Physio First gets face-to-face with international colleagues to talk about value
Physio First, the professional network of the CSP representing physios working in private practice, attended a hybrid meeting in September alongside representatives from private practices in 17 different countries.
IPPTA is the subgroup of World Physiotherapy that represents the interests of private practitioners in members’ countries. In Helsinki, Finland, the focus for the business meeting was to concentrate one of the main IPPTA strategic goals, which is “to help private physiotherapy organisations help their members to determine and compete on quality and evidenced based value.”
The variations in travel restrictions and vaccine status meant that the following countries were in the room: Belgium, Netherlands, Switzerland, Finland, United States, UK, Denmark and Ireland; while other member countries joined by electronic platform, including: South Africa, Spain, Lebanon, Colombia, New Zealand, Namibia, Australia, Iceland and Germany. Apologies came from Canada, Malta and Malawi. Very careful planning and technical know-how from some of the IPPTA executives, plus the dedication of members to defeat the time zone differences, led to a great meeting. It was clear that we are “far more united than the things that divide us”.
In order to achieve the IPPTA strategic goals, the gathered representatives had to share and discuss such marketplace and professional differences across the world as –
- Direct access for patients
- Autonomy of diagnosis and decisions re treatment pathways
- The position regarding remote consultations and treatment post pandemic
- How is treatment funded? The different government and insurer models and the percentage or popularity of self-pay options
- What outcome data is collected, how it is collected, who owns it and how should it be used to demonstrate value?
The number of comparisons, differences and situations are too great to explain in brief, but it is clear that following these discussions the UK representatives feel very lucky to be physios in this country. In the UK, physiotherapists are autonomous practitioners and can diagnose and discuss with their patients the treatment plan and the way forward. Even the constraints coming from some large private medical insurers which include the stark aspects of a prescribed number of treatments and a fixed price do not, by and large, dictate treatment pathways.
What physiotherapists find difficult to do in this country is effectively demonstrate “value” or “cost effectiveness,” as all private practitioners can charge their own fee structure for their self-paying patients and conduct their own price agreements with insurers or other intermediaries or contractors. Physio First does not collect cost data from its members so this part of the “quality equation” is difficult but most definitely not insurmountable.
Of course, Physio First does collect outcome measures from members using a standardised data collection tool which is an anonymised dataset collected and analysed by third-party partners, the University of Brighton, and where members are successful, awards Quality Assured Practitioner or Quality Assured Clinic status. This tool includes both validated PROMS and PREMS and as the analysis measurement for the quality kitemarks does include number of treatments in its equation, this is the key to Physio First’s analysis of cost effectiveness or value of any single treatment episode.
Other countries with systems that are different, especially where they can more accurately determine cost data, are now beginning to think about how they can demonstrate the value of private physiotherapy interventions in many ways. The most notable of these studies has been carried out by The Australian Physiotherapy Association and published in its paper of 1 October 2020: “The value of Physiotherapy in Australia.” To find out more about this paper, read it in its entirety or watch a short explanatory video visit www.australian.physio/economic-value.
APA summarised it as follows: “The study found that treatments by physiotherapists deliver both health and economic benefits. Interventions are clinically effective and deliver net economic benefits, with quality of life improvements exceeding treatment costs.”
Other golden thread topics discussed at the IPPTA meeting included the emergence over the last 12 to 18 months of larger chains attempting to buy large numbers of clinics, something that the IPPTA delegates globally are calling the “Starbucks effect”. This is something worth watching for in the UK, but the presence of the NHS and the patient choice element of self-pay probably mean that our diverse private clinics are less likely to fit this model, but time will tell.
The final ‘wait and see’ issue discussed was the future of remote consultation and treatment. We know that in the UK many physios adapted to this form of treatment during the various lockdowns and some have continued in small number and many more as an option for the patient especially as a check-in following a course of face-to-face treatment. We do know that the majority of private practitioners have returned to face-to-face, which has led to some criticism for not embracing remote consultation in a bigger way and seeing it as the longer-term future for physiotherapy, as it perhaps is seen as the way forward for some sections of the NHS.
From the meeting’s global discussions it seemed that all countries reported a return to face-to-face consultation as the preferred option for their patients. The trend from global funders seems to be to pay a fee equal to or slightly less than the fee for face-to-face sessions. There is also a growth in the number of companies setting up in many countries just as telehealth providers of physiotherapy alone. We know these exist and some are very successful in the UK so once again it is “wait and see” as to where the market forces will take us.
What is interesting is that all delegates agreed that ultimately, whether patients self-fund or choose an insurer, it is the detailed outcome and value data provided by the physios and the patients that will decide what sort of physiotherapy they are prepared to pay for in whatever form it is purchased.