Guest guest Posted August 28, 2000 Report Share Posted August 28, 2000 Barrett, I suggest that to get them to rescind their new policy you recruit the help of your chapter reimbursement committee to contact them. Many times too the APTA GUIDE has been used as a successful tool to point out the distinctions in service which we can use to support use of certain CPT codes. Let's hope too that by posting the changes on the list you will recruit numbers of members of the list who will call and write Anthem. Annette B. Herrick, PT, MPA providing Management Consults, Lectures and Publications 138 Cold Spring Road Avon, CT 06001-4053 Phone & FAX E-Mail AHERR12345@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 28, 2000 Report Share Posted August 28, 2000 Do tell. I would think that they would have to respond to this change in Medicare policy in the monthly newsletter. http://www.adminastar.com/anthem/affiliates/adminastar/medb/ky/index.html Here is location of their newsletter and I did not see any notification of this change. Pages 99-157 of the August edition discuss PM & R. Although this is for Indiana, I believe this is the same FI for Ohio. As always, please keep us updated on changes you see -- i don't propose to be an expert and look to this newsgroup as a way to look for trends from those pesky intemediaries. Steve Passmore steve@... A change at Anthem > To the list, > > Quite suddenly and without notice (no big surprise) Anthem BC/BS (in Ohio) > has bundled the code 97002 with 97110 and cut the reimbursement rate in half. > > Has anybody else discovered this yet? Any ideas about what might be done? > > Thanks in advance for any help. > > Barrett L. Dorko, P.T. > " The Clinician's Manual " <http://barrettdorko.com> > Also at <http://rehabedge.com> > And <http://prorehabonline.com> > And <http://physicaltherapist.com> > And <http://rehabmax.com> > > > Rehab Pro - The New Way...A Better Way to Rehab Success! Call for details -. > Rehab Management Solutions can solve your cash flow problems - (877) 552-2996 > Coming September 22,2000 - Helene Fearon on Coding and Reimbursement - Rochester Michigan. Register at today. > How to Start a Private Practice with Dick Hillyer - 9/23-24, 2000 Register at . > Visit our EStore at www.RehabBusiness.com > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 28, 2000 Report Share Posted August 28, 2000 Barrett; I agree with Annette's comments. Here in Iowa, a provider panel has met twice with BCBS regarding several reimbursement issues. One was bundling treatments with Evals. One or our group contacted the APTA reimbursement area and they drafted a letter to the Medical Director of Blue Cross of Iowa. The Medical Director has acknowledged that new software has led to this error and they are in the process of fixing the problem. My guess is that something similar is happening in not only your state but others. Based upon a volunteer survey that I conducted on BCBS a couple of months ago, I am now of the opinion that all therapists nationwide need to look VERY CLOSELY at their BCBS reimbursement. They need to decide whether rates are equitable and what needs to be done to get them equitable if they are not. In Iowa's case, BCBS had not raised reimbursement rates in over 5 years and they were proposing decreases in reimbursement rates until this panel hooked up with them and explained the ramifications of their proposal. In fairness to BCBS of Iowa, they are so large that they indicated they didn't have a clue as to the impact of their proposal. The time is now to stand up for what is right. Too many times therapists have declined to stand up and fight for their reimbursement. Now is the time. The most effective way to fight is through your state chapter. If you are not a member, now is the time to join. Reimbursement is not getting better and the environment will not change without your input. Join your state chapter and APTA if you haven't!!! Jim Hall, CPA <///>< General Manager Rehab Management Services, LLC Cedar Rapids, IA 319/447-5625 Major changes coming to our web page soon!!! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 28, 2000 Report Share Posted August 28, 2000 Barrett, You have identified just the surface of reimbursement problems with Anthem, but one similar that Cigna and others are bundling evals and reevals. Seems that McKesson wrote the software that is the problem. OPTN and APTA have both addressed the problem and we have had success overturning some of these tactics. The latest with Anthem is they have stated that 97014 and 97032 are mutually exclusive and cannot be used during the same treatment day. This is not supported by the CPT or CCI but they do it anyway. I would agree with Jim that we as a profession has to start screaming for some equality and fairness with this whole mess. Now that the Doc's have to start using the code as we do and start keeping more meticulous records I wonder how long the AMA will sit ideally by. Not long I would guess if in fact they have to account for the codes in the same manner we are expected to comply. Where did this system go wrong? We are now rewarding inefficient and ineffective care and practitioners who are good and fast are penalized. Is it just me or are there others out there that think the system is broke? A. Towne, PT President, OPTN Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 29, 2000 Report Share Posted August 29, 2000 We are now rewarding inefficient and ineffective care and practitioners who are good and fast are penalized. : I agree we need to start screaming - but in a clear and concise manner. I must disagree that practitioners who are good and fast are also efficient and effective. Good and fast, to me, is reminiscent of Ford's assembly line concept - which has no place in health care. Efficient and effective, to me, is a practitioner delivering care that is evidenced based - appropriately. Fighting a battle is OK, but if we are to WIN the battle we must articulate ourselves in a manner that clearly describes our position. Ed Flickinger, PT, MBA PATowne@... wrote: Barrett, You have identified just the surface of reimbursement problems with Anthem, but one similar that Cigna and others are bundling evals and reevals. Seems that McKesson wrote the software that is the problem. OPTN and APTA have both addressed the problem and we have had success overturning some of these tactics. The latest with Anthem is they have stated that 97014 and 97032 are mutually exclusive and cannot be used during the same treatment day. This is not supported by the CPT or CCI but they do it anyway. I would agree with Jim that we as a profession has to start screaming for some equality and fairness with this whole mess. Now that the Doc's have to start using the code as we do and start keeping more meticulous records I wonder how long the AMA will sit ideally by. Not long I would guess if in fact they have to account for the codes in the same manner we are expected to comply. Where did this system go wrong? We are now rewarding inefficient and ineffective care and practitioners who are good and fast are penalized. Is it just me or are there others out there that think the system is broke? A. Towne, PT President, OPTN Rehab Pro - The New Way...A Better Way to Rehab Success! Call for details -. Rehab Management Solutions can solve your cash flow problems - (877) 552-2996 Coming September 22,2000 - Helene Fearon on Coding and Reimbursement - Rochester Michigan. Register at today. How to Start a Private Practice with Dick Hillyer - 9/23-24, 2000 Register at . Visit our EStore at www.RehabBusiness.com Attachment: vcard [not shown] Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 29, 2000 Report Share Posted August 29, 2000 : I would contend that " the system " is not merely " broken " but perverted. If it were broken it would just fail to function properly. However, what we're seeing are vast amounts of energy and resources being re-directed from patient care towards fulfilling inane requirements generated by third parties and being justified by " the system " . Jim, a non-member can see the enormous advantage of dealing with the situation as an association of professionals and endorses APTA membership. Ed is also quite correct, we need to be articulate. The best course is to develop a strategy (mission) which involves a greater number of combatants (increased APTA membership base and alliances with other associations) which is well researched and articulate in its presentation. For those on this listserve who are not members of the APTA and who may not be members for reasons other than $, this is your opportunity to stand and fight. " The system " is out of control; it's far too perverse to deal with individually. You won't see a replay of and Goliath here. If we fight this individually we'll just be wasting more valuable time, energy, $, and will become increasingly more frustrated with our life's work. Far beyond those basic considerations, we owe it to our patients. They're the ones who are losing the most and the majority of them are not even aware! It's time to act! Elmer Platz, PT 418 Route 515 Vernon, NJ 07462-3027 fax http://www.platzpt.com " Every man owes part of his time and money to the business or industry in which he is engaged. No man has the moral right to withhold his support from an organization that is striving to improve conditions within his sphere. " President Theodore Roosevelt Re: A change at Anthem Barrett, You have identified just the surface of reimbursement problems with Anthem, but one similar that Cigna and others are bundling evals and reevals. Seems that McKesson wrote the software that is the problem. OPTN and APTA have both addressed the problem and we have had success overturning some of these tactics. The latest with Anthem is they have stated that 97014 and 97032 are mutually exclusive and cannot be used during the same treatment day. This is not supported by the CPT or CCI but they do it anyway. I would agree with Jim that we as a profession has to start screaming for some equality and fairness with this whole mess. Now that the Doc's have to start using the code as we do and start keeping more meticulous records I wonder how long the AMA will sit ideally by. Not long I would guess if in fact they have to account for the codes in the same manner we are expected to comply. Where did this system go wrong? We are now rewarding inefficient and ineffective care and practitioners who are good and fast are penalized. Is it just me or are there others out there that think the system is broke? A. Towne, PT President, OPTN Rehab Pro - The New Way...A Better Way to Rehab Success! Call for details -. Rehab Management Solutions can solve your cash flow problems - (877) 552-2996 Coming September 22,2000 - Helene Fearon on Coding and Reimbursement - Rochester Michigan. Register at today. How to Start a Private Practice with Dick Hillyer - 9/23-24, 2000 Register at . Visit our EStore at www.RehabBusiness.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 29, 2000 Report Share Posted August 29, 2000 FYI: (please allow me to cut in here) A quick background on the intended use of the eval/re-eval codes, the current issues with billing eval and treatment on the same date, and a sample copy of our appeal letter, is posted on the APTA web site. APTA members can view it at: http://www.apta.org/PT_Practice/reimbursement/Evalpayment . Debra Lansey, Asst. Director APTA Reimbursement Dept ph ext 3171 debralansey@... Re: A change at Anthem Barrett; I agree with Annette's comments. Here in Iowa, a provider panel has met twice with BCBS regarding several reimbursement issues. One was bundling treatments with Evals. One or our group contacted the APTA reimbursement area and they drafted a letter to the Medical Director of Blue Cross of Iowa. The Medical Director has acknowledged that new software has led to this error and they are in the process of fixing the problem. *SNIP* Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 29, 2000 Report Share Posted August 29, 2000 Towne; I need to thank you (I think you were the one that posted information stating that insurers are purchasing canned software that is bundling evaluation and treatments). Guess what?!? I received several different checks today on one of my clients (I operate a billing service for therapists in 4 states). Within that packet of checks, I encountered evaluations being bundled with therapeutic exercise. Elaborating further, these insurance companies bundled the evaluation with the therex and paid the therex only. In essence, my provider was paid $22-25 for an hour long service. I spent 45 minutes to an hour on phone calls working the provider phone lines trying to get these reprocessed. Alright, here's a reality check for those of you in private practice. Are you experiencing these issues? Or are they being delegated to an office staff person? Is that office person fighting for the reimbursement or are they adjusting it off the books? What are you doing to get these types of issues resolved? They are not going away, they are becoming more commonplace! Have I ever mentioned that it would be good to join a professional organization which will assist in fighting for the good of your profession? Like it or not, my voice on behalf of my clients is not effective with the insurance companies. I have to enlist my providers to stand up and fight for their reimbursement. But if they don't get involved with their reimbursement or with their professional organization, it's an uphill battle that I/you cannot win. Jim Hall, the man on the soapbox who's getting sick of insurance B.S. games yada, yada and so on. Major changes coming to our web site soon!!! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 29, 2000 Report Share Posted August 29, 2000 Kim; I will not say that going through the phone bank is a waste of time, but your time would be better spent making a bee line for the top. I would suggest that you start with your provider representative. They are not going to offer you any solutions either. In many respects, they are as much a waste of time as the phone bank. However, the provider representative will know who sets reimbursement policy and who their immediate line of reporting is to. In Iowa, we started with the provider representative and later found out that someone with the title of Provider Economics (I think) was in charge of reimbursement decisions). If they do not respond to you within a reasonable period, send copies to their immediate reporting responsibility as well as a copy to your state insurance commission. Believe me, you will get a response in a very short order if you haven't by that time. Good luck and make sure you try and enlist multiple providers in your area prior to making contact. The real strength comes in the numbers (especially if you are able to enlist your state chapter president-as we did here). God Bless, Jim <///>< Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 29, 2000 Report Share Posted August 29, 2000 Anyone know who to speak with at the insurance companies to begin the reversal process? I never seem to be able to get in touch with anyone who cares to listen to the PT point of view. Kim Kranz, PT Virginia Beach, VA JHall49629@... wrote: > > Towne; > > I need to thank you (I think you were the one that posted information stating > that insurers are purchasing canned software that is bundling evaluation and > treatments). Guess what?!? I received several different checks today on one > of my clients (I operate a billing service for therapists in 4 states). > Within that packet of checks, I encountered evaluations being bundled with > therapeutic exercise. Elaborating further, these insurance companies bundled > the evaluation with the therex and paid the therex only. In essence, my > provider was paid $22-25 for an hour long service. I spent 45 minutes to an > hour on phone calls working the provider phone lines trying to get these > reprocessed. > > Alright, here's a reality check for those of you in private practice. Are > you experiencing these issues? Or are they being delegated to an office > staff person? Is that office person fighting for the reimbursement or are > they adjusting it off the books? What are you doing to get these types of > issues resolved? They are not going away, they are becoming more > commonplace! Have I ever mentioned that it would be good to join a > professional organization which will assist in fighting for the good of your > profession? Like it or not, my voice on behalf of my clients is not > effective with the insurance companies. I have to enlist my providers to > stand up and fight for their reimbursement. But if they don't get involved > with their reimbursement or with their professional organization, it's an > uphill battle that I/you cannot win. > > Jim Hall, the man on the soapbox who's getting sick of insurance B.S. games > yada, yada and so on. > > Major changes coming to our web site soon!!! > > Rehab Pro - The New Way...A Better Way to Rehab Success! Call for details -. > Rehab Management Solutions can solve your cash flow problems - > Coming September 22,2000 - Helene Fearon on Coding and Reimbursement - Rochester Michigan. Register at today. > How to Start a Private Practice with Dick Hillyer - 9/23-24, 2000 Register at . > Visit our EStore at www.RehabBusiness.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 29, 2000 Report Share Posted August 29, 2000 Ed, Talk about assembly lines, what have we been asked to comply with but an assembly line mentality which judges all activities performed without respect to the provider. That to me is insane and unfounded. I believe that I can use my skills and 42 years of experience better in the clinic than a new graduate or someone who has not attended or stayed abreast with current treatment methods, but, can the current system demonstrate any difference -- h--- NO! If that makes me faster and more efficient that should not be used as a governor to throttle me back. The current system creates no incentives no one and rewards the mundane. Sorry, but the system, in my opinion is typical big government, with lots of paper, rules and arcane motives that benefit only the government or payers. At the time that we had major changes in the CPT codes, developed by us, in the mid 90's, we thought the system would understand and reward our motives to save the system money and reimburse us for our professional skills. What has happened over the past 2 years is beyond my belief and appears to have totally lost sight of what we attempted to accomplish when the CPT codes were revised. In this time period has everybody else suddenly based all if its procedures on " evidenced based practice " or is this just a fancy way for the managed care payers to deny reimbursement? While I agree we need better research I do not agree that what we do is suddenly unworthy. Has Medicine reached such a high pinnacle that they no longer need research or is it not more the fact that we and all of health care will continue to evolve as we refine and make qualified changes as research supports such changes. What I see happening is a system run amok, payers are creating their own rules on a regular basis. I do believe they are in concert with each other as one tests the market, gets away with reducing various procedures or treatments and in no time another company does the same thing. This continues to occur with regularity as the list has begun to understand. In the meantime we, as individuals, have to fight the fight almost without support and it is getting to be pretty d--- old. How does a company like McKesson create software which creates CCI's without reflecting back to the CPT codes and its so called authority? I have fought the fight for many years from lots of positions, elected and individual. I shall continue to do so and it would be nice if we as a collective body got our collective butts moving in the same direction and spoke as one voice. A dream no doubt but then if one can't dream why live. We still have much to offer our patients and we should be proud to stand for what we have developed in our 79 years. A. Towne, PT Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 29, 2000 Report Share Posted August 29, 2000 Kim, You might try getting the name of the Medical Director or name of who to send an appeal to and send them a detailed letter. At least this way you get " above the heads " of the folks on the phone who have no power to change the system, and it is in writing. (I have now spent two years doing billing and collections in both PT and radiology, it is a constant battle) Caren ,PTA - Re: A change at Anthem Anyone know who to speak with at the insurance companies to begin the reversal process? I never seem to be able to get in touch with anyone who cares to listen to the PT point of view. Kim Kranz, PT Virginia Beach, VA JHall49629@... wrote: > > Towne; > > I need to thank you (I think you were the one that posted information stating > that insurers are purchasing canned software that is bundling evaluation and > treatments). Guess what?!? I received several different checks today on one > of my clients (I operate a billing service for therapists in 4 states). > Within that packet of checks, I encountered evaluations being bundled with > therapeutic exercise. Elaborating further, these insurance companies bundled > the evaluation with the therex and paid the therex only. In essence, my > provider was paid $22-25 for an hour long service. I spent 45 minutes to an > hour on phone calls working the provider phone lines trying to get these > reprocessed. > > Alright, here's a reality check for those of you in private practice. Are > you experiencing these issues? Or are they being delegated to an office > staff person? Is that office person fighting for the reimbursement or are > they adjusting it off the books? What are you doing to get these types of > issues resolved? They are not going away, they are becoming more > commonplace! Have I ever mentioned that it would be good to join a > professional organization which will assist in fighting for the good of your > profession? Like it or not, my voice on behalf of my clients is not > effective with the insurance companies. I have to enlist my providers to > stand up and fight for their reimbursement. But if they don't get involved > with their reimbursement or with their professional organization, it's an > uphill battle that I/you cannot win. > > Jim Hall, the man on the soapbox who's getting sick of insurance B.S. games > yada, yada and so on. > > Major changes coming to our web site soon!!! > > Rehab Pro - The New Way...A Better Way to Rehab Success! Call for details -. > Rehab Management Solutions can solve your cash flow problems - (877) 552-2996 > Coming September 22,2000 - Helene Fearon on Coding and Reimbursement - Rochester Michigan. Register at today. > How to Start a Private Practice with Dick Hillyer - 9/23-24, 2000 Register at . > Visit our EStore at www.RehabBusiness.com Rehab Pro - The New Way...A Better Way to Rehab Success! Call for details -. Rehab Management Solutions can solve your cash flow problems - (877) 552-2996 Coming September 22,2000 - Helene Fearon on Coding and Reimbursement - Rochester Michigan. Register at today. How to Start a Private Practice with Dick Hillyer - 9/23-24, 2000 Register at . Visit our EStore at www.RehabBusiness.com ----------------------------------------------- FREE! The World's Best Email Address @email.com Reserve your name now at http://www.email.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 31, 2000 Report Share Posted August 31, 2000 Reply to towne on Anthem. Two thoughts---1. If we are paid for the results we get[outcomes] instead of what we do then the clinician can use their skill to apply any treatment[regardless of reimbursement] for the benefit of the patient. This requires that there is an industry wide, and payer accepted outcomes tool that everybody uses to measure outcomes[ treatment results] . All providers must use the same tool so that all can communicate effectiveness to the payer, Doctor, patient, researcher, etc. This can be done now. Can explain this in detail if you are interested. 2. Payers/HCFA don't understand rehab process, don't trust that Rehab makes a difference in patients' lives.That is why they are looking at at 'evidence based practice " as a way to determine what to pay for. Eugene s, Steve Rose, Jules Rothstein and others have been warning PT for years to " prove what we do " . Here's my offer. If you use FOTO to collect data for clinical purposes, and use the data to publish a clinically relevant paper in a refereed journal{ so it will be accepted by the medical directors of Anthem, HCFA, etc.] FOTO will offer the help of Dennis Hart Ph.D, PT , Director of Research and Consulting, to design, and write the paper. FOTO database already has been used for 17 papers in print, 25 abstracts, and 3 masters level theses . We welcome others to use this resourse. What do you think? Al Amato, PT, MBA President, FOTO 1- PATowne@... wrote: > Ed, > > Talk about assembly lines, what have we been asked to comply with but an > assembly line mentality which judges all activities performed without respect > to the provider. That to me is insane and unfounded. I believe that I can > use my skills and 42 years of experience better in the clinic than a new > graduate or someone who has not attended or stayed abreast with current > treatment methods, but, can the current system demonstrate any difference -- > h--- NO! If that makes me faster and more efficient that should not be used > as a governor to throttle me back. The current system creates no incentives > no one and rewards the mundane. Sorry, but the system, in my opinion is > typical big government, with lots of paper, rules and arcane motives that > benefit only the government or payers. > At the time that we had major changes in the CPT codes, developed by us, in > the mid 90's, we thought the system would understand and reward our motives > to save the system money and reimburse us for our professional skills. What > has happened over the past 2 years is beyond my belief and appears to have > totally lost sight of what we attempted to accomplish when the CPT codes were > revised. In this time period has everybody else suddenly based all if its > procedures on " evidenced based practice " or is this just a fancy way for the > managed care payers to deny reimbursement? While I agree we need better > research I do not agree that what we do is suddenly unworthy. Has Medicine > reached such a high pinnacle that they no longer need research or is it not > more the fact that we and all of health care will continue to evolve as we > refine and make qualified changes as research supports such changes. > > What I see happening is a system run amok, payers are creating their own > rules on a regular basis. I do believe they are in concert with each other > as one tests the market, gets away with reducing various procedures or > treatments and in no time another company does the same thing. This > continues to occur with regularity as the list has begun to understand. In > the meantime we, as individuals, have to fight the fight almost without > support and it is getting to be pretty d--- old. How does a company like > McKesson create software which creates CCI's without reflecting back to the > CPT codes and its so called authority? > > I have fought the fight for many years from lots of positions, elected and > individual. I shall continue to do so and it would be nice if we as a > collective body got our collective butts moving in the same direction and > spoke as one voice. A dream no doubt but then if one can't dream why live. > We still have much to offer our patients and we should be proud to stand for > what we have developed in our 79 years. > > A. Towne, PT > > Rehab Pro - The New Way...A Better Way to Rehab Success! Call for details -. > Rehab Management Solutions can solve your cash flow problems - > Coming September 22,2000 - Helene Fearon on Coding and Reimbursement - Rochester Michigan. Register at today. > How to Start a Private Practice with Dick Hillyer - 9/23-24, 2000 Register at . > Visit our EStore at www.RehabBusiness.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 31, 2000 Report Share Posted August 31, 2000 , You are very kind, I appreciate the comments. I guess that with over 42+ years of working in patent care and my association with some great leaders and practitioners has helped me achieve a certain perspective. I really love what we do but it is getting increasing more difficult to see the positives with the current system. I still think the fight is worth it. Regards, A. Towne, PT Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 31, 2000 Report Share Posted August 31, 2000 Mr. Amato: After weeding through your lengthy ad for your business, I fail to see your point. How exactly does outcomes measurement affect bundling of codes? It seems to me that bundling is just a way to decrease the total $ amount paid out to a provider. In 18yrs. of clinical practice, I have found most medical directors @ insurers to be semi-retired pathologists with little understanding of what rehab entails yet alone even grasp the idea of what outcomes measures mean. PErhaps you can explain yourself...with out the ad campaign? Ed Flickinger, PT, MBA Al Amato wrote: Reply to towne on Anthem. Two thoughts---1. If we are paid for the results we get[outcomes] instead of what we do then the clinician can use their skill to apply any treatment[regardless of reimbursement] for the benefit of the patient. This requires that there is an industry wide, and payer accepted outcomes tool that everybody uses to measure outcomes[ treatment results] . All providers must use the same tool so that all can communicate effectiveness to the payer, Doctor, patient, researcher, etc. This can be done now. Can explain this in detail if you are interested. 2. Payers/HCFA don't understand rehab process, don't trust that Rehab makes a difference in patients' lives.That is why they are looking at at 'evidence based practice" as a way to determine what to pay for. Eugene s, Steve Rose, Jules Rothstein and others have been warning PT for years to" prove what we do". Here's my offer. If you use FOTO to collect data for clinical purposes, and use the data to publish a clinically relevant paper in a refereed journal{ so it will be accepted by the medical directors of Anthem, HCFA, etc.] FOTO will offer the help of Dennis Hart Ph.D, PT , Director of Research and Consulting, to design, and write the paper. FOTO database already has been used for 17 papers in print, 25 abstracts, and 3 masters level theses . We welcome others to use this resourse. What do you think? Al Amato, PT, MBA President, FOTO 1- PATowne@... wrote: > Ed, > > Talk about assembly lines, what have we been asked to comply with but an > assembly line mentality which judges all activities performed without respect > to the provider. That to me is insane and unfounded. I believe that I can > use my skills and 42 years of experience better in the clinic than a new > graduate or someone who has not attended or stayed abreast with current > treatment methods, but, can the current system demonstrate any difference -- > h--- NO! If that makes me faster and more efficient that should not be used > as a governor to throttle me back. The current system creates no incentives > no one and rewards the mundane. Sorry, but the system, in my opinion is > typical big government, with lots of paper, rules and arcane motives that > benefit only the government or payers. > At the time that we had major changes in the CPT codes, developed by us, in > the mid 90's, we thought the system would understand and reward our motives > to save the system money and reimburse us for our professional skills. What > has happened over the past 2 years is beyond my belief and appears to have > totally lost sight of what we attempted to accomplish when the CPT codes were > revised. In this time period has everybody else suddenly based all if its > procedures on "evidenced based practice" or is this just a fancy way for the > managed care payers to deny reimbursement? While I agree we need better > research I do not agree that what we do is suddenly unworthy. Has Medicine > reached such a high pinnacle that they no longer need research or is it not > more the fact that we and all of health care will continue to evolve as we > refine and make qualified changes as research supports such changes. > > What I see happening is a system run amok, payers are creating their own > rules on a regular basis. I do believe they are in concert with each other > as one tests the market, gets away with reducing various procedures or > treatments and in no time another company does the same thing. This > continues to occur with regularity as the list has begun to understand. In > the meantime we, as individuals, have to fight the fight almost without > support and it is getting to be pretty d--- old. How does a company like > McKesson create software which creates CCI's without reflecting back to the > CPT codes and its so called authority? > > I have fought the fight for many years from lots of positions, elected and > individual. I shall continue to do so and it would be nice if we as a > collective body got our collective butts moving in the same direction and > spoke as one voice. A dream no doubt but then if one can't dream why live. > We still have much to offer our patients and we should be proud to stand for > what we have developed in our 79 years. > > A. Towne, PT > > Rehab Pro - The New Way...A Better Way to Rehab Success! Call for details -. > Rehab Management Solutions can solve your cash flow problems - (877) 552-2996 > Coming September 22,2000 - Helene Fearon on Coding and Reimbursement - Rochester Michigan. Register at today. > How to Start a Private Practice with Dick Hillyer - 9/23-24, 2000 Register at . > Visit our EStore at www.RehabBusiness.com Rehab Pro - The New Way...A Better Way to Rehab Success! Call for details -. Rehab Management Solutions can solve your cash flow problems - (877) 552-2996 Coming September 22,2000 - Helene Fearon on Coding and Reimbursement - Rochester Michigan. Register at today. How to Start a Private Practice with Dick Hillyer - 9/23-24, 2000 Register at . Visit our EStore at www.RehabBusiness.com Attachment: vcard [not shown] Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 31, 2000 Report Share Posted August 31, 2000 , What an outstanding response, this is one of the rare emails that ought to be read by every licensed PT. If ever an email ought to implore someone to take action and understand why and for what cause, it is this email. Not many could have said it better. You put down in writing every little bit of frustration that I have about this country's policies against health care providers and their patients and in favor of big business and payers and the almighty bottom line. van Well, PT APTA Member PATowne@... wrote: > Ed, > > Talk about assembly lines, what have we been asked to comply with but an > assembly line mentality which judges all activities performed without respect > to the provider. That to me is insane and unfounded. I believe that I can > use my skills and 42 years of experience better in the clinic than a new > graduate or someone who has not attended or stayed abreast with current > treatment methods, but, can the current system demonstrate any difference -- > h--- NO! If that makes me faster and more efficient that should not be used > as a governor to throttle me back. The current system creates no incentives > no one and rewards the mundane. Sorry, but the system, in my opinion is > typical big government, with lots of paper, rules and arcane motives that > benefit only the government or payers. > At the time that we had major changes in the CPT codes, developed by us, in > the mid 90's, we thought the system would understand and reward our motives > to save the system money and reimburse us for our professional skills. What > has happened over the past 2 years is beyond my belief and appears to have > totally lost sight of what we attempted to accomplish when the CPT codes were > revised. In this time period has everybody else suddenly based all if its > procedures on " evidenced based practice " or is this just a fancy way for the > managed care payers to deny reimbursement? While I agree we need better > research I do not agree that what we do is suddenly unworthy. Has Medicine > reached such a high pinnacle that they no longer need research or is it not > more the fact that we and all of health care will continue to evolve as we > refine and make qualified changes as research supports such changes. > > What I see happening is a system run amok, payers are creating their own > rules on a regular basis. I do believe they are in concert with each other > as one tests the market, gets away with reducing various procedures or > treatments and in no time another company does the same thing. This > continues to occur with regularity as the list has begun to understand. In > the meantime we, as individuals, have to fight the fight almost without > support and it is getting to be pretty d--- old. How does a company like > McKesson create software which creates CCI's without reflecting back to the > CPT codes and its so called authority? > > I have fought the fight for many years from lots of positions, elected and > individual. I shall continue to do so and it would be nice if we as a > collective body got our collective butts moving in the same direction and > spoke as one voice. A dream no doubt but then if one can't dream why live. > We still have much to offer our patients and we should be proud to stand for > what we have developed in our 79 years. > > A. Towne, PT > > Rehab Pro - The New Way...A Better Way to Rehab Success! Call for details -. > Rehab Management Solutions can solve your cash flow problems - > Coming September 22,2000 - Helene Fearon on Coding and Reimbursement - Rochester Michigan. Register at today. > How to Start a Private Practice with Dick Hillyer - 9/23-24, 2000 Register at . > Visit our EStore at www.RehabBusiness.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 3, 2000 Report Share Posted September 3, 2000 A recent report, Better Information, Better Outcomes The Use of Health Technology Assessment and Clinical Effectiveness Data in Health Care Purchasing Decisions in the United Kingdom and the United States, July 2000 provides invaluable information for this discussion, at http://www.milbank.org/000726purchasing.html#executive. The executive summary includes: Given the influential role purchasers currently play in determining which health care services will be covered, to what extent, and for whom, it is important to examine how purchasing decisions are made. Of particular interest is whether purchasers have access to and use empirical evaluations of the clinical value and cost-effectiveness of a wide variety of new technologies, procedures, and interventions. Available for decades, health technology assessment (HTA) and clinical effectiveness data have the potential to help purchasers better select, monitor, and assess the quality and value of the health care services they purchase for millions of beneficiaries. But do purchasers have access to this information, and, more important, do they use it in their decision-making processes? Purchasers cited four general factors that have contributed to their relatively limited use of HTA and HTA information: (1) their overriding concern with the cost rather than the quality of services; (2) difficulties in accessing clinical and cost-effectiveness data; (3) insufficient training in using, interpreting, and critically appraising HTA information; and (4) a lack of skills and/or training in translating research evidence into practice. Other interesting reports can be found at http://www.milbank.org/sea.html Kathy Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 5, 2000 Report Share Posted September 5, 2000 Thanks Kathy, for sharing this reference. It highlights the issues I wanted to raise in this discussion. Published research about clinical effectiveness is necessary but wanting in Rehab. There needs to be a common language in assessing patient response to care for understanding to take place between payer and clinician. The information should be easy to understand by non-professional and professional alike. When these things are in place, I believe, there will be less focus on paying for what we do, and moving toward paying for affect of what we do. The emphasis will still be on cost containment, but hopefully a more reasonable way to pay for health care. My response was to aid in publishing clinically based research, suggested how it could be used to move toward a reasonable way to pay us for what we do. After reading the attached file, I am more convinced than ever about this course of action, but also sobered about the amount of information exchange and understanding that has to take place before it will become a reality. Al Amato, PT, MBA President, FOTO Kathy wrote: A recent report, Better Information, Better Outcomes The Use of Health Technology Assessment and Clinical Effectiveness Data in Health Care Purchasing Decisions in the United Kingdom and the United States, July 2000 provides invaluable information for this discussion, at http://www.milbank.org/000726purchasing.html#executive. The executive summary includes: Given the influential role purchasers currently play in determining which health care services will be covered, to what extent, and for whom, it is important to examine how purchasing decisions are made. Of particular interest is whether purchasers have access to and use empirical evaluations of the clinical value and cost-effectiveness of a wide variety of new technologies, procedures, and interventions. Available for decades, health technology assessment (HTA) and clinical effectiveness data have the potential to help purchasers better select, monitor, and assess the quality and value of the health care services they purchase for millions of beneficiaries. But do purchasers have access to this information, and, more important, do they use it in their decision-making processes? Purchasers cited four general factors that have contributed to their relatively limited use of HTA and HTA information: (1) their overriding concern with the cost rather than the quality of services; (2) difficulties in accessing clinical and cost-effectiveness data; (3) insufficient training in using, interpreting, and critically appraising HTA information; and (4) a lack of skills and/or training in translating research evidence into practice. Other interesting reports can be found at http://www.milbank.org/sea.html Kathy Rehab Pro - The New Way...A Better Way to Rehab Success! Call for details -. Rehab Management Solutions can solve your cash flow problems - Coming September 22,2000 - Helene Fearon on Coding and Reimbursement - Rochester Michigan. Register at today. How to Start a Private Practice with Dick Hillyer - 9/23-24, 2000 Register at . Visit our EStore at www.RehabBusiness.com Quote Link to comment Share on other sites More sharing options...
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