Re: Student affiliations and Econ101

[Guest guest]

With all of our wringing of hands and outrage over the BBA, HCFA rulings on

students etc. I don't hear much discussion about how we as the professionals

responsible for providing the service are ensuring that the fees charged for

our services are reasonable and that the billing practices are appropriate.

Have people done an analysis of the reimbursements?

My point being is we have been hit very hard because the OIG etc. sees

widespread fraud and abuse in Rehab. How many of us were objecting to the

situation when OT and SLP was being billed at $600+ an hour for example?

We must not lose site of the fact that a lot of people and companies got

very rich off of rehab in the last 10-15 years. Just this week OIG blasted

the practices of our industry again. Is anybody standing up to the

corporations and expressing outrage about their practices? Who knows what

the profit margin is of their employer? (including the so called

non-profits) How many bites out of the apple are there before the PT gets

the core?

Lets talk about empowering the PT to deal with their employer.

Dick Hillyer wrote:

> >

> > What would you predict will be the watershed event that will make

> payors work to decrease long term care costs

> > by keeping people mobile and at home longer. To me that seems where

> we will have to 'pay' for these decisions in the long run.

>

> >This will reduce further the ability to pay for programs. Seems to me

> like a path of economic self destruction.

> >

>

> Steve -- great question!

>

> If people were more mobile and at home longer, they'd think they didn't

> " need " another central government " program " ...so I doubt payors (as a

> class) will ever work that hard to decrease costs and make their

> customers less dependent upon them by improving people's health.

> They'll just work to decrease their own per-case costs (medical loss

> ratios) by cutting payments to providers and then say " It's YOUR fault! "

> to the providers. Sort of like what they now do with documentation.

> They just can't tell Grandmom that she's going to get less 'cause

> they're running out of money. Grandmom might get upset with them... so

> they'll blame us.

>

> If the Balanced Budget Act showed us nothing else, it's that programs

> which spend more than they take in cannot survive for long. Duh!

> Keynesian spending plans cannot run ad infinitum or they do become a

> path to economic self-destruction. Before the BBA, the interest on the

> national debt was said to be consuming almost all of each year's

> personal income tax revenues. Just the interest.

>

> We post-war babies will cost a lot to care for, and our kids and

> grandkids will not be able to afford the taxation. We'd better have

> been investing for ourselves for the past 30 years. The only entity

> truly interested in our personal welfare... is us!

>

> Personally, I think we'll head for a two (or more) tiered system of

> benefits. For everyone, a program similar to what Medicaid now offers,

> with meagre subsistence care as we decline and die, which will seem fine

> to the planners. (Remember the observations that the vast bulk of a

> person's health care expenses came in the final six months of life?

> Managing and reducing services and expenditures will still yield the

> same result at a lower cost.)

>

> I also expect to see a small opportunity emerge for the affluent to

> purchase several levels of services above and beyond the basics, outside

> of the central system. That'll be abhorrent to the central social

> planners, but I think that someone will make the case for it as being in

> the interest of the nation, and it'll be allowed. Or, as Medicare

> provides ever diminishing value to them, people with some retirement and

> some means will begin opting out of the Medicare program altogether, so

> that they may obtain desired services as they wish. And there will be

> non-Medicare providers to serve them. As always, the provision of

> superior perceived value to the purchaser will be the determinant.

>

> Futurists are telling us, however, that in the new millenium people will

> be willing to pay privately and substantially for goods and services

> which will serve to prolong their life and enjoyment. They're

> accumulating (and compounding) the means in today's very healthy

> economy.

>

> For the rehab industry, after a period of " industry fallout " I think

> that the survivors will have a less hostile environment in which to

> operate. Society will -- through public policy -- find ways to preserve

> the institutions which they do value. That's one reason that the $1500

> cap doesn't apply to acute care hospitals: Society wants to try to keep

> its hospitals viable. And its a reason why PTIPs have the incredibly

> restrictive, phony " same room supervision " clause. Payors want to get

> rid of them.

>

> Ready for another break? The midterm's coming very soon, ...and the

> Final Exam will be real life...or death.

>

> Dick H

>

> ------------------------------------------------------------------------

>

> eGroups.com home: /group/ptmanager

> - Simplifying group communications

Attachment: vcard [not shown]

[Guest guest]

Thank you, Doug, for identifying and framing this concern so clearly.

When we do not adequately 'police' ourselves, in any aspect of our

professional obligations, there will be others that do it for us. When

that happens it moves out of the professions control and we generally

lose out.

Jim , PT, MA

Director, PTA Program

Naugatuck Valley C-T College

750 Chase Parkway

Waterbury, CT 06708

> Re: Student affiliations and Econ101

>

> With all of our wringing of hands and outrage over the BBA, HCFA

> rulings on

> students etc. I don't hear much discussion about how we as the

> professionals

> responsible for providing the service are ensuring that the fees

> charged for

> our services are reasonable and that the billing practices are

> appropriate.

> Have people done an analysis of the reimbursements?

>

> My point being is we have been hit very hard because the OIG etc. sees

> widespread fraud and abuse in Rehab. How many of us were objecting to

> the

> situation when OT and SLP was being billed at $600+ an hour for

> example?

>

> We must not lose site of the fact that a lot of people and companies

> got

> very rich off of rehab in the last 10-15 years. Just this week OIG

> blasted

> the practices of our industry again. Is anybody standing up to the

> corporations and expressing outrage about their practices? Who knows

> what

> the profit margin is of their employer? (including the so called

> non-profits) How many bites out of the apple are there before the PT

> gets

> the core?

>

> Lets talk about empowering the PT to deal with their employer.

>

>

>

> Dick Hillyer wrote:

>

> > >

> > > What would you predict will be the watershed event that will make

> > payors work to decrease long term care costs

> > > by keeping people mobile and at home longer. To me that seems

> where

> > we will have to 'pay' for these decisions in the long run.

> >

> > >This will reduce further the ability to pay for programs. Seems to

> me

> > like a path of economic self destruction.

> > >

> >

> > Steve -- great question!

> >

> > If people were more mobile and at home longer, they'd think they

> didn't

> > " need " another central government " program " ...so I doubt payors (as

> a

> > class) will ever work that hard to decrease costs and make their

> > customers less dependent upon them by improving people's health.

> > They'll just work to decrease their own per-case costs (medical loss

> > ratios) by cutting payments to providers and then say " It's YOUR

> fault! "

> > to the providers. Sort of like what they now do with documentation.

> > They just can't tell Grandmom that she's going to get less 'cause

> > they're running out of money. Grandmom might get upset with them...

> so

> > they'll blame us.

> >

> > If the Balanced Budget Act showed us nothing else, it's that

> programs

> > which spend more than they take in cannot survive for long. Duh!

> > Keynesian spending plans cannot run ad infinitum or they do become a

> > path to economic self-destruction. Before the BBA, the interest on

> the

> > national debt was said to be consuming almost all of each year's

> > personal income tax revenues. Just the interest.

> >

> > We post-war babies will cost a lot to care for, and our kids and

> > grandkids will not be able to afford the taxation. We'd better have

> > been investing for ourselves for the past 30 years. The only entity

> > truly interested in our personal welfare... is us!

> >

> > Personally, I think we'll head for a two (or more) tiered system of

> > benefits. For everyone, a program similar to what Medicaid now

> offers,

> > with meagre subsistence care as we decline and die, which will seem

> fine

> > to the planners. (Remember the observations that the vast bulk of a

> > person's health care expenses came in the final six months of life?

> > Managing and reducing services and expenditures will still yield the

> > same result at a lower cost.)

> >

> > I also expect to see a small opportunity emerge for the affluent to

> > purchase several levels of services above and beyond the basics,

> outside

> > of the central system. That'll be abhorrent to the central social

> > planners, but I think that someone will make the case for it as

> being in

> > the interest of the nation, and it'll be allowed. Or, as Medicare

> > provides ever diminishing value to them, people with some retirement

> and

> > some means will begin opting out of the Medicare program altogether,

> so

> > that they may obtain desired services as they wish. And there will

> be

> > non-Medicare providers to serve them. As always, the provision of

> > superior perceived value to the purchaser will be the determinant.

> >

> > Futurists are telling us, however, that in the new millenium people

> will

> > be willing to pay privately and substantially for goods and services

> > which will serve to prolong their life and enjoyment. They're

> > accumulating (and compounding) the means in today's very healthy

> > economy.

> >

> > For the rehab industry, after a period of " industry fallout " I think

> > that the survivors will have a less hostile environment in which to

> > operate. Society will -- through public policy -- find ways to

> preserve

> > the institutions which they do value. That's one reason that the

> $1500

> > cap doesn't apply to acute care hospitals: Society wants to try to

> keep

> > its hospitals viable. And its a reason why PTIPs have the

> incredibly

> > restrictive, phony " same room supervision " clause. Payors want to

> get

> > rid of them.

> >

> > Ready for another break? The midterm's coming very soon, ...and the

> > Final Exam will be real life...or death.

> >

> > Dick H

> >

> >

> ----------------------------------------------------------------------

> --

> >

> > eGroups.com home: /group/ptmanager

> > - Simplifying group communications

>

>

> ----------------------------------------------------------------------

> --

>

> eGroups.com home: /group/ptmanager

> - Simplifying group communications

>

>

> << File: douglaswhite.vcf >>

[Guest guest]

Dear List:

This is an EXCELLENT critic of the history of billing in health care. I

was always concerned at the outrageous billing that took place in PT--why

did a hotpack cost $40 to apply in a hospital. I was always interested in

the mechanics of billing and often wondered why insurance companies and the

government tolerated " our " billing practices. It is interesting the outcry

that is taking place because now [maybe] the insurance companies and

medicare are taking advantage of PTs--unfortunately, " passive " PTs who do

the work (and cirlce the charges on the superbill) have been content with

" doing their job " and doing what they are told. Since there is no true

price comparison shopping in health care (if someone charges $8 for

ultrasound vs. $20, the question remains " was it delivered appropriately?

was it even necessary? and hence, in both cases and excess charge), and

since it is illegal to price fix, there needs to be a better solution. A

great starting point is to determine how much it costs to deliver your

services. If I was paid in a timely fashion, I could cut 15% or more off

of my bill! If I didn't have to go through all the insurance verification,

I could cut off another 5-10%! If patients were treated appropriately and

efficiently with appropriate results, the reduction in costs to the health

care industry could be another 20-40%. Then there are marketing costs.

The waste, fraud and inefficientcy is where the costs are in

healthcare--not in whether we charge $20 or $5 for an ultrasound. Again, a

good start is to determine where the true " costs " are and work towards

reducing the areas of inefficiency. In the right environment, $45-$60 a PT

visit would be PLENTY of revenue to pay a PT in the range of $50,000 to

$65,000 a year! Where is all the rest of the money going?

Herb Silver, PT, MBA

At 10:10 PM 9/2/99 -0400, you wrote:

>With all of our wringing of hands and outrage over the BBA, HCFA rulings on

>students etc. I don't hear much discussion about how we as the professionals

>responsible for providing the service are ensuring that the fees charged for

>our services are reasonable and that the billing practices are appropriate.

>Have people done an analysis of the reimbursements?

>

>My point being is we have been hit very hard because the OIG etc. sees

>widespread fraud and abuse in Rehab. How many of us were objecting to the

>situation when OT and SLP was being billed at $600+ an hour for example?

>

>We must not lose site of the fact that a lot of people and companies got

>very rich off of rehab in the last 10-15 years. Just this week OIG blasted

>the practices of our industry again. Is anybody standing up to the

>corporations and expressing outrage about their practices? Who knows what

>the profit margin is of their employer? (including the so called

>non-profits) How many bites out of the apple are there before the PT gets

>the core?

>

>Lets talk about empowering the PT to deal with their employer.

>

>

>

>Dick Hillyer wrote:

>

>> >

>> > What would you predict will be the watershed event that will make

>> payors work to decrease long term care costs

>> > by keeping people mobile and at home longer. To me that seems where

>> we will have to 'pay' for these decisions in the long run.

>>

>> >This will reduce further the ability to pay for programs. Seems to me

>> like a path of economic self destruction.

>> >

>>

>> Steve -- great question!

>>

>> If people were more mobile and at home longer, they'd think they didn't

>> " need " another central government " program " ...so I doubt payors (as a

>> class) will ever work that hard to decrease costs and make their

>> customers less dependent upon them by improving people's health.

>> They'll just work to decrease their own per-case costs (medical loss

>> ratios) by cutting payments to providers and then say " It's YOUR fault! "

>> to the providers. Sort of like what they now do with documentation.

>> They just can't tell Grandmom that she's going to get less 'cause

>> they're running out of money. Grandmom might get upset with them... so

>> they'll blame us.

>>

>> If the Balanced Budget Act showed us nothing else, it's that programs

>> which spend more than they take in cannot survive for long. Duh!

>> Keynesian spending plans cannot run ad infinitum or they do become a

>> path to economic self-destruction. Before the BBA, the interest on the

>> national debt was said to be consuming almost all of each year's

>> personal income tax revenues. Just the interest.

>>

>> We post-war babies will cost a lot to care for, and our kids and

>> grandkids will not be able to afford the taxation. We'd better have

>> been investing for ourselves for the past 30 years. The only entity

>> truly interested in our personal welfare... is us!

>>

>> Personally, I think we'll head for a two (or more) tiered system of

>> benefits. For everyone, a program similar to what Medicaid now offers,

>> with meagre subsistence care as we decline and die, which will seem fine

>> to the planners. (Remember the observations that the vast bulk of a

>> person's health care expenses came in the final six months of life?

>> Managing and reducing services and expenditures will still yield the

>> same result at a lower cost.)

>>

>> I also expect to see a small opportunity emerge for the affluent to

>> purchase several levels of services above and beyond the basics, outside

>> of the central system. That'll be abhorrent to the central social

>> planners, but I think that someone will make the case for it as being in

>> the interest of the nation, and it'll be allowed. Or, as Medicare

>> provides ever diminishing value to them, people with some retirement and

>> some means will begin opting out of the Medicare program altogether, so

>> that they may obtain desired services as they wish. And there will be

>> non-Medicare providers to serve them. As always, the provision of

>> superior perceived value to the purchaser will be the determinant.

>>

>> Futurists are telling us, however, that in the new millenium people will

>> be willing to pay privately and substantially for goods and services

>> which will serve to prolong their life and enjoyment. They're

>> accumulating (and compounding) the means in today's very healthy

>> economy.

>>

>> For the rehab industry, after a period of " industry fallout " I think

>> that the survivors will have a less hostile environment in which to

>> operate. Society will -- through public policy -- find ways to preserve

>> the institutions which they do value. That's one reason that the $1500

>> cap doesn't apply to acute care hospitals: Society wants to try to keep

>> its hospitals viable. And its a reason why PTIPs have the incredibly

>> restrictive, phony " same room supervision " clause. Payors want to get

>> rid of them.

>>

>> Ready for another break? The midterm's coming very soon, ...and the

>> Final Exam will be real life...or death.

>>

>> Dick H

>>

>> ------------------------------------------------------------------------

>>

>> eGroups.com home: /group/ptmanager

>> - Simplifying group communications

>

>

>------------------------------------------------------------------------

>

>eGroups.com home: /group/ptmanager

> - Simplifying group communications

>

>

>

>

>Attachment Converted: " d:\eudora\attach\douglaswhite22.vcf "

>