There are a couple of ways a PT can build a good healthy practice. One is treat everyone like gold and they in turn refer all their friends to you. Another is to try to funnel patients into your clinic whether they want to be there or not. Here’s how that works right now in Canada.
Large corporation preferred provider networks in Canada
Large corporations own physiotherapy clinics across the country. These corporations have agreements with insurance companies to be a part of their preferred provider network (PPN), offering to provide service to their customers. Now the people in charge of these large corporations aren’t always physiotherapists, but sometimes they are. The ones in the dual role of physiotherapist / business executive are faced with a dilemma.
First of all, they have an obligation to help their company maximize profits. That’s exactly what they should be doing. But they’re also faced with obligations to their profession and adherence to Standards of Practice. Many Colleges have Standards that require disclosure of referral networks to the patient to avoid a conflict of interest. Can you see the dilemma they’re now faced with? Profits over professionalism. Here’s how that leads to the stealing of patients.
The Science of theft
If you’re one of those physios in a senior position with large company, you will have nicely distanced yourself from the site of the theft. You will have made sure that a non-regulated administrataive person will be put in charge of the process. Here’s how that works:
As the company executive, you meet with a representative of the insurance company and they dictate to you the terms they want you to follow for the agreement. Once you sign that agreement, that insurance representative goes to their department heads and filters the information down to the call centre and adjusters.
The call centre telephone operators now have a script to follow and an imperative to try to book all their injured clients with the PPN. Knowing how data works, you can see how easy it would be for the company to provide their call centre operators a monthly score of how they're doing. One can imagine that they might set a goal of, say 85% of all patients booked with the PPN.
The call centre operator will be under pressure to meet that goal, and they are now tempted to use coercion and misdirection to avoid a poor performance review with their manager. (Remember, they are not regulated by the physiotherapy College. They are only responsible to their company.) This makes sense from the company's point of view. But the company doesn't think about it deeply the way they should. They don't see the whole picture the way a physiotherapist would.
What the company should really do is first of all determine whether the client already has their own family physiotherapist . Because we know that if you have a family physio, there's a very good chance that your physiotherapist knows you well and can provide the best treatment to you. There is ample research that supports that working with a physiotherapist you trust produces better outcomes. (1)
The insurance company should want you to get the best treatment, and if that's with your own physio, they should encourage that. They should really only step in and offer one of their PPN clinics if you don't already have a family physio. But that's not how it works. And so the large corporation physiotherapist / business executive who made the agreement with the insurance company is very nicely distanced from where this stealing of patients is occurring. They are so far removed from it that they don't have to think about it, and they don't feel a professional obligation to interfere with it.
In order to avoid a poor performance review, the call centre operators that Canadians contact to report their car accidents are under pressure to funnel patients to the PPN. Here are some ways that the call centre staff use misleading information or coercion .
“They made me feel like they might not approve my claim unless I go to their recommended clinic.”*
“They told me I should go to their preferred provider clinic because they can directly bill us.” … without then letting the patient know that any Physio clinic can directly bill them.*
“They told me that the clinic I chose is new and probably started by new graduates. They told me I should go to one of their preferred clinics instead.”*
(*comments made by actual patients)
That's a summary of how to steal patients. Someone makes a decision in the boardroom and distances themself from the day-to-day activity. In this way they can ignore their professional responsibilities. Then they hope that the physiotherapists they hire to see the patients don't think too deeply about it, and go along with the plan.
The Art of professionalism
Here's what you can do if you're a physiotherapist in a PPN treating patients who are only seeing you because they have been made to feel they have to.
When you're doing your assessment, start by asking "have you ever had Physiotherapy before?” In fact that's a question you should ask every patient you see. If they say yes, ask them then if they have a physiotherapist that they like to see. If they do, you should then ask them whether they would like to continue their care with their own physiotherapist.
When I worked for a large corporation and asked this question, the patient might say “well yes, it's more convenient to me to see my own Physio.” And then I would tell them, “no problem, let me finish your assessment today and then I'll send all your notes and the report over to your own Physio and they can carry on from there.”
This takes a bit of courage because your clinic manager may question you as to why you are turning away patients that the company has worked hard to bring in to your caseload. You'll have to think of your own answer for that. Maybe you'll use the evidence:
Disclosing a preferred provider network is often mandated by your college
One physiotherapy College in Canada has this to say about physiotherapists working within preferred provider networks:
If a preferred provider relationship exists the physiotherapist should disclose its existence, the nature of that business relationship to [the patient], and explain how they are managing the potential conflict of interest (2)
The Ontario Physiotherapy Association says it this way:
The OPA cautions members who participate in a preferred provider network to ensure that they have fully disclosed the relationship to the patient and obtain consent before conducting an assessment or initiating treatment.
If you work in a PPN and you don't tell your patients this directly, you are likely in breach of college standards.
Doing the right thing is hard, but right
It's hard to verbalize why you are doing the right thing over following company orders. But make no mistake, that's a good practice to get into in life - doing the right thing in the face of corporate pressure. Otherwise, you're just stealing patients.
Here are some social media-ready images for you to post on your clinic’s account. Let’s educate patients that they have a choice.
Sources;
Bernhardsson, Susanne & Larsson, Maria & Johansson, Kajsa & Oberg, Birgitta. (2017). “In the physio we trust”: A qualitative study on patients’ preferences for physiotherapy. Physiotherapy Theory and Practice. 33. 1-15.
https://www.cpta.ab.ca/for-the-public/blog/do-i-have-to-use-my-insurances-preferred-provider/
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