(note: this episode was published before the CMS 2027 Physician Fee Schedule Proposed Rule was published)
Is physical therapy heading toward its own financial reckoning?
In Episode 32, Dana and Alex run MSK care through the same systems logic Ray Dalio uses to explain how countries go broke. Here's what you'll hear:
- How physical therapy goes broke. Large systems are already taking write-offs and defaulting as payers stop feeding operations that don't return what they promised. Alex makes the case that these are the first signs of a two-to-three year restructuring, and that it's predictable if you know the cycle.Your evaluation pays $90. Your treatment pays $30. The system is already telling you where your value is. We get into why that gap exists and what it should change about how you design your day, your team, and your top-of-license time.Your patients are already grading your plan of care with ChatGPT. A time-constrained patient can drop their symptoms and your plan into AI and ask "is this any good?" in thirty seconds. We talk through what that means for how defensible your plans need to be, starting now.The money is moving to primary care (even in fee-for-service), and PT is sitting in the specialty bucket. Advanced Primary Care Management codes, capitation tests in ACO models, and a closed-system reality where dollars flowing to primary care flow away from the rest of us. Dana lays out a four-to-six year forecast and why PTs need to fight into that definition before it hardens.Your discharges might be creating your own return visits. Tissue remodels over months and years. An episode of care runs days and weeks. We unpack that mismatch and why treating to symptom relief (often with unnecessarily high visit frequency) keeps sending patients back through the door.AI is safer than your intuition wants to believe. Iatrogenesis is one of the largest preventable costs in medicine. Bring in the Waymo that has never had a fatality, add the difference between training and tuning these models, and you get a real role for clinicians as the people who tune them.The optimistic close. Done right, AI plus interoperability finally plugs PT into the rest of the medical system and makes the work more individualized, more rewarding, and more visible. Or you can keep your paper charts and your goniometer.
Chapters:
00:10 Introduction to Payment Stressors in Healthcare
01:43 The Evolution of Physical Therapy and Payment Reform
05:30 The Impact of AI on Healthcare Delivery
09:53 Revolution vs. Evolution in Healthcare Systems
14:01 The Future of Payment Models and AI Integration
19:30 AI's Role in Healthcare Precision and Transparency
21:05 Access Challenges in Urban vs. Rural Healthcare
22:52 Understanding Access Problems in Healthcare
25:02 AI's Impact on Healthcare Access
26:51 Network Adequacy and AI's Potential
29:08 AI Safety and Bias in Healthcare
31:16 The Future of Physical Therapy with AI
33:48 Embracing Change in Healthcare Delivery
Dr. Chad Cook
Dr. Trevor Lentz
Ray Dalio's books
CMS Physician Fee Schedule home page
Medicare Shared Savings Program
ACO REACH Model
LEAD Model
ACCESS Model
ACCESS Model: landing page for referring and co-managing clinicians (including PTs and OTs)
Advanced Primary Care Management services and codes under the Physical Fee Schedule
Duke research finding removing financial barriers to physical therapy led to more evidence-based care and cut unnecessary healthcare utilization.
"Healthcare Dive's" coverage of the Hinge Health IPO
Waymo's March 2026 landing page covering their safety data
About the show: Future Proof PT is a podcast for physical therapists, physical therapists assistants, and others who want to think beyond the clinic, about policy, payment, identity, and the future of the profession.
Hosts: Alex Bendersky and Dana Strauss
Want information on PT and OT reimbursement and opportunities in policy and advocacy? Read Dana's guest post series for OT Potential here: "How OTs and PTs Get Paid" and Therapy and Value-Based Care Models.
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