Facing the uncertain world of health-care reform, Blaine Stimac, a physical therapist and owner of Professional Therapy Associates, ignored the trend of health-care providers fleeing private practices for jobs in a hospital setting.

“We’ve grown to four locations, we employ 13 physical therapists and we’re actually trying to expand,” he said. “We just expanded with two additional clinics that we will be acquiring in Lakeside and Polson here in the next month.”   

Stimac followed this path with his eyes wide open about substantial challenges ahead: reduced reimbursements, the potential insolvency of Medicare, competition from larger hospital groups with built-in patient referrals and physical therapists needing higher starting salaries to pay back $100,000 education loans.

Rather than looking to sell his practice, Stimac decided to embrace reform with a simple philosophical concept — excellence in physical therapy and business practices.

“We have to be so good that we could go cash,” he said. “People would be willing to come and pay us to work on something because we are that good.”

According to Stimac, that would transpire only if Medicare and insurance reimbursements dropped so low that a practice would have to become a factory or assembly line, treating such high numbers of patients that quality becomes compromised.

Stimac said he hopes never to confront a need to quit accepting insurance.

“The reality is if we prepare for that and it doesn’t happen, anything we gain is going to make us that much better,” he said.

His vision began evolving after about six years of private practice. Stimac said he got past the honeymoon excitement of establishing his own practice and began getting beat up by the non-patient-care side.

“I realized that I wasn’t a very good business owner even though I was a good therapist,” he  said. “So that led me down a path of trying to go back and study business.”

When Stimac got up to speed on good business practices, he also became involved in his profession at the state and national levels. He gained a view of what was happening in other areas and was coming to Montana.

“It’s going to get a lot harder to stay in private practice and stay successful,” Stimac said. “It was the start of me deciding that we were going to need to change, evolve and maybe considerably.”

His larger view was that health-care trends of the last 10 to 20 years were unsustainable, which is why health-care reform became an issue. Stimac views rising costs as a symptom of a system that doesn’t work well, beginning with health insurance.

Stimac said health insurance only works if you have many more healthy people than sick people in the pool paying premiums. He said the system now has too many people with health problems.

“That’s because of our lifestyle,” he said. “There are many statistics to support this.”

Insurance companies responded to shrinking profit margins by raising premiums and cutting reimbursements for the last 20 years. Stimac said that reimbursements rather than the best medical care then began driving medicine.

“No model can provide a significant amount of something at a loss and expect to survive,” Stimac said. “So usually you are going to start shifting to procedures that pay. That’s the basics of it.”

He added that technology and advancements, while a good thing, have added more to the health-care menu and have extended life spans. Stimac called it a double-edged sword because it also drives up costs.

“I believe we could solve the health-care problem is we could find a way to pay for outcomes,” he said. “I believe there is an enormous amount of waste that exists in our current system.”

According to Stimac, efficiency lies at the heart of fixing the system. Part of fixing it requires balancing the three prongs of the system: the person receiving the care, the provider giving the care and the business paying for the care.

An ideal system has the person receiving the service paying for the service and not returning to a provider not giving good service.

“When someone gets care without having to evaluate the effectiveness of that or look at the effectiveness, it allows for the violation of the most basic concepts of competition,” Stimac said.

Referring patterns only add to the problem, with patients going to providers referred by an organization connected to those providers rather than because they do the best work.   

He said cost containment makes sense and some parts of those attempts make sense. The federal Affordable Care Act has driven private practices to become part of large health-care organizations for efficiency.

“The problem is that it does not breed success. It does not breed that the best are the ones who become noted and excel,” he said. “It becomes a system. It has a chance to not work as cleanly as something that is a little more tailored.”

Stimac said the insurance model now pays for time spent with a client or procedures performed, regardless of the outcome. He said in the same industry, some excel more than others and the system needs to reward those or the most skilled eventually leave.

He said the intentions of the reform law were good but he doesn’t believe it will accomplish what it sets out to do. Stimac said pilot projects such as bundling just try to pay less for a whole lot more care, not better outcomes resulting in fewer visits.

“If I were running an insurance company, I would want to find those providers that are the best out there and I might even pay them more,” he said.

Medicare now has a program where it pays a very small amount more in reimbursements to providers who submit outcomes. But Stimac said the amount is only about 0.5 percent.

“Medicare is a prime example of an insurance company that has made many attempts to correct problems but rarely do their solutions actually produce the intended results,” he said.

Stimac said most in the medical community, including himself, still have no clear understanding of the Affordable Care Act. He said he believes it must create a system between the consumer, provider and payer that breeds excellence and efficiency.

“If the Affordable Care Act cannot do that, then we need to scrap it and go to the next reform model,” he said. “Whatever we pick as a reforming model, we need to make sure that the fundamental things that are needed don’t change.”

It comes down to a universalized system or an improved private sector system, he said. His business has geared up to serve the later.

Because Stimac’s Professional Therapy Associates has no direct affiliation with a hospital or clinic treating injuries, the physical therapists don’t have built-in referrals. They must build a reputation for results and earn referrals.

“We have to be better and we like that,” he said. “If we do a good enough job with our patients, we should get more patients. We believe that should be embraced.”

Reporter Candace Chase may be reached at 758-4436 or by email at cchase@dailyinterlake.com.