Barry Olsen, the Director of the Rehab Institute of Montana
How do you believe the Affordable Care Act will affect the quality of care?
"The goal is going to be to obtain quality of care and reduce costs and keep our costs down, so our cost to deliver the services don't exceed the reimbursement that we receive."
Do you think patients will have to drive to Spokane or Boise?
"No, I don't think they will have to leave the state, but what you are seeing is: visits are going to decrease.
Instead of seeing a physical therapist for multiple treatments, it might be a few treatments to obtain what they need and minimize it and do more independently at home, so we will see the frequency decrease."
Will time with the therapist decrease?
"It's definitely a concern, as far as the cap on therapies that's allowed that we are going to struggle with, as far as reimbursement in the future."
Will I be able to see the therapist that I have been seeing?
"A lot of that is going to come down to the plans they have because there are definitely alliances with different associations, so people may have to stay within their plans.
If they go outside their plans, then the amount of expenses to the employee can be higher, and so people will self select and choose where they are going to go."
What about closing down certain specialties?
"We don't anticipate that at all. I think our goal and challenge is going to become as efficient as possible to still be able to offer the services that the patients need."
What about across the nation?
"There's definitely .... the independent hospitals will struggle that are not tied with large organizations that might have more financial backing. So, nationally you see a trend that there are some hospitals that would close. We don't anticipate that at all In Missoula, but you will see that, as well as some clinics too, who can't afford to take on the additional expenses to run the business you are seeing, reimbursements not keeping up with the expenses to deliver the services. It's a challenge nationwide with the service industries beyond just the therapies, but all medical industries."
What are your patients saying?
"One, is this going to be reimbursed, is this going to be out of pocket, and then, how long can they continue services.
What you are seeing nationally is people's deductibles are increasing. So, before insurance plans will kick in, you are seeing patients self-select to not receive the services, especially if they are elective surgeries or services.
They are waiting to receive services until they meet the deductible. So, you are seeing a lot of people who need services, but they are choosing not to get the services because they can not afford to pay."
"A lot of the elective proceedures, which can be a lot of the surgeries that are not urgent, that are not needed right now, they will postpone the surgeries,
they will postpone therapies, waiting for that deductible to be filled."
What kind of effect does that have on your body?
"In delaying any service... it can have an effect. The push right now is for wellness.. So, if you are postponing things to prevent, to maintain things and catch them before they escalate and become too bad, it's definitely going to have its impact on the patient. you want them to get the service as quick as when they need them."
"Unfortunately to get the quality... technology changes to fast, so the expertise to get that and the education is extremely expensive, so the labor to generate or provide services is very expensive, and yet, the reimbursement is so poor, so it is a challenge for us to provide the best care and the quality at the level you need, and yet, how to do that in the most economical way is definately a challenge and we are meeting it head on and hope its successful.