Problem 1: The Client’s experience: A conflict of interest
I was asked recently by the organising committee of the 2017 ESSA (Exercise & Sports Science Australia) Business Forum to deliver a keynote presentation on the topic of outcome based clinical practice.
POGO Physio is Australia’s first practice to offer fixed fee and unlimited access physio programs with our Finish Line™ Programs. As a result POGO Physio is enjoying increasing attention from not only savvy healthcare consumers, but also leading healthcare organisations such as ESSA.
My presentation was titled ‘Stop selling time and start selling outcomes’.
In the presentation I shared 30 problems of selling time.
Here’s the first problem with selling time rather than clinical outcomes, as experienced by the healthcare consumer.
Selling time creates a conflict of interest
While I rarely believe that physiotherapists have anything other than the client’s best intentions in mind, the very nature of ‘the game’ is such that even if the physiotherapists intentions are nothing but client-directed best care, the perception of the client on learning what is required for rehabilitation can be that the physiotherapist unnecessarily wants me to keep coming back for ‘the sake of it’.
The client’s perception of such time based session to session delivery of care can be one of ‘the longer it takes to get a result the better for you’ (ie. more income derived off my treatment), and the worse for me (‘Im paying for the service’).
Hence while no physiotherapist’s want to see their client’s delayed with their progress, the sad irony of this conflict of interest is that the physio’s recommendations will often be ‘diluted’ from what the ideal treatment recommendation would look like.
Consider the client with an injured knee who is trying to run a marathon several weeks. The client’s condition may very well warrant hands on manual therapy and progressive exercise programming performed on a daily basis. However the industry norm with such a client would be perhaps two treatments per week for 2-3weeks. Why such a treatment recommendation? The physiotherapist would typically recommend this based on the fact that one treatment alone will not suffice in order to achieve time effective rehabilitation, and yet doing more than two treatments in a given week may be viewed as cost prohibitive for many clients.
Hence the physiotherapist has succumb to the conflict of interest where the client could really benefit from ‘x’ recommendation (truth), such as ‘come every day this week so we can get on top of this quickly’, but they have been advised of a lesser treatment schedule eg come twice this week, as the physiotherapist has feared that the client would perceive their recommendations as unnecessary or even greedy.
In the end the client likely opts for the twice per week model, taking longer in rehabilitation with an ultimate lesser clinical outcome or success of rehabilitation.
Physio With a Finish Line™,
Brad Beer (APAM)
Author ‘You CAN Run Pain Free!’
Founder POGO Physio
Host The Physical Performance Show