Where has quality spine treatment gone?

Where has quality spine treatment gone?

As I look back at my career treating spine, scoliosis, and orthopedic problems here in Utah I am disappointed with the direction that most physical therapy has taken, esepcially in the spine realm.  Things have definitely changed, and they continue to change, and not for the better in most cases. 

For those who don’t know what I am talking about, let me explain.  There is a lot that goes into this, so please bare with me as I lay our what I have seen over the last 20 years in physical therapy, and where I see things going.  

Currently, I am sitting on a flight from Costa Rica to Fort Lauderdale.  As we all know, air travel has changed a lot over the last 30 years.  It seems all airlines have looked to improve their profit margins by shrinking seats, offerring less complimentary items, and gererally doing less for the customer.  

I know I have seen this when trying to save money on flights like Spirit or Frontier.  Those budget airlines are definitely cheaper, but you get what you pay for.  You still get from point A to point B, but you definitely have to plan ahead, and you might not get there quite as comfortable.  Most of the time, none of their seats recline AT ALL.  

Contrast that to the JetBlue flight I am currently on.  We got a good deal on this flight, and so I am really surprised to see so much value in this flight.  We get complimentary soda and snacks, free wifi, in-flight entertainment, and the seats even recline!  It is like the good old days of flight.  

The flight attendant was also one of the best I have had in a long time.  He took the time to look up our names and was really helpful and cheerful.  Such a difference from many of the flights I have been on in the past couple of years.  

So, why do I mention this?  How does it relate to spine treatment and physical therapy?  

The fact that this flight wow’d me is striking because it has almost become the exception rather than the rule.  We used to have better customer service on flights and we use to be treated differently.  It was refreshing to me to see that it can still happen without paying out the nose for it.  

In Physical Therapy it is very similar.  Back when I was in college, the PT world was a bit different.  It was more personal, more hands on, and more an art.  We didn’t have insurance dicatating what treatment could and couldn’t be provided.  That was up to the provider! Shocking, I know.  

The current environment with physical therapy is one where multiple patients are being seen at the same time, treatment is being provided less and less hands on, and most patients don’t see the same PT each time they come in because they are too busy.  It is actually abnormal for the receptionist or PT for that matter to know your name when you go in for your treatment session.  

The quality of treatment has also reduced. Because of the restrictions by insurance on what we can do and get paid for, many providers let this guide their treatment regimen.  If a patient would benefit the most from Dry Needling for their sciatica, but the insurance doesn’t pay for it, then they either have to pay out of pocket for it (which actually isn’t too bad), or do something else.  Most PTs, not wanting to make their patients cover the cost of treatment, will just default to what the insurance will pay for. 

(And the BIG SECRET…..this isn’t just happening in PT)

So, what is driving all of this?  This is an easy answer with a perhaps complicated explanation.  Here goes. 


Yep, that is right, finances are to blame.  Specifically, health insurance reimbursement that is reducing over time has driven a need to cut costs wherever we can. This cost cutting happens with employing more non-professional staff to provide treatment, because they are less expensive…not doing treatments that would get people better faster, because the insurance won’t pay for it…and many others.  

Think about it.  If insurance reimbursement is going down, but inflation keeps going up, and the cost of EVERYTHING is more expensive, and a PT clinic owner has to pay their therapists and staff more (most of you probably got a raise over the past couple years)…..but what we are paid for our treatments GOES DOWN!!  How does that make any sense, first of all? And! How are we supposed to deal with that?  

Most clinics increase the number of patients they see at one time to compensate for this reduction in reimbursement.  Because of that, the quality of each treatment goes down because it is not one on one with the therapist.  This results in taking longer to see the results you are looking for, and more out of pocket expense for the patient.  

It also doesn’t really leave any excess to give the patient a good quality experience.  We all want a good experience, right?  

So, we have gotten to this point and I haven’t even talked about the “quality” of spine specific treatment.  Well, in this scenario, the quality is reduced because of the volume of patients that is needed.  You CANNOT give high quality treatment and customer service, with a high volume practice where you are one of 3-4 people being seen by the same PT.  It just can’t happen. 

Taking time out of that busy schedule to really go search out what is best for patients is also challenging.  And, even if you did, when would you have time to implement it? 

What to do???

When I founded Align Therapy in 2015, I wanted to change this trend.  We started out with TRUE one on one treatment where the therapist is with the patient for ENTIRE treatment.  No aides or techs.  This preserves the quality of our treatment. 

I also wanted to do treatments that have really been shown to be effective.  This involved getting specific training in Scoliosis Specific Exercise, along with other spine treatment techniques to provide the best treatment possible for our patients.  

Then, I decided to not play the game with insurance companies.  Yes, we do take some insurances, but those are the ones who will pay us enough to spend that one on one time with the patient, and who don’t restrict how we treat our patients.  

Yes, it is a struggle sometimes when someone finds out we are out of network with their insurance, but we try to explain this is because we are not willing to compromise our treatment quality or effectiveness.  Being out of network allows US to decide how the patient should be treated.  After all, isn’t that why you would be visiting us?

Honestly, most of the time, with deductibles as high as they are, most insurance patients are “self pay” anyway, unless they have something large happen.  If you are paying that much for treatment anyway, wouldn’t you want it to be the best quality, and be the most efficient?  

Just a thought! 

One final note on insurances.  I think we have all seen our deductibles and premiums go up.  This is not something new, but it seems to be accelerating.  It definitely won’t stop.  This is all happening when insurance companies are posting RECORD profits!  

Seems kind of backwards to me.  They reduce the quality of treatment by reducing reimbursement and denying treatments and claims, and then they get to pocket it?  That is not right.  Shouldn’t that be given back in lower premiums? 

The truth is, most of these large insurance companies are publicly traded and need to increase their quarterly earnings to satisfy their investors.  I will let you connect the dots on how they do that.  

So, the moral to the story?  If you want good quality spine and physical therapy treatment, it is still out there, you just have to look a little harder for it.   

Just like this flight i am on, you can also be surprised that there is good customer service still out ther.  They will even call you by name and give you a treat or snack (we do at my clinic). 

If you are looking for quality treatment, please don’t hesitate to reach out.  I would love to show you what we can do, and I know you will have a top notch experience.  

We actually guarantee it!  

Thanks for reading!

David Butler, Physical Therapist.

Who We Help At Align Therapy

At Align Therapy, we understand that every single person’s problem is unique, which is why our first step is to get a deep understanding of what is happening to your body, and how it is effecting your life so we can create a plan that focuses on YOU and your goals.
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David Butler PT DPT

David Butler

Align Therapy

"We help people with scoliosis and spine problems avoid surgery, reduce pain, and improve posture even if you have been told to wait and see if it gets worse."
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