably pay a lot of money for. So I say all that to say this, we need to be realistic that most of us will probably come and go from this profession before we really see a significant shift in how patients interact with the healthcare system, most notably from how they pay for their healthcare. Why does that matter? And why is that unlikely to change? I think looking at the state of the economy in general, again, if you get a lot of your news from social media, you may believe that the economy is on the edge of being destroyed at any minute. But again, that could not be further from the truth. We dodged the depression that was forecasted. The economy is at an all-time high. And that is shown if we look at insurance company profits. So let's go down this list. I love to look at data like this. Blue Cross Blue Shield last year, $457 billion. Almost half a trillion dollars. UnitedHealthcare right behind them, $414 billion. Anthem Blue Cross Blue Shield, so kind of a conglomerate of a bunch of different state Blue Cross Blue Shield associations, $109 billion. Cigna, that's a private commercial insurance, $76 billion. Humana is another private insurer, $55 billion. If we look at just the five largest health insurance providers in the country, they comprise 5% of the country's total GDP. All of the money that we essentially generate and spend across the span of a year. We also need to recognize as we've talked on here before that by 2030, 70% of Americans will be Medicare eligible. So if anything, what we see over time is that more people are carrying insurance, more people have nicer insurance, whether they're paying for that themselves or whether they're just being provided nicer insurance through their employer and that more and more Americans are also going to be carrying Medicare insurance as they turn 65 or whatever that age becomes over the next couple years. So why are we unlikely to see a significant shift in payment methodology in physical therapy or in health care in general? Look at all of that money, right? If we include all the other health insurers, we're looking about one-tenth of all of our money coming and being generated by health insurance providers. If we include what's being spent on health care, both through insurance and through private pay, that is beginning to comprise almost a quarter of our economy. What does that translate to practically? What can we glean from that? It really says that the chief product that the United States produces is sick, injured people in pain, and that our primary export is dealing with the subsequent secondary issues that come with a sedentary lifestyle that produces really sick people. So I think we're really unlikely to see things shift because a lot of people are making a lot of money either being on the health insurance side of the equation or being on the health care system side of the equation. And I think we are living in denial if we don't think that those giant companies that are making half a trillion dollars a year aren't making sure that some of that money goes to lobbying members of Congress to make sure that there are laws that r