When I moved back to California from Vermont in 2004, and began to look for a Physical Therapy job, I was surprised by how little time potential employers expected me to spend with patients. Often they allowed no more than 15 minutes with a patient.

When considering the paperwork involved with each patient, that would have been something like working in a mill. Basically, check in with the patient, then do whatever would be minimally necessary to hand them off to an aide.

Fortunately, I was able to find a clinic that held to a strong philosophy of effective patient care, and thus was able to avoid mill work.

Therapists treating many patients per hour are typically "in-network providers". That is, they've negotiated a billing rate with one or more insurance companies, and as a result must sustain a high patient turnover rate in order to remain afloat. This is burdensome for both the therapist and the patient, and the effectiveness of such treatment seems questionable.

One way for a practice to avoid a mill situation is to bill the patient's insurance as an "out of network provider"; any amount not paid by insurance is expected to be paid by the patient, including any charge added to cover the cost of the billing specialists. However, there is often significant lag time prior to being reimbursed with this model, and insurance companies often employ delaying tactics to deny reimbursement to the therapist for as long as possible; it's obviously difficult for anyone to not be paid for an indefinite period of time.

As a sole practitioner interested in providing the best possible care to my patients, neither of these approaches seems to be viable. I've elected to go with a third, simpler approach.

I treat patients one-on-one for a full hour, without the use of an aide; this level of care, in my experience, allows patients to get better faster with fewer visits, thus improving their quality of life more rapidly.

I accept payment from the patient at the time of service, and provide a written statement. The statement, along with any necessary additional documentation, can then be submitted by the patient to their insurance for reimbursement.

In this way, I can focus on what is most important: caring for my patients, and providing a customized treatment approach that addresses individual patient needs and goals.