Rate Controversy: Federal Government Angers Physiotherapists

“I love my job,” says Nina Ferrer. Her real name is different; she wants to remain anonymous for fear of problems with health insurers. “But 5,000 francs a month for a 60-hour working week is too little.” The problem: Rates have remained virtually the same since 1998. Collective bargaining partners, insurance companies and associations must continually adapt these. But: they haven’t been able to agree for years.

The Federal Council intervenes

Now the Federal Council is getting involved. He has sent a proposal to change the rate structure for consultation. However, he does not want to adjust and increase the earnings of physiotherapists to the current situation. Better: set specific meeting durations. He hopes this will lead to savings.

The background is that the costs of outpatient physiotherapy have risen disproportionately. From the perspective of the Federal Office for Public Health (BAG), the reason for this could be that the meetings are being shortened. Because nowadays therapists decide how long the session lasts. Shortened sessions resulted in more consultations and therefore higher costs.

The Federal Council’s proposal provides for a minimum duration of 20, 30 or 45 minutes for short, general or complex physiotherapy. Or: a minimum duration of 20 minutes, which can be extended in five-minute increments.

A suggestion in the dark?

“Our figures show that patients today are treated on average for as long as when the tariff was introduced almost thirty years ago,” says Florian Kurz, head of communications and politics at the Physioswiss association. The federal government does not have such figures: according to the explanatory report accompanying the consultation, there is no data on how many meetings would be shortened.

According to Florian Kurz, the proposal is fatal for the sector. Demands on therapists have increased and the cost of running the practice has risen by a quarter since 1994, but rates have barely risen. Many in the sector are already on the brink of existence. “A member survey at the end of October showed that 90 percent feared losses as a result of the collective bargaining.” Furthermore, “Society is aging, chronic diseases are increasing, and the politically desirable principle of ‘outpatient over inpatient’ means that outpatient physiotherapy is preferable to inpatient.” It’s no surprise that costs are rising.

“Five-minute increments would mean even more administrative work, which is already hardly rewarded,” says Nina Ferrer. Gaps in the schedule are programmed. And: “I can’t do justice to the patients in twenty minutes.”

According to BAG, the planned adjustment is not primarily about savings, but rather about transparency. The five-minute increments are intended to increase flexibility. In addition, there is no obligation for 20-minute sessions. Adjusting rates to increase wages is primarily the responsibility of collective bargaining partners. So the insurer and associations. The federal government wants to respect this autonomy.

Thousands demonstrate

The consultation ended on November 17. On the same day, thousands demonstrated at Bundesplatz against the planned change, and a petition with 283,000 signatures was presented to the federal government. The scheme with the adjusted rate structure is expected to come into effect on January 1, 2025. Nina Ferrer wonders what happens next: “Has anyone up there looked at reality?”