MICHELE NORRIS, Host:
From NPR News, this is ALL THINGS CONSIDERED. I'm Michele Norris.
MELISSA BLOCK, Host:
As NPR's Joshua Brockman reports, some patients and practitioners are increasingly frustrated with what they see as a focus on the bottom line.
JOSHUA BROCKMAN: Last summer, 32-year-old Rebecca Neusteter went out for a leisurely bike ride. But she fell off her bike and shattered her knee. It required surgery, the kind where doctors insert a metal plate and eight screws in order to put the pieces back together.
NORRIS: And so when I was discharged, I couldn't really leave my house for a while. I was in bad shape.
BROCKMAN: Neusteter couldn't walk, so she needed physical therapy twice a week in Washington, D.C. But Neusteter is still paying a high price for her therapy. She pays $140 out of pocket for each weekly session.
NORRIS: And she doesn't process insurance herself. So you have to pay out of pocket to see her. So it gets to be like, pretty much a financial hardship.
BROCKMAN: Neusteter gets about $100 back from her insurance company for each visit, after meeting a $550 annual deductible. But, she says, she's willing to pay so much because the stakes are high.
NORRIS: Stand up for me, Rebecca. I want to watch how you're walking today.
BROCKMAN: Rosalie Begun is Neusteter's therapist. She's had her own practice for more than a decade. And she says she doesn't take insurance because it would compromise patient care.
NORRIS: And I have found in my practice that my patients get better faster, and require fewer visits, when they can actually have more time and more care. If insurance reimbursement was better, then therapists could spend more time with their patients.
BROCKMAN: Neusteter's hour-long session with Rosalie Begun is anything but rushed. It's a focused, one-on-one as Neusteter steps onto two circular discs loaded with ball bearings.
NORRIS: So first your knees, your knees are going to be straight. You're going to stand up tall. And you're going to use your hip muscles to turn your feet out, and then come back to parallel.
BROCKMAN: Rosalie Begun is Rebecca's sixth physical therapist. Neusteter says she walked away from the others because she was often rushed in and out.
NORRIS: Their office really felt like it was run as if it were a business. They have half-an-hour sessions, and they back other sessions immediately before and immediately after.
BROCKMAN: Across town, at the National Rehabilitation Hospital, Eve Bulford is warming up on a machine you pedal with your arms. The 28-year-old is also getting one-on-one attention. But she's not paying a dime. That's because of workers' compensation.
NORRIS: I was injured doing a drill at fire academy, where I had to jump out a window, a second-story window, head first onto a ladder. And the idea is to save yourself in case the room is going to flash over.
BROCKMAN: She saved herself, but she dislocated her right shoulder, tore some cartilage, and knocked some bone off to boot. Bulford is no stranger to physical therapy. But in the past, she says she's had to make hefty co-payments - up to $40 per session.
NORRIS: And with two or three sessions a week, it added up to quite a bit.
NORRIS: As in any business, the more customers you see, in this case the more patients you treat, the more income you can generate.
BROCKMAN: Scott Ward is the president of the American Physical Therapy Association. He says insurance company regulations and policies essentially force physical therapists to see as many patients as they can.
NORRIS: Frankly, I think the biggest challenge - and likely, the biggest frustration - are these regulations and policies associated with payment and care.
BROCKMAN: Susan Pisano, a spokeswoman for America's Health Insurance Plans, says it's a dilemma caused by the rising cost of care in the U.S.
NORRIS: Our members are trying to do the best they can to serve consumers and employers who are saying, we really can't absorb any more cost increases.
BROCKMAN: Joshua Brockman, NPR News, Washington.
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