In healthcare, there are many instances of great value. An excellent nurse, a dedicated primary-care, a skilled physical therapist, or any other provider can all deliver strong return on investment. But value has come to mean something different than helping patients achieve the best outcomes: our system right now prioritizes (and has become very effective at) finding opportunities for clinicians to bill lots of service units, and the cost has been fewer chances to genuinely impact those they serve.

It’s crucial that PTs understand the concept of value in healthcare and that our peers know what we can do. All of our roles are evolving in a system which is itself far from static, and while the scope of what PTs offer relative to what they cost is favorable by a wide margin, utilization can be improved.

We have some strong and timely factors on our side. Prevention is less expensive than treating disease, from pain to obesity, after it’s progressed. Conservative intervention is more sustainable and accompanied by fewer consequences than invasive treatment. Recent changes in academic training mean that PTs bring meaningful expertise at low cost relative to skill.

Any year’s CDC data for chronic disease incidence make a case that prevention has been so far unsuccessful. We run the risk of payers misinterpreting prevention as cost-ineffective, but they should instead see an opportunity to expand the roles of providers who are well-trained in conservative interventions. With a massive and costly burden of diseases amenable to lifestyle change, if the real goal of our healthcare system is to improve the wellness of the people who interact with it, it makes sense to encourage the things we know they need.

The fee-for-service model’s emphasis on passive involvement from patients is a major source of healthcare’s trouble: come in with a complaint, receive some treatment, repeat. Providers don’t set out to enable poor decision making, but contend with culturally ingrained demands for quick-fixes that trivialize effort and accountability, and sometimes face pressures themselves to solve problems in certain ways.

Because of fee-for-service, our system has relegated cheap, conservative treatments which help the whole person to a lower tier of importance. This is a mistake, and a legitimate criticism of the business-like organization of healthcare. PT and lifestyle intervention can produce great impact at low cost, but are not reimbursed like surgeries or hospitalizations. Low cost should be the major strength of PT, but when hospital systems need to maximize revenue to stay competitive, a strength becomes a barrier.

One great appeal of rehab medicine is how different it can be from other healthcare services. Patients’ outcomes depend more directly on their effort; they can see and feel progress if they’re engaged and won’t improve if they expect a passive relationship with their own health. Just as we expect active involvement from our patients, we owe to our system active demonstration of the value we can add to it, particularly in the care of patients with chronic disease.

The scope of physical therapist practice has expanded immensely and PTs are a bargain right now, but patients, providers and insurers don’t always know it. For payers, this should be seen as a market inefficiency and a case for greater utilization. One demonstrative example is the widely variable management of back pain: a patient with a herniated disc might end up at their PCP’s office, with a physical therapist, with a neurosurgeon, in a pain clinic, or somewhere outside of the healthcare system entirely.

Despite no shortage of data illustrating the best course of evaluation and treatment, this haphazard process continues. For example, in many cases of back pain there is no indication for costly and invasive spinal surgery over PT intervention. But surgery is passive, which appeals to some patients. And hospitals are reimbursed huge sums for those procedures, which appeals to those whose focus is the financial statement.

The problem is not lack of knowledge, it’s absence of incentive to choose the best thing for the patient and the best thing for the entire system of healthcare financing. Under a value-based payment structure, this will change.

There are so many instances beyond outpatient orthopedic care where PTs can deliver great impact: early intervention in the ICU, assisting in the diagnosis of a movement disorder before functional limitation, outreach programs to help maintain independence or engage with patients affected by chronic disease.

We need to continue to demonstrate our cost-effectiveness, but also to position ourselves to implement these high-value programs. We have few barriers to streamlining referrals for diagnoses that are already understood as PT appropriate, like back pain. We should advocate for prevention initiatives focused on the chronic conditions where lifestyle modification can be highly cost-effective. We can participate in policy change and model best practice in terms not only of patient outcomes, but of value to a healthcare system that is starved for it.

PTs won’t solve healthcare problems alone, but are positioned to contribute meaningfully to the solutions this system needs. We have some responsibility to advocate for greater involvement in areas where we can better help patients than more costly alternatives. We need to refocus our advocacy efforts towards better understanding of what we do and how impactful it can be for patients relative to what it costs. If we don’t, we repeat a problem already too common in healthcare: addressing symptoms, like Medicare’s therapy cap, rather than meet them at their source.