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Practice Owners Should Take Notice as ACOs Grow

The movement to make health care more affordable to patients is actually a profitable proposition for physical therapy practice owners who take advantage of a key trend.

The concept of an accountable care organization (ACO) established by the Affordable Care Act is an important opportunity for physical therapists, who share the goal of eliminating waste, unnecessary physiological care and duplication of services.

Julie Marley, PT, Dip. MDT, is one of a rising number of physical therapy practice owners taking advantage of this trend. ACOs are collectives of health care providers - physicians for the most part. Physical therapists can benefit as ideal targets for cost-cutting referrals.

"ACOs are a rapidly growing part of the health care marketplace," says Marley, owner of SOS PT in Delaware. "There are often more than 200 new ACOs created annually."

California, Florida and Texas are among the leaders in growth of ACOs, which now exist in every state. Some 5.3 million Medicare recipients used an ACO in 2015 and the government program plans to shift 80 percent of its payment toward alternative care by 2018, Marley says.

"This has significant potential to affect private physical therapy practice owners," Marley says, noting more than 12.9 million people are currently enrolled in private ACOs. "Physicians in ACOs are interested in referring to practices that have good outcomes with their patients, thus saving money.

Unlike the health maintenance organizations (HMOs) of yesteryear that shared the cost-cutting ideal, ACOs do not require a primary care "gatekeeper," which diminished freedom of choice. In an ACO, patients are guided to less-expensive in-network providers, but not required to see them.

The ACO model rewards private practice owners for minimizing costs. Providers can earn bonuses based on the savings, but also take a loss if care exceeds the budget.

"If the patients get better with physical therapy, they will not go on to utilize more expensive interventions, such as imaging, injections and surgery," says Marley, who practices the McKenzie Method® of Mechanical Diagnosis and Therapy® (MDT).

Patient education and self-treatment, along with the consequential cost savings, are at the heart of MDT.

The evidence-based MDT patient management system begins with a thorough mechanical analysis to establish a "cause-and-effect" relationship between historical pain behavior as well as the response to repeated test movements, positions and activities.

A systematic progression of applied mechanical forces utilizes pain response to monitor changes in motion and function to classify the disorder. Clinicians then develop a plan of care that empowers patients to treat themselves when possible.

"Well-trained, skilled MDT therapists can have a substantial impact on the cost of care, patient satisfaction and lower utilization of health care resources," Marley says.

For practitioners of any method of physical therapy, the ACO market offers a largely untapped referral source. MDT practitioners are particularly attractive as they are generally able to treat patients in less than half the national average of physical therapy visits.

Marley recommends seeking out ACOs in the local market, attending member meetings and using that as a conduit to build rapport with the organization's primary stakeholders, namely physicians and business people. It helps to come armed with hard data that shows success within your practice, so start collecting empirical proof if you don't track it already.

To learn more about the McKenzie Method and how it can help gain more ACO referrals for your practice, visit

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