Kudos to Dave Mason

Good job for painting a real picture of what's going on in our world!  Physical Therapy Clinics Feeling the Pain

Healthsouth and Physiotherapy Associates besides being corporate-model clinics had issues and ramifications incurred for their day to day operations in some of their clinics.  I'd think it would be difficult to survive with imposed fines/penalties combined with a large change in day to day operations to be within rules and regulations which would substantially reduce projected revenue especially with the current state of dwindling reimbursement.  (Stryker and Physiotherapy Associates issues... right, sloppy paperwork )

Comments

[Mark Schwall, PT]

Selena, I'm not sure I agree.
I'm cross-posting this entry from my blog.

This article which I received via Google Alerts Physical therapy clinics feeling the pain points out a number of the challenges faced by Physical Therapists and particularly those in private practice. I do have to comment on a couple of comments by Mr. Dave Mason, APTA Vice President of Government Affairs and Reimbursement Advocacy.

Mr. Mason reportedly stated "It is a very competitive marketplace, where payment rates are causing pressures". This statement is inherently misleading. It assumes that free market influences are at work in the physical therapy marketplace when nothing could be further from the truth.

I believe a more correct statement would have been, "It is a very anti-competitive marketplace characterized by laws and regulatory policies which are biased to the advantage of insurers, consolidation of the insurance marketplace, the rise of third party "Organized Delivery" intermediaries who represent multiple insurers and Referral for Profit.

Consolidation of the insurance industry, biased regulation, and the Organized Delivery Entities result in less competition amongst insurers to attract network providers. Allows insurers to "negotiate" contracts with a "take it or leave it" stance thereby allowing them to reimburse at rates which make practice unsustainable.

Additionally because of Physical Therapists failure to protect and enforce their ownership of the practice of Physical Therapy, others are employing parasitic business models as reflected in the burgeoning number of referral for profit situations across the country. Referral for profit eliminates a patient's choice of providers, increases utilization as pointed out by a recent Medicare report and reduces the financial resources available by practicing Physical Therapists to reinvest in the profession by supporting research, their professional Associations and Societies.

I also take issue with Mr. Mason's reported comment "The practice models (therapists) had are not really working now." This comment whether taken out of context or not I feel reinforces the continuing impression I have that the APTA would rather capitulate to the strong arm tactics of the insurance industry rather than forcefully advocate for a fair and reasonable reimbursement. The continued focus of the Association on alternative models including "cash based practice" is a prime example of capitulation. If "cash based practice" is the alternative model I'd ask where this leaves those healthcare consumers who pay premiums and can't afford a "cash based practitioner" We and our patients deserve better.

How long before we all make a stand to protect and defend our practice and our profession? I hope soon before it's too late.

As President Kennedy said, "There are risks and costs to action. But they are far less than the long range risks of comfortable inaction"

[Selena Horner]

I didn't read as deeply as you did in the article, Mark. From my perspective, Mason was trying to make 2 points very clear. 1)Referral for profit situations may be a factor for physical therapy clinics to close their doors. 2) Dwindling reimbursement creates a difficult business situation and could potentially lead to a clinic closing its doors. I believe you are focusing on the word "competitive" in his statement.

I don't believe anyone would deny that dwindling reimbursement is a problem. I believe I read that 3 hospitals in your neck of the woods were closing. 2 hospitals were accused of fraud and both of them filed bankruptcy. I'd tend to believe that the dwindling reimbursement rates drove 2 hospital organizations to commit potential fraud.

Mason's comment about the common practice models utilized by physical therapy businesses is correct. The models aren't as effective today as they were 15-20 years ago. If we're trying to drum up business as we were 15-20 years ago, we aren't going to be successful because of a few factors with those being: referral for profit, lack of a marketing strategy directed to consumers, lack of an identity, lack of third party payors seeing value in the services we provide to reduce their costs.

Most third party payors are financially strong opponents. How does one fight such a strong opponent? Our attorney general is quite against the newest scheme by Blue Cross Blue Shield of Michigan. The numbers in this Powerpoint are sickening and really speak of greed. How can a non-profit organization be allowed this level of profit?
Michigan Attorney General’s office PowerPoint presentation: http://www.michigan.gov/documents/ag/Blue_Cross_11.29.07_217273_7.pdf

Physical therapists enforcing ownership of physical therapy isn't the full answer. The billions of dollars above would still crush any of our endeavors to improve our situation. We probably need to work with the third party payors and utilize data to show them that in quite a few cases we can actually reduce their costs. Or maybe somehow employers could be targeted to have employers have something included as the desired route for provided services where we as the neuromusculoskeletal specialists come first? I really don't know the answer, but the system is a mess and I don't know if I'd necessarily use the word anti-competitive, but I would say we are attempting to function within a system that has third party payors fully controlling both ends of their industry (and substantially reducing their risks) - the premium costs AND the fee schedules with no "real" checks and balance system such that they are always in a win-win profitable situation.

[John Ware]

Selena, I think Mark's use of the term "anti-competititve" is accurate. However, I would be more on your side from the standpoint of who's to "blame" for the situation. We can point to the insurance companies' profiteering motives all day long, but that is going to get us nowhere. It sure hasn't in the 13 years that I've been practicing. Rather, I'm with you that the onus is on us to prove beyond a shadow of a doubt that what we do has value, so that the insurance companies will be convinced that their profits can by enhanced by taking a more active role in promoting physical therapy for their subscribers. Wouldn't it be almost shocking to go to the Blue Cross/Blue Shield website and see a big banner across the top of the page saying something like, "Ask your doctor about physical therapy the next time you back goes out"? Why couldn't we convince BC/BS that this would be a win-win-win, that is, good for us, good for them and most importantly good for the public?

By the way, the whole of health care in the US is anti-competitive. This is nothing new. Until the system is more market-based and focused on producing results instead of reimbursement being driven by procedures, cost-containment will be the only way for 3rd party payers to profit.

[Gakybloolop]

"How many people work here?"
"Oh, about half."

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[swisytewPes]

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