Re: Re: PT/OT/SP Negotiation Group

[Guest guest]

All

I am disappointed there hasn't been much interest in this thread. While I have

received a few responses, it is apparent that less than $60 for treating a

patient is acceptable reimbursement in the Northeast US (and less than that in

other markets). Maybe there are a couple of reasons for this:

1. Providers are spending less time in treatment of these patients (although

contracts are usually written to state you cannot treat these patients any

differently than other patients entering your clinic.

2. You are passing treatment off to an LPTA/COTA after initial eval (see

statement in #1 above).

3. $60 or less is acceptable reimbursement.

4. Clinic is too busy and we don't have time to fight.

5. My clinic cannot cancel the contract or we risk losing referrals to

competitors that will accept this contract.

6. Other reasons

A group like PTPN is effective if it provides enough clinic/provider density.

However, my experience in past dealings with PTPN is that it was expensive and

gives too many providers sticker shock. I know that State APTA and AOTA

organizations have reimbursement committees, but these are volunteer positions

and state associations may not be willing to use their organization as a bully

pulpit. I am curious as to whether a particular state has the numbers of

therapists that are willing to set aside the time and resources necessary to

MAKE change happen? I would think that PA, NY, NJ, and nearby states might be a

ripe climate for this type of groundswell. Less than $60 per patient treatment

for going on 10 years with no change in reimbursement and no hope of an

increase..., that seems to be a good enough reason to organize and begin

discussion.

Jim <///><

Re: PT/OT/SP Negotiation Group

Great suggestion Jim - in fact, what you describe is what PTPN has been

doing in many states for years, beginning in California in 1985. PTPN is

a network of therapist-owned private practices whose original goal was

to get independent therapists a seat at the table as managed care was

emerging in the 80s, and that continues to advocate for the private

practitioner today with many entities - payers, state legislatures, CMS

and many others. You're right on target with your thoughts: It is

important to do at a state-by-state level, given the variations among

state laws and regulations, which is why PTPN has regional offices and

officers across the country that focus on state-specific issues. In

addition, you're correct that it's important to have legal guidance to

avoid collusion/monopoly activities, and PTPN has worked with leading

healthcare lawyers throughout our history to ensure that we're

maximizing our ability to advocate for our providers while staying on

the right side of all relevant laws. If you'd like more information,

please contact me, and if you let me know what state you're in, I can

put you in touch with the PTPN folks in your area if it's a state in

which we operate.

Mitch

Mitchel Kaye, P.T.

Director, Quality Assurance

PTPN

telephone

800-766-PTPN

fax

Please visit us at ptpn.com <http://www.ptpn.com/> and physiquality.com

<http://www.physiquality.com/>

<http://www.facebook.com/PTPNInc> Like PTPN

<http://www.facebook.com/PTPNInc> on Facebook

<http://www.facebook.com/physiquality> Like Physiquality

<http://www.facebook.com/physiquality> on Facebook

[Guest guest]

Hi Jim,

What you left out is that many more therapists are more willing to try to get

the rules changed so more patients can be seen per hour and more units can be

billed per hour. Whether it is the constant battle against Medicare

regulations, battles in the APTA House of Delegates over use of supportive

personnel or the same battles at the state level, it seems like the easier route

is to try to change these laws, regulations and policies to recoup reimbursement

by farming treatment out to non-licensed personnel and get paid for it (for

treatment done at the same time as a number of other clients).

As I have said before about this, I don’t know if pursuing that course is good

or bad because there just isn’t enough research to support it or deny it. It

is a fundamental question for our profession that needs an answer.

Banding PT’s together at the state level to fight for payment issues has been

one of the most difficult things to do. The threat of a loss of salary even for

a short time (in protest) cannot be absorbed by a majority of therapists, in my

opinion, so there is too much risk to take this route. It will only be when PT

is going to be cut altogether or paid at less than the survival level for all

therapists that action might be taken. Right now successful clinic owners can

balance patient types and fill in costs with work comp and third party which

still may pay full price rates in some states and they can absorb the low cost.

We have done that but it has still meant eliminating a lot of things and getting

back to bare bones basics. Our treatment remains first rate but we are living

with less (which may not be a bad thing). So I guess that also may be what you

are seeing is that many, like us, have just accepted the new reality.

M. Howell, P.T., M.P.T.

Howell Physical Therapy

Eagle, Idaho

thowell@...

This email and any files transmitted with it may contain PRIVILEGED or

CONFIDENTIAL information and may be read or used only by the intended recipient.

If you are not the intended recipient of the email or any of its attachments,

please be advised that you have received this email in error and that any use,

dissemination, distribution, forwarding, printing or copying of this email or

any attached files is strictly prohibited. If you have received this email in

error, please immediately purge it and all attachments and notify the sender by

reply email.

From: PTManager [mailto:PTManager ] On Behalf Of

JHall49629@...

Sent: Wednesday, May 25, 2011 10:30 AM

To: PTManager

Subject: Re: Re: PT/OT/SP Negotiation Group

All

I am disappointed there hasn't been much interest in this thread. While I have

received a few responses, it is apparent that less than $60 for treating a

patient is acceptable reimbursement in the Northeast US (and less than that in

other markets). Maybe there are a couple of reasons for this:

1. Providers are spending less time in treatment of these patients (although

contracts are usually written to state you cannot treat these patients any

differently than other patients entering your clinic.

2. You are passing treatment off to an LPTA/COTA after initial eval (see

statement in #1 above).

3. $60 or less is acceptable reimbursement.

4. Clinic is too busy and we don't have time to fight.

5. My clinic cannot cancel the contract or we risk losing referrals to

competitors that will accept this contract.

6. Other reasons

A group like PTPN is effective if it provides enough clinic/provider density.

However, my experience in past dealings with PTPN is that it was expensive and

gives too many providers sticker shock. I know that State APTA and AOTA

organizations have reimbursement committees, but these are volunteer positions

and state associations may not be willing to use their organization as a bully

pulpit. I am curious as to whether a particular state has the numbers of

therapists that are willing to set aside the time and resources necessary to

MAKE change happen? I would think that PA, NY, NJ, and nearby states might be a

ripe climate for this type of groundswell. Less than $60 per patient treatment

for going on 10 years with no change in reimbursement and no hope of an

increase..., that seems to be a good enough reason to organize and begin

discussion.

Jim <///><

Re: PT/OT/SP Negotiation Group

Great suggestion Jim - in fact, what you describe is what PTPN has been

doing in many states for years, beginning in California in 1985. PTPN is

a network of therapist-owned private practices whose original goal was

to get independent therapists a seat at the table as managed care was

emerging in the 80s, and that continues to advocate for the private

practitioner today with many entities - payers, state legislatures, CMS

and many others. You're right on target with your thoughts: It is

important to do at a state-by-state level, given the variations among

state laws and regulations, which is why PTPN has regional offices and

officers across the country that focus on state-specific issues. In

addition, you're correct that it's important to have legal guidance to

avoid collusion/monopoly activities, and PTPN has worked with leading

healthcare lawyers throughout our history to ensure that we're

maximizing our ability to advocate for our providers while staying on

the right side of all relevant laws. If you'd like more information,

please contact me, and if you let me know what state you're in, I can

put you in touch with the PTPN folks in your area if it's a state in

which we operate.

Mitch

Mitchel Kaye, P.T.

Director, Quality Assurance

PTPN

telephone

800-766-PTPN

fax

Please visit us at ptpn.com <http://www.ptpn.com/> and physiquality.com

<http://www.physiquality.com/>

<http://www.facebook.com/PTPNInc> Like PTPN

<http://www.facebook.com/PTPNInc> on Facebook

<http://www.facebook.com/physiquality> Like Physiquality

<http://www.facebook.com/physiquality> on Facebook

[Guest guest]

Hi Jim,

What you left out is that many more therapists are more willing to try to get

the rules changed so more patients can be seen per hour and more units can be

billed per hour. Whether it is the constant battle against Medicare

regulations, battles in the APTA House of Delegates over use of supportive

personnel or the same battles at the state level, it seems like the easier route

is to try to change these laws, regulations and policies to recoup reimbursement

by farming treatment out to non-licensed personnel and get paid for it (for

treatment done at the same time as a number of other clients).

As I have said before about this, I don’t know if pursuing that course is good

or bad because there just isn’t enough research to support it or deny it. It

is a fundamental question for our profession that needs an answer.

Banding PT’s together at the state level to fight for payment issues has been

one of the most difficult things to do. The threat of a loss of salary even for

a short time (in protest) cannot be absorbed by a majority of therapists, in my

opinion, so there is too much risk to take this route. It will only be when PT

is going to be cut altogether or paid at less than the survival level for all

therapists that action might be taken. Right now successful clinic owners can

balance patient types and fill in costs with work comp and third party which

still may pay full price rates in some states and they can absorb the low cost.

We have done that but it has still meant eliminating a lot of things and getting

back to bare bones basics. Our treatment remains first rate but we are living

with less (which may not be a bad thing). So I guess that also may be what you

are seeing is that many, like us, have just accepted the new reality.

M. Howell, P.T., M.P.T.

Howell Physical Therapy

Eagle, Idaho

thowell@...

This email and any files transmitted with it may contain PRIVILEGED or

CONFIDENTIAL information and may be read or used only by the intended recipient.

If you are not the intended recipient of the email or any of its attachments,

please be advised that you have received this email in error and that any use,

dissemination, distribution, forwarding, printing or copying of this email or

any attached files is strictly prohibited. If you have received this email in

error, please immediately purge it and all attachments and notify the sender by

reply email.

From: PTManager [mailto:PTManager ] On Behalf Of

JHall49629@...

Sent: Wednesday, May 25, 2011 10:30 AM

To: PTManager

Subject: Re: Re: PT/OT/SP Negotiation Group

All

I am disappointed there hasn't been much interest in this thread. While I have

received a few responses, it is apparent that less than $60 for treating a

patient is acceptable reimbursement in the Northeast US (and less than that in

other markets). Maybe there are a couple of reasons for this:

1. Providers are spending less time in treatment of these patients (although

contracts are usually written to state you cannot treat these patients any

differently than other patients entering your clinic.

2. You are passing treatment off to an LPTA/COTA after initial eval (see

statement in #1 above).

3. $60 or less is acceptable reimbursement.

4. Clinic is too busy and we don't have time to fight.

5. My clinic cannot cancel the contract or we risk losing referrals to

competitors that will accept this contract.

6. Other reasons

A group like PTPN is effective if it provides enough clinic/provider density.

However, my experience in past dealings with PTPN is that it was expensive and

gives too many providers sticker shock. I know that State APTA and AOTA

organizations have reimbursement committees, but these are volunteer positions

and state associations may not be willing to use their organization as a bully

pulpit. I am curious as to whether a particular state has the numbers of

therapists that are willing to set aside the time and resources necessary to

MAKE change happen? I would think that PA, NY, NJ, and nearby states might be a

ripe climate for this type of groundswell. Less than $60 per patient treatment

for going on 10 years with no change in reimbursement and no hope of an

increase..., that seems to be a good enough reason to organize and begin

discussion.

Jim <///><

Re: PT/OT/SP Negotiation Group

Great suggestion Jim - in fact, what you describe is what PTPN has been

doing in many states for years, beginning in California in 1985. PTPN is

a network of therapist-owned private practices whose original goal was

to get independent therapists a seat at the table as managed care was

emerging in the 80s, and that continues to advocate for the private

practitioner today with many entities - payers, state legislatures, CMS

and many others. You're right on target with your thoughts: It is

important to do at a state-by-state level, given the variations among

state laws and regulations, which is why PTPN has regional offices and

officers across the country that focus on state-specific issues. In

addition, you're correct that it's important to have legal guidance to

avoid collusion/monopoly activities, and PTPN has worked with leading

healthcare lawyers throughout our history to ensure that we're

maximizing our ability to advocate for our providers while staying on

the right side of all relevant laws. If you'd like more information,

please contact me, and if you let me know what state you're in, I can

put you in touch with the PTPN folks in your area if it's a state in

which we operate.

Mitch

Mitchel Kaye, P.T.

Director, Quality Assurance

PTPN

telephone

800-766-PTPN

fax

Please visit us at ptpn.com <http://www.ptpn.com/> and physiquality.com

<http://www.physiquality.com/>

<http://www.facebook.com/PTPNInc> Like PTPN

<http://www.facebook.com/PTPNInc> on Facebook

<http://www.facebook.com/physiquality> Like Physiquality

<http://www.facebook.com/physiquality> on Facebook

[Guest guest]

Hi Jim,

What you left out is that many more therapists are more willing to try to get

the rules changed so more patients can be seen per hour and more units can be

billed per hour. Whether it is the constant battle against Medicare

regulations, battles in the APTA House of Delegates over use of supportive

personnel or the same battles at the state level, it seems like the easier route

is to try to change these laws, regulations and policies to recoup reimbursement

by farming treatment out to non-licensed personnel and get paid for it (for

treatment done at the same time as a number of other clients).

As I have said before about this, I don’t know if pursuing that course is good

or bad because there just isn’t enough research to support it or deny it. It

is a fundamental question for our profession that needs an answer.

Banding PT’s together at the state level to fight for payment issues has been

one of the most difficult things to do. The threat of a loss of salary even for

a short time (in protest) cannot be absorbed by a majority of therapists, in my

opinion, so there is too much risk to take this route. It will only be when PT

is going to be cut altogether or paid at less than the survival level for all

therapists that action might be taken. Right now successful clinic owners can

balance patient types and fill in costs with work comp and third party which

still may pay full price rates in some states and they can absorb the low cost.

We have done that but it has still meant eliminating a lot of things and getting

back to bare bones basics. Our treatment remains first rate but we are living

with less (which may not be a bad thing). So I guess that also may be what you

are seeing is that many, like us, have just accepted the new reality.

M. Howell, P.T., M.P.T.

Howell Physical Therapy

Eagle, Idaho

thowell@...

This email and any files transmitted with it may contain PRIVILEGED or

CONFIDENTIAL information and may be read or used only by the intended recipient.

If you are not the intended recipient of the email or any of its attachments,

please be advised that you have received this email in error and that any use,

dissemination, distribution, forwarding, printing or copying of this email or

any attached files is strictly prohibited. If you have received this email in

error, please immediately purge it and all attachments and notify the sender by

reply email.

From: PTManager [mailto:PTManager ] On Behalf Of

JHall49629@...

Sent: Wednesday, May 25, 2011 10:30 AM

To: PTManager

Subject: Re: Re: PT/OT/SP Negotiation Group

All

I am disappointed there hasn't been much interest in this thread. While I have

received a few responses, it is apparent that less than $60 for treating a

patient is acceptable reimbursement in the Northeast US (and less than that in

other markets). Maybe there are a couple of reasons for this:

1. Providers are spending less time in treatment of these patients (although

contracts are usually written to state you cannot treat these patients any

differently than other patients entering your clinic.

2. You are passing treatment off to an LPTA/COTA after initial eval (see

statement in #1 above).

3. $60 or less is acceptable reimbursement.

4. Clinic is too busy and we don't have time to fight.

5. My clinic cannot cancel the contract or we risk losing referrals to

competitors that will accept this contract.

6. Other reasons

A group like PTPN is effective if it provides enough clinic/provider density.

However, my experience in past dealings with PTPN is that it was expensive and

gives too many providers sticker shock. I know that State APTA and AOTA

organizations have reimbursement committees, but these are volunteer positions

and state associations may not be willing to use their organization as a bully

pulpit. I am curious as to whether a particular state has the numbers of

therapists that are willing to set aside the time and resources necessary to

MAKE change happen? I would think that PA, NY, NJ, and nearby states might be a

ripe climate for this type of groundswell. Less than $60 per patient treatment

for going on 10 years with no change in reimbursement and no hope of an

increase..., that seems to be a good enough reason to organize and begin

discussion.

Jim <///><

Re: PT/OT/SP Negotiation Group

Great suggestion Jim - in fact, what you describe is what PTPN has been

doing in many states for years, beginning in California in 1985. PTPN is

a network of therapist-owned private practices whose original goal was

to get independent therapists a seat at the table as managed care was

emerging in the 80s, and that continues to advocate for the private

practitioner today with many entities - payers, state legislatures, CMS

and many others. You're right on target with your thoughts: It is

important to do at a state-by-state level, given the variations among

state laws and regulations, which is why PTPN has regional offices and

officers across the country that focus on state-specific issues. In

addition, you're correct that it's important to have legal guidance to

avoid collusion/monopoly activities, and PTPN has worked with leading

healthcare lawyers throughout our history to ensure that we're

maximizing our ability to advocate for our providers while staying on

the right side of all relevant laws. If you'd like more information,

please contact me, and if you let me know what state you're in, I can

put you in touch with the PTPN folks in your area if it's a state in

which we operate.

Mitch

Mitchel Kaye, P.T.

Director, Quality Assurance

PTPN

telephone

800-766-PTPN

fax

Please visit us at ptpn.com <http://www.ptpn.com/> and physiquality.com

<http://www.physiquality.com/>

<http://www.facebook.com/PTPNInc> Like PTPN

<http://www.facebook.com/PTPNInc> on Facebook

<http://www.facebook.com/physiquality> Like Physiquality

<http://www.facebook.com/physiquality> on Facebook

[Guest guest]

OK Jim,

I will take a " small bite " at that hook (or just to the side of it) and

also throw some " devils advocate " for good measure. The issue of " getting

more dollars " for what we do has so many contextual layers to ponder, I don't

think it is always as simple as it might seem.

Last week I attended a conference that talked about wellness. Conference

had some moments disparaging " health insurance reform " instead of " health

reform " , but had some concrete thoughts on the latter. As part of the

discussions of hospital systems like Geisinger and Kaiser and their ACO type

activities, they discussed the need to " hold steady " all costs, as there are

stats that 35% of healthcare is " waste " . These groups asked all the

partners to commit to " zero cost growth " and share in monies saved. All the

partners in the group met and exceeded their targets and feel they can keep

growth below 5% a year based on the lessons they are learning at being more

effective/efficient.

Perhaps we have been " wringing out the waste " as we have been in zero

growth and we don't know it? How do we show value if we ask for the money and

show " where we are going " ? The challenge may be that we don't yet have a

comprehensive enough model or concise enough sound bytes to have a truly

unified and powerful message. I think we have lots of pieces and people

working on it- from professional groups/associations and think tanks, etc.

It is fresh and I am still " percolating " on my thoughts, so apologies for

any fragmented thoughts,

Dee

Dee Daley, PT DPT

WorkWell Sytems

New Ipswich, NH

In a message dated 5/25/2011 9:31:01 P.M. Eastern Daylight Time,

JHall49629@... writes:

All

I am disappointed there hasn't been much interest in this thread. While I

have received a few responses, it is apparent that less than $60 for

treating a patient is acceptable reimbursement in the Northeast US (and less

than

that in other markets). Maybe there are a couple of reasons for this:

1. Providers are spending less time in treatment of these patients

(although contracts are usually written to state you cannot treat these

patients

any differently than other patients entering your clinic.

2. You are passing treatment off to an LPTA/COTA after initial eval (see

statement in #1 above).

3. $60 or less is acceptable reimbursement.

4. Clinic is too busy and we don't have time to fight.

5. My clinic cannot cancel the contract or we risk losing referrals to

competitors that will accept this contract.

6. Other reasons

A group like PTPN is effective if it provides enough clinic/provider

density. However, my experience in past dealings with PTPN is that it was

expensive and gives too many providers sticker shock. I know that State APTA

and

AOTA organizations have reimbursement committees, but these are volunteer

positions and state associations may not be willing to use their

organization as a bully pulpit. I am curious as to whether a particular state

has the

numbers of therapists that are willing to set aside the time and resources

necessary to MAKE change happen? I would think that PA, NY, NJ, and nearby

states might be a ripe climate for this type of groundswell. Less than $60

per patient treatment for going on 10 years with no change in reimbursement

and no hope of an increase..., that seems to be a good enough reason to

organize and begin discussion.

Jim <///><

-----Original Message-----

From: Kaye, Mitch <_mkaye@..._ (mailto:mkaye@...) >

To: _PTManager _ (mailto:PTManager )

Sent: Fri, May 20, 2011 1:50 pm

Subject: Re: PT/OT/SP Negotiation Group

Great suggestion Jim - in fact, what you describe is what PTPN has been

doing in many states for years, beginning in California in 1985. PTPN is

a network of therapist-owned private practices whose original goal was

to get independent therapists a seat at the table as managed care was

emerging in the 80s, and that continues to advocate for the private

practitioner today with many entities - payers, state legislatures, CMS

and many others. You're right on target with your thoughts: It is

important to do at a state-by-state level, given the variations among

state laws and regulations, which is why PTPN has regional offices and

officers across the country that focus on state-specific issues. In

addition, you're correct that it's important to have legal guidance to

avoid collusion/monopoly activities, and PTPN has worked with leading

healthcare lawyers throughout our history to ensure that we're

maximizing our ability to advocate for our providers while staying on

the right side of all relevant laws. If you'd like more information,

please contact me, and if you let me know what state you're in, I can

put you in touch with the PTPN folks in your area if it's a state in

which we operate.

Mitch

Mitchel Kaye, P.T.

Director, Quality Assurance

PTPN

telephone

800-766-PTPN

fax

Please visit us at ptpn.com <_http://www.ptpn.com/_ (http://www.ptpn.com/)

> and physiquality.com

<_http://www.physiquality.com/_ (http://www.physiquality.com/) >

<_http://www.facebook.com/PTPNInc_ (http://www.facebook.com/PTPNInc) >

Like PTPN

<_http://www.facebook.com/PTPNInc_ (http://www.facebook.com/PTPNInc) > on

Facebook

<_http://www.facebook.com/physiquality_

(http://www.facebook.com/physiquality) > Like Physiquality

<_http://www.facebook.com/physiquality_

(http://www.facebook.com/physiquality) > on Facebook

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Guest guest]

OK Jim,

I will take a " small bite " at that hook (or just to the side of it) and

also throw some " devils advocate " for good measure. The issue of " getting

more dollars " for what we do has so many contextual layers to ponder, I don't

think it is always as simple as it might seem.

Last week I attended a conference that talked about wellness. Conference

had some moments disparaging " health insurance reform " instead of " health

reform " , but had some concrete thoughts on the latter. As part of the

discussions of hospital systems like Geisinger and Kaiser and their ACO type

activities, they discussed the need to " hold steady " all costs, as there are

stats that 35% of healthcare is " waste " . These groups asked all the

partners to commit to " zero cost growth " and share in monies saved. All the

partners in the group met and exceeded their targets and feel they can keep

growth below 5% a year based on the lessons they are learning at being more

effective/efficient.

Perhaps we have been " wringing out the waste " as we have been in zero

growth and we don't know it? How do we show value if we ask for the money and

show " where we are going " ? The challenge may be that we don't yet have a

comprehensive enough model or concise enough sound bytes to have a truly

unified and powerful message. I think we have lots of pieces and people

working on it- from professional groups/associations and think tanks, etc.

It is fresh and I am still " percolating " on my thoughts, so apologies for

any fragmented thoughts,

Dee

Dee Daley, PT DPT

WorkWell Sytems

New Ipswich, NH

In a message dated 5/25/2011 9:31:01 P.M. Eastern Daylight Time,

JHall49629@... writes:

All

I am disappointed there hasn't been much interest in this thread. While I

have received a few responses, it is apparent that less than $60 for

treating a patient is acceptable reimbursement in the Northeast US (and less

than

that in other markets). Maybe there are a couple of reasons for this:

1. Providers are spending less time in treatment of these patients

(although contracts are usually written to state you cannot treat these

patients

any differently than other patients entering your clinic.

2. You are passing treatment off to an LPTA/COTA after initial eval (see

statement in #1 above).

3. $60 or less is acceptable reimbursement.

4. Clinic is too busy and we don't have time to fight.

5. My clinic cannot cancel the contract or we risk losing referrals to

competitors that will accept this contract.

6. Other reasons

A group like PTPN is effective if it provides enough clinic/provider

density. However, my experience in past dealings with PTPN is that it was

expensive and gives too many providers sticker shock. I know that State APTA

and

AOTA organizations have reimbursement committees, but these are volunteer

positions and state associations may not be willing to use their

organization as a bully pulpit. I am curious as to whether a particular state

has the

numbers of therapists that are willing to set aside the time and resources

necessary to MAKE change happen? I would think that PA, NY, NJ, and nearby

states might be a ripe climate for this type of groundswell. Less than $60

per patient treatment for going on 10 years with no change in reimbursement

and no hope of an increase..., that seems to be a good enough reason to

organize and begin discussion.

Jim <///><

-----Original Message-----

From: Kaye, Mitch <_mkaye@..._ (mailto:mkaye@...) >

To: _PTManager _ (mailto:PTManager )

Sent: Fri, May 20, 2011 1:50 pm

Subject: Re: PT/OT/SP Negotiation Group

Great suggestion Jim - in fact, what you describe is what PTPN has been

doing in many states for years, beginning in California in 1985. PTPN is

a network of therapist-owned private practices whose original goal was

to get independent therapists a seat at the table as managed care was

emerging in the 80s, and that continues to advocate for the private

practitioner today with many entities - payers, state legislatures, CMS

and many others. You're right on target with your thoughts: It is

important to do at a state-by-state level, given the variations among

state laws and regulations, which is why PTPN has regional offices and

officers across the country that focus on state-specific issues. In

addition, you're correct that it's important to have legal guidance to

avoid collusion/monopoly activities, and PTPN has worked with leading

healthcare lawyers throughout our history to ensure that we're

maximizing our ability to advocate for our providers while staying on

the right side of all relevant laws. If you'd like more information,

please contact me, and if you let me know what state you're in, I can

put you in touch with the PTPN folks in your area if it's a state in

which we operate.

Mitch

Mitchel Kaye, P.T.

Director, Quality Assurance

PTPN

telephone

800-766-PTPN

fax

Please visit us at ptpn.com <_http://www.ptpn.com/_ (http://www.ptpn.com/)

> and physiquality.com

<_http://www.physiquality.com/_ (http://www.physiquality.com/) >

<_http://www.facebook.com/PTPNInc_ (http://www.facebook.com/PTPNInc) >

Like PTPN

<_http://www.facebook.com/PTPNInc_ (http://www.facebook.com/PTPNInc) > on

Facebook

<_http://www.facebook.com/physiquality_

(http://www.facebook.com/physiquality) > Like Physiquality

<_http://www.facebook.com/physiquality_

(http://www.facebook.com/physiquality) > on Facebook

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Guest guest]

Jim -

Helsinki Syndrome? The victims eventually identify with their oppressors,

and may actually work to further the oppressor's goals.

There is also a wrong view point that " They " (the oppressor) are smarter

than " We " (the victims) are, and that they should therefore be allowed to

make decisions about what is in our best interest. That never goes well.

I once lived and worked for a great company in a small town (as did you) in

which there was only one cable TV company. We had to pay whatever they told

us that we had to pay: They were " Deal Makers " , and we were " Deal Takers " .

That happens when one party has far too much power. When satellite TV came

along, things changed because there was competition and customers had

choices.

Because therapists have traditionally been willing to accept bad contracts

rather than have none at all, we have allowed ourselves to be " deal takers "

rather than " deal makers " . This has been our road to serfdom and will be

our path to extinction. In the interest of survival, therapy providers

should match insurors in every negotiation tactic. Of course we should

organize. We are far more interested in compassion than insurance companies

are, and we owe it to our communities to be as strong in our business skills

as we are with neurons and myofibrils.

Warm regards,

Dr. Dick Hillyer

Dr. Hillyer, PT,DPT,MBA,MSM

Hillyer Consulting

Cape Coral, FL 33914

_____

From: PTManager [mailto:PTManager ] On Behalf

Of JHall49629@...

Sent: Wednesday, May 25, 2011 12:30 PM

To: PTManager

Subject: Re: Re: PT/OT/SP Negotiation Group

All

I am disappointed there hasn't been much interest in this thread. While I

have received a few responses, it is apparent that less than $60 for

treating a patient is acceptable reimbursement in the Northeast US (and less

than that in other markets). Maybe there are a couple of reasons for this:

1. Providers are spending less time in treatment of these patients (although

contracts are usually written to state you cannot treat these patients any

differently than other patients entering your clinic.

2. You are passing treatment off to an LPTA/COTA after initial eval (see

statement in #1 above).

3. $60 or less is acceptable reimbursement.

4. Clinic is too busy and we don't have time to fight.

5. My clinic cannot cancel the contract or we risk losing referrals to

competitors that will accept this contract.

6. Other reasons

A group like PTPN is effective if it provides enough clinic/provider

density. However, my experience in past dealings with PTPN is that it was

expensive and gives too many providers sticker shock. I know that State APTA

and AOTA organizations have reimbursement committees, but these are

volunteer positions and state associations may not be willing to use their

organization as a bully pulpit. I am curious as to whether a particular

state has the numbers of therapists that are willing to set aside the time

and resources necessary to MAKE change happen? I would think that PA, NY,

NJ, and nearby states might be a ripe climate for this type of groundswell.

Less than $60 per patient treatment for going on 10 years with no change in

reimbursement and no hope of an increase..., that seems to be a good enough

reason to organize and begin discussion.

Jim <///><

Re: PT/OT/SP Negotiation Group

Great suggestion Jim - in fact, what you describe is what PTPN has been

doing in many states for years, beginning in California in 1985. PTPN is

a network of therapist-owned private practices whose original goal was

to get independent therapists a seat at the table as managed care was

emerging in the 80s, and that continues to advocate for the private

practitioner today with many entities - payers, state legislatures, CMS

and many others. You're right on target with your thoughts: It is

important to do at a state-by-state level, given the variations among

state laws and regulations, which is why PTPN has regional offices and

officers across the country that focus on state-specific issues. In

addition, you're correct that it's important to have legal guidance to

avoid collusion/monopoly activities, and PTPN has worked with leading

healthcare lawyers throughout our history to ensure that we're

maximizing our ability to advocate for our providers while staying on

the right side of all relevant laws. If you'd like more information,

please contact me, and if you let me know what state you're in, I can

put you in touch with the PTPN folks in your area if it's a state in

which we operate.

Mitch

Mitchel Kaye, P.T.

Director, Quality Assurance

PTPN

telephone

800-766-PTPN

fax

Please visit us at ptpn.com <http://www.ptpn.com/> and physiquality.com

<http://www.physiquality.com/>

<http://www.facebook.com/PTPNInc> Like PTPN

<http://www.facebook.com/PTPNInc> on Facebook

<http://www.facebook.com/physiquality> Like Physiquality

<http://www.facebook.com/physiquality> on Facebook

[Guest guest]

Jim -

Helsinki Syndrome? The victims eventually identify with their oppressors,

and may actually work to further the oppressor's goals.

There is also a wrong view point that " They " (the oppressor) are smarter

than " We " (the victims) are, and that they should therefore be allowed to

make decisions about what is in our best interest. That never goes well.

I once lived and worked for a great company in a small town (as did you) in

which there was only one cable TV company. We had to pay whatever they told

us that we had to pay: They were " Deal Makers " , and we were " Deal Takers " .

That happens when one party has far too much power. When satellite TV came

along, things changed because there was competition and customers had

choices.

Because therapists have traditionally been willing to accept bad contracts

rather than have none at all, we have allowed ourselves to be " deal takers "

rather than " deal makers " . This has been our road to serfdom and will be

our path to extinction. In the interest of survival, therapy providers

should match insurors in every negotiation tactic. Of course we should

organize. We are far more interested in compassion than insurance companies

are, and we owe it to our communities to be as strong in our business skills

as we are with neurons and myofibrils.

Warm regards,

Dr. Dick Hillyer

Dr. Hillyer, PT,DPT,MBA,MSM

Hillyer Consulting

Cape Coral, FL 33914

_____

From: PTManager [mailto:PTManager ] On Behalf

Of JHall49629@...

Sent: Wednesday, May 25, 2011 12:30 PM

To: PTManager

Subject: Re: Re: PT/OT/SP Negotiation Group

All

I am disappointed there hasn't been much interest in this thread. While I

have received a few responses, it is apparent that less than $60 for

treating a patient is acceptable reimbursement in the Northeast US (and less

than that in other markets). Maybe there are a couple of reasons for this:

1. Providers are spending less time in treatment of these patients (although

contracts are usually written to state you cannot treat these patients any

differently than other patients entering your clinic.

2. You are passing treatment off to an LPTA/COTA after initial eval (see

statement in #1 above).

3. $60 or less is acceptable reimbursement.

4. Clinic is too busy and we don't have time to fight.

5. My clinic cannot cancel the contract or we risk losing referrals to

competitors that will accept this contract.

6. Other reasons

A group like PTPN is effective if it provides enough clinic/provider

density. However, my experience in past dealings with PTPN is that it was

expensive and gives too many providers sticker shock. I know that State APTA

and AOTA organizations have reimbursement committees, but these are

volunteer positions and state associations may not be willing to use their

organization as a bully pulpit. I am curious as to whether a particular

state has the numbers of therapists that are willing to set aside the time

and resources necessary to MAKE change happen? I would think that PA, NY,

NJ, and nearby states might be a ripe climate for this type of groundswell.

Less than $60 per patient treatment for going on 10 years with no change in

reimbursement and no hope of an increase..., that seems to be a good enough

reason to organize and begin discussion.

Jim <///><

Re: PT/OT/SP Negotiation Group

Great suggestion Jim - in fact, what you describe is what PTPN has been

doing in many states for years, beginning in California in 1985. PTPN is

a network of therapist-owned private practices whose original goal was

to get independent therapists a seat at the table as managed care was

emerging in the 80s, and that continues to advocate for the private

practitioner today with many entities - payers, state legislatures, CMS

and many others. You're right on target with your thoughts: It is

important to do at a state-by-state level, given the variations among

state laws and regulations, which is why PTPN has regional offices and

officers across the country that focus on state-specific issues. In

addition, you're correct that it's important to have legal guidance to

avoid collusion/monopoly activities, and PTPN has worked with leading

healthcare lawyers throughout our history to ensure that we're

maximizing our ability to advocate for our providers while staying on

the right side of all relevant laws. If you'd like more information,

please contact me, and if you let me know what state you're in, I can

put you in touch with the PTPN folks in your area if it's a state in

which we operate.

Mitch

Mitchel Kaye, P.T.

Director, Quality Assurance

PTPN

telephone

800-766-PTPN

fax

Please visit us at ptpn.com <http://www.ptpn.com/> and physiquality.com

<http://www.physiquality.com/>

<http://www.facebook.com/PTPNInc> Like PTPN

<http://www.facebook.com/PTPNInc> on Facebook

<http://www.facebook.com/physiquality> Like Physiquality

<http://www.facebook.com/physiquality> on Facebook

[Guest guest]

Jim -

Helsinki Syndrome? The victims eventually identify with their oppressors,

and may actually work to further the oppressor's goals.

There is also a wrong view point that " They " (the oppressor) are smarter

than " We " (the victims) are, and that they should therefore be allowed to

make decisions about what is in our best interest. That never goes well.

I once lived and worked for a great company in a small town (as did you) in

which there was only one cable TV company. We had to pay whatever they told

us that we had to pay: They were " Deal Makers " , and we were " Deal Takers " .

That happens when one party has far too much power. When satellite TV came

along, things changed because there was competition and customers had

choices.

Because therapists have traditionally been willing to accept bad contracts

rather than have none at all, we have allowed ourselves to be " deal takers "

rather than " deal makers " . This has been our road to serfdom and will be

our path to extinction. In the interest of survival, therapy providers

should match insurors in every negotiation tactic. Of course we should

organize. We are far more interested in compassion than insurance companies

are, and we owe it to our communities to be as strong in our business skills

as we are with neurons and myofibrils.

Warm regards,

Dr. Dick Hillyer

Dr. Hillyer, PT,DPT,MBA,MSM

Hillyer Consulting

Cape Coral, FL 33914

_____

From: PTManager [mailto:PTManager ] On Behalf

Of JHall49629@...

Sent: Wednesday, May 25, 2011 12:30 PM

To: PTManager

Subject: Re: Re: PT/OT/SP Negotiation Group

All

I am disappointed there hasn't been much interest in this thread. While I

have received a few responses, it is apparent that less than $60 for

treating a patient is acceptable reimbursement in the Northeast US (and less

than that in other markets). Maybe there are a couple of reasons for this:

1. Providers are spending less time in treatment of these patients (although

contracts are usually written to state you cannot treat these patients any

differently than other patients entering your clinic.

2. You are passing treatment off to an LPTA/COTA after initial eval (see

statement in #1 above).

3. $60 or less is acceptable reimbursement.

4. Clinic is too busy and we don't have time to fight.

5. My clinic cannot cancel the contract or we risk losing referrals to

competitors that will accept this contract.

6. Other reasons

A group like PTPN is effective if it provides enough clinic/provider

density. However, my experience in past dealings with PTPN is that it was

expensive and gives too many providers sticker shock. I know that State APTA

and AOTA organizations have reimbursement committees, but these are

volunteer positions and state associations may not be willing to use their

organization as a bully pulpit. I am curious as to whether a particular

state has the numbers of therapists that are willing to set aside the time

and resources necessary to MAKE change happen? I would think that PA, NY,

NJ, and nearby states might be a ripe climate for this type of groundswell.

Less than $60 per patient treatment for going on 10 years with no change in

reimbursement and no hope of an increase..., that seems to be a good enough

reason to organize and begin discussion.

Jim <///><

Re: PT/OT/SP Negotiation Group

Great suggestion Jim - in fact, what you describe is what PTPN has been

doing in many states for years, beginning in California in 1985. PTPN is

a network of therapist-owned private practices whose original goal was

to get independent therapists a seat at the table as managed care was

emerging in the 80s, and that continues to advocate for the private

practitioner today with many entities - payers, state legislatures, CMS

and many others. You're right on target with your thoughts: It is

important to do at a state-by-state level, given the variations among

state laws and regulations, which is why PTPN has regional offices and

officers across the country that focus on state-specific issues. In

addition, you're correct that it's important to have legal guidance to

avoid collusion/monopoly activities, and PTPN has worked with leading

healthcare lawyers throughout our history to ensure that we're

maximizing our ability to advocate for our providers while staying on

the right side of all relevant laws. If you'd like more information,

please contact me, and if you let me know what state you're in, I can

put you in touch with the PTPN folks in your area if it's a state in

which we operate.

Mitch

Mitchel Kaye, P.T.

Director, Quality Assurance

PTPN

telephone

800-766-PTPN

fax

Please visit us at ptpn.com <http://www.ptpn.com/> and physiquality.com

<http://www.physiquality.com/>

<http://www.facebook.com/PTPNInc> Like PTPN

<http://www.facebook.com/PTPNInc> on Facebook

<http://www.facebook.com/physiquality> Like Physiquality

<http://www.facebook.com/physiquality> on Facebook

[Guest guest]

I guess I have been sleeping while this conversation has been going on.

It is one of my so called “favorite topics†as it touches in so many “PT

thingsâ€, particularly about “PT presumptionsâ€.

I am sure I am going to miss some of the many presumptions. I am sure I am

going to inflame many a peaceful PTs (unintendedly) and I am sure I presume I

will resonate with very few colleagues if any.

PT Presumptions:

-Insurance companies and any other payer has any type of formula for lowering

payments other than just push as low as they can before their marketing efforts

get affected in selling more policies to more lives.

- Insurance companies or any other payers utilize current scientific evidence in

making payment decisions.

-Time of treatment of a patient matters to ANY body other than the PT (unless

you are selling massages, how long it takes you to fix the problem does not

matter to anybody)

- That payers care if you are using a PTA, a DPT, a PhD, a chimp or your janitor

to rub ultrasound on someone’s back. It should only matter to you and I (as I

care the image you may inflict on me as my peer by the things you do), and you

and I should write the rules, rather than continue allowing someone else to

write them. I promise you the janitor and the chimp would do equal job at

rubbing the ultrasound and by having the PhD rub it doesn’t make it

“skilled†(you gotta love it when PTs call things skilled vs. non-skilled,

as if a PT watching someone on a bike or counts SLR reps makes it skilled, but

if the janitor does it would no longer be skilled)

- APTA or any other institution would be bullying by using any or all pushing

power to advance our interests, PARTICULARLY financial interests (what else are

they taking your membership dues for, if not to represent you in everyway

possible and to push the envelope screaming on the “impossible�)

- Medicare rules are somewhat golden standard

- That a PT owned “contract negotiator exclusive club†somewhat would be any

different than anybody else profiting from our work, like anything else, as in

“network negotiators†are there to fight the insurance for you and that

insurance payers give a damn (until affects their business of course).

“Contract negotiator clubs†do not constitute Physiotherapists Organizing.

Means another business. Working to make a buck like anyone else. Not to get

our profession off the dark ages.

- That somehow we (PT) are a staple in healthcare, when the hands down majority

of this country doesn’t have a clue what a PT is or does (including many PTs

themselves).

- That somehow we are part of this “medical community†and that somehow we

should enjoy equal benefits to other members of this community, when in fact, if

we were to wake up one day, we would realize we would be their worse nightmare,

their biggest competitor hands down and even though we don’t see it ourselves,

they do and it remains the reason number one why they (MDs)(and others – i.e.

Chiropracotrs) all bar direct access from us through out the country, fight to

perpetuate the prostitution of our profession (POPTs) in spite of ourselves and

we still waste time concerned if we are being ethical enough, policing ourselves

enough and ensuring we are not bullying anybody while we comply with an absurd

number of nonsensical rules.

We need to take care of one another.

We need to step out of this “medical community†where we are marginalized,

we need to grow up, team up and gear up, get heavy and then throw our weight

around, after all, it is not like we (PT community) don’t want to offer a

good service for a reasonable price.

We need to give “the medical community†the competition they need.

For the “PT contract negotiators of this worldâ€, when they impose

geographical exclusivity to “fight for youâ€, they are not fighting for PTs,

they are gimmicking you into paying them so they can get you what you could get

yourself but didn’t know it.

We are still asking for an English duel, with white gloves and all, but we are

in the middle of a bar fight and don’t know it. The sooner we see it, the

sooner we may get out without being stabbed.

“By, the way, you all can buy our PT leather vest and our removable PT clan

tattoo at the gift shop. It is in the shelf next to the English punch and the

razor blades, by the Kevlar vests.â€

Every day we go anywhere in this country without full and unrestricted direct

access I go to sleep completely and utterly ashamed and embarrassed of who we

still allow others make of us. (yes, it has a lot to do with it).

I am sure I missed a point here and there and I sure could go on for another 10

pages, possibly exploring every possible tangent our collective amateur

technician status would allow me, single spaced, but its getting hard to hold

the timer while I apply this ultrasound for 8.5 min so It can be long enough and

skilled enough so I can get paid $3.46 for it and at the end of the 60 min I

allotted to this patient it will all add up mathematically and I can collect

$53.00 without offending any of the 3000 rules that regulate me, 3 1/2 months

from now if my biller knows what hoops to jump.

Peace ; )

Armin Loges, PT

Tampa, FL

From: Dick Hillyer

Sent: Thursday, May 26, 2011 10:40 AM

To: PTManager

Subject: RE: Re: PT/OT/SP Negotiation Group

Jim -

Helsinki Syndrome? The victims eventually identify with their oppressors,

and may actually work to further the oppressor's goals.

There is also a wrong view point that " They " (the oppressor) are smarter

than " We " (the victims) are, and that they should therefore be allowed to

make decisions about what is in our best interest. That never goes well.

I once lived and worked for a great company in a small town (as did you) in

which there was only one cable TV company. We had to pay whatever they told

us that we had to pay: They were " Deal Makers " , and we were " Deal Takers " .

That happens when one party has far too much power. When satellite TV came

along, things changed because there was competition and customers had

choices.

Because therapists have traditionally been willing to accept bad contracts

rather than have none at all, we have allowed ourselves to be " deal takers "

rather than " deal makers " . This has been our road to serfdom and will be

our path to extinction. In the interest of survival, therapy providers

should match insurors in every negotiation tactic. Of course we should

organize. We are far more interested in compassion than insurance companies

are, and we owe it to our communities to be as strong in our business skills

as we are with neurons and myofibrils.

Warm regards,

Dr. Dick Hillyer

Dr. Hillyer, PT,DPT,MBA,MSM

Hillyer Consulting

Cape Coral, FL 33914

_____

From: mailto:PTManager%40yahoogroups.com

[mailto:mailto:PTManager%40yahoogroups.com] On Behalf

Of mailto:JHall49629%40aol.com

Sent: Wednesday, May 25, 2011 12:30 PM

To: mailto:PTManager%40yahoogroups.com

Subject: Re: Re: PT/OT/SP Negotiation Group

All

I am disappointed there hasn't been much interest in this thread. While I

have received a few responses, it is apparent that less than $60 for

treating a patient is acceptable reimbursement in the Northeast US (and less

than that in other markets). Maybe there are a couple of reasons for this:

1. Providers are spending less time in treatment of these patients (although

contracts are usually written to state you cannot treat these patients any

differently than other patients entering your clinic.

2. You are passing treatment off to an LPTA/COTA after initial eval (see

statement in #1 above).

3. $60 or less is acceptable reimbursement.

4. Clinic is too busy and we don't have time to fight.

5. My clinic cannot cancel the contract or we risk losing referrals to

competitors that will accept this contract.

6. Other reasons

A group like PTPN is effective if it provides enough clinic/provider

density. However, my experience in past dealings with PTPN is that it was

expensive and gives too many providers sticker shock. I know that State APTA

and AOTA organizations have reimbursement committees, but these are

volunteer positions and state associations may not be willing to use their

organization as a bully pulpit. I am curious as to whether a particular

state has the numbers of therapists that are willing to set aside the time

and resources necessary to MAKE change happen? I would think that PA, NY,

NJ, and nearby states might be a ripe climate for this type of groundswell.

Less than $60 per patient treatment for going on 10 years with no change in

reimbursement and no hope of an increase..., that seems to be a good enough

reason to organize and begin discussion.

Jim <///><

Re: PT/OT/SP Negotiation Group

Great suggestion Jim - in fact, what you describe is what PTPN has been

doing in many states for years, beginning in California in 1985. PTPN is

a network of therapist-owned private practices whose original goal was

to get independent therapists a seat at the table as managed care was

emerging in the 80s, and that continues to advocate for the private

practitioner today with many entities - payers, state legislatures, CMS

and many others. You're right on target with your thoughts: It is

important to do at a state-by-state level, given the variations among

state laws and regulations, which is why PTPN has regional offices and

officers across the country that focus on state-specific issues. In

addition, you're correct that it's important to have legal guidance to

avoid collusion/monopoly activities, and PTPN has worked with leading

healthcare lawyers throughout our history to ensure that we're

maximizing our ability to advocate for our providers while staying on

the right side of all relevant laws. If you'd like more information,

please contact me, and if you let me know what state you're in, I can

put you in touch with the PTPN folks in your area if it's a state in

which we operate.

Mitch

Mitchel Kaye, P.T.

Director, Quality Assurance

PTPN

telephone

800-766-PTPN

fax

Please visit us at ptpn.com <http://www.ptpn.com/> and physiquality.com

<http://www.physiquality.com/>

<http://www.facebook.com/PTPNInc> Like PTPN

<http://www.facebook.com/PTPNInc> on Facebook

<http://www.facebook.com/physiquality> Like Physiquality

<http://www.facebook.com/physiquality> on Facebook

[Guest guest]

I guess I have been sleeping while this conversation has been going on.

It is one of my so called “favorite topics†as it touches in so many “PT

thingsâ€, particularly about “PT presumptionsâ€.

I am sure I am going to miss some of the many presumptions. I am sure I am

going to inflame many a peaceful PTs (unintendedly) and I am sure I presume I

will resonate with very few colleagues if any.

PT Presumptions:

-Insurance companies and any other payer has any type of formula for lowering

payments other than just push as low as they can before their marketing efforts

get affected in selling more policies to more lives.

- Insurance companies or any other payers utilize current scientific evidence in

making payment decisions.

-Time of treatment of a patient matters to ANY body other than the PT (unless

you are selling massages, how long it takes you to fix the problem does not

matter to anybody)

- That payers care if you are using a PTA, a DPT, a PhD, a chimp or your janitor

to rub ultrasound on someone’s back. It should only matter to you and I (as I

care the image you may inflict on me as my peer by the things you do), and you

and I should write the rules, rather than continue allowing someone else to

write them. I promise you the janitor and the chimp would do equal job at

rubbing the ultrasound and by having the PhD rub it doesn’t make it

“skilled†(you gotta love it when PTs call things skilled vs. non-skilled,

as if a PT watching someone on a bike or counts SLR reps makes it skilled, but

if the janitor does it would no longer be skilled)

- APTA or any other institution would be bullying by using any or all pushing

power to advance our interests, PARTICULARLY financial interests (what else are

they taking your membership dues for, if not to represent you in everyway

possible and to push the envelope screaming on the “impossible�)

- Medicare rules are somewhat golden standard

- That a PT owned “contract negotiator exclusive club†somewhat would be any

different than anybody else profiting from our work, like anything else, as in

“network negotiators†are there to fight the insurance for you and that

insurance payers give a damn (until affects their business of course).

“Contract negotiator clubs†do not constitute Physiotherapists Organizing.

Means another business. Working to make a buck like anyone else. Not to get

our profession off the dark ages.

- That somehow we (PT) are a staple in healthcare, when the hands down majority

of this country doesn’t have a clue what a PT is or does (including many PTs

themselves).

- That somehow we are part of this “medical community†and that somehow we

should enjoy equal benefits to other members of this community, when in fact, if

we were to wake up one day, we would realize we would be their worse nightmare,

their biggest competitor hands down and even though we don’t see it ourselves,

they do and it remains the reason number one why they (MDs)(and others – i.e.

Chiropracotrs) all bar direct access from us through out the country, fight to

perpetuate the prostitution of our profession (POPTs) in spite of ourselves and

we still waste time concerned if we are being ethical enough, policing ourselves

enough and ensuring we are not bullying anybody while we comply with an absurd

number of nonsensical rules.

We need to take care of one another.

We need to step out of this “medical community†where we are marginalized,

we need to grow up, team up and gear up, get heavy and then throw our weight

around, after all, it is not like we (PT community) don’t want to offer a

good service for a reasonable price.

We need to give “the medical community†the competition they need.

For the “PT contract negotiators of this worldâ€, when they impose

geographical exclusivity to “fight for youâ€, they are not fighting for PTs,

they are gimmicking you into paying them so they can get you what you could get

yourself but didn’t know it.

We are still asking for an English duel, with white gloves and all, but we are

in the middle of a bar fight and don’t know it. The sooner we see it, the

sooner we may get out without being stabbed.

“By, the way, you all can buy our PT leather vest and our removable PT clan

tattoo at the gift shop. It is in the shelf next to the English punch and the

razor blades, by the Kevlar vests.â€

Every day we go anywhere in this country without full and unrestricted direct

access I go to sleep completely and utterly ashamed and embarrassed of who we

still allow others make of us. (yes, it has a lot to do with it).

I am sure I missed a point here and there and I sure could go on for another 10

pages, possibly exploring every possible tangent our collective amateur

technician status would allow me, single spaced, but its getting hard to hold

the timer while I apply this ultrasound for 8.5 min so It can be long enough and

skilled enough so I can get paid $3.46 for it and at the end of the 60 min I

allotted to this patient it will all add up mathematically and I can collect

$53.00 without offending any of the 3000 rules that regulate me, 3 1/2 months

from now if my biller knows what hoops to jump.

Peace ; )

Armin Loges, PT

Tampa, FL

From: Dick Hillyer

Sent: Thursday, May 26, 2011 10:40 AM

To: PTManager

Subject: RE: Re: PT/OT/SP Negotiation Group

Jim -

Helsinki Syndrome? The victims eventually identify with their oppressors,

and may actually work to further the oppressor's goals.

There is also a wrong view point that " They " (the oppressor) are smarter

than " We " (the victims) are, and that they should therefore be allowed to

make decisions about what is in our best interest. That never goes well.

I once lived and worked for a great company in a small town (as did you) in

which there was only one cable TV company. We had to pay whatever they told

us that we had to pay: They were " Deal Makers " , and we were " Deal Takers " .

That happens when one party has far too much power. When satellite TV came

along, things changed because there was competition and customers had

choices.

Because therapists have traditionally been willing to accept bad contracts

rather than have none at all, we have allowed ourselves to be " deal takers "

rather than " deal makers " . This has been our road to serfdom and will be

our path to extinction. In the interest of survival, therapy providers

should match insurors in every negotiation tactic. Of course we should

organize. We are far more interested in compassion than insurance companies

are, and we owe it to our communities to be as strong in our business skills

as we are with neurons and myofibrils.

Warm regards,

Dr. Dick Hillyer

Dr. Hillyer, PT,DPT,MBA,MSM

Hillyer Consulting

Cape Coral, FL 33914

_____

From: mailto:PTManager%40yahoogroups.com

[mailto:mailto:PTManager%40yahoogroups.com] On Behalf

Of mailto:JHall49629%40aol.com

Sent: Wednesday, May 25, 2011 12:30 PM

To: mailto:PTManager%40yahoogroups.com

Subject: Re: Re: PT/OT/SP Negotiation Group

All

I am disappointed there hasn't been much interest in this thread. While I

have received a few responses, it is apparent that less than $60 for

treating a patient is acceptable reimbursement in the Northeast US (and less

than that in other markets). Maybe there are a couple of reasons for this:

1. Providers are spending less time in treatment of these patients (although

contracts are usually written to state you cannot treat these patients any

differently than other patients entering your clinic.

2. You are passing treatment off to an LPTA/COTA after initial eval (see

statement in #1 above).

3. $60 or less is acceptable reimbursement.

4. Clinic is too busy and we don't have time to fight.

5. My clinic cannot cancel the contract or we risk losing referrals to

competitors that will accept this contract.

6. Other reasons

A group like PTPN is effective if it provides enough clinic/provider

density. However, my experience in past dealings with PTPN is that it was

expensive and gives too many providers sticker shock. I know that State APTA

and AOTA organizations have reimbursement committees, but these are

volunteer positions and state associations may not be willing to use their

organization as a bully pulpit. I am curious as to whether a particular

state has the numbers of therapists that are willing to set aside the time

and resources necessary to MAKE change happen? I would think that PA, NY,

NJ, and nearby states might be a ripe climate for this type of groundswell.

Less than $60 per patient treatment for going on 10 years with no change in

reimbursement and no hope of an increase..., that seems to be a good enough

reason to organize and begin discussion.

Jim <///><

Re: PT/OT/SP Negotiation Group

Great suggestion Jim - in fact, what you describe is what PTPN has been

doing in many states for years, beginning in California in 1985. PTPN is

a network of therapist-owned private practices whose original goal was

to get independent therapists a seat at the table as managed care was

emerging in the 80s, and that continues to advocate for the private

practitioner today with many entities - payers, state legislatures, CMS

and many others. You're right on target with your thoughts: It is

important to do at a state-by-state level, given the variations among

state laws and regulations, which is why PTPN has regional offices and

officers across the country that focus on state-specific issues. In

addition, you're correct that it's important to have legal guidance to

avoid collusion/monopoly activities, and PTPN has worked with leading

healthcare lawyers throughout our history to ensure that we're

maximizing our ability to advocate for our providers while staying on

the right side of all relevant laws. If you'd like more information,

please contact me, and if you let me know what state you're in, I can

put you in touch with the PTPN folks in your area if it's a state in

which we operate.

Mitch

Mitchel Kaye, P.T.

Director, Quality Assurance

PTPN

telephone

800-766-PTPN

fax

Please visit us at ptpn.com <http://www.ptpn.com/> and physiquality.com

<http://www.physiquality.com/>

<http://www.facebook.com/PTPNInc> Like PTPN

<http://www.facebook.com/PTPNInc> on Facebook

<http://www.facebook.com/physiquality> Like Physiquality

<http://www.facebook.com/physiquality> on Facebook

[Guest guest]

I guess I have been sleeping while this conversation has been going on.

It is one of my so called “favorite topics†as it touches in so many “PT

thingsâ€, particularly about “PT presumptionsâ€.

I am sure I am going to miss some of the many presumptions. I am sure I am

going to inflame many a peaceful PTs (unintendedly) and I am sure I presume I

will resonate with very few colleagues if any.

PT Presumptions:

-Insurance companies and any other payer has any type of formula for lowering

payments other than just push as low as they can before their marketing efforts

get affected in selling more policies to more lives.

- Insurance companies or any other payers utilize current scientific evidence in

making payment decisions.

-Time of treatment of a patient matters to ANY body other than the PT (unless

you are selling massages, how long it takes you to fix the problem does not

matter to anybody)

- That payers care if you are using a PTA, a DPT, a PhD, a chimp or your janitor

to rub ultrasound on someone’s back. It should only matter to you and I (as I

care the image you may inflict on me as my peer by the things you do), and you

and I should write the rules, rather than continue allowing someone else to

write them. I promise you the janitor and the chimp would do equal job at

rubbing the ultrasound and by having the PhD rub it doesn’t make it

“skilled†(you gotta love it when PTs call things skilled vs. non-skilled,

as if a PT watching someone on a bike or counts SLR reps makes it skilled, but

if the janitor does it would no longer be skilled)

- APTA or any other institution would be bullying by using any or all pushing

power to advance our interests, PARTICULARLY financial interests (what else are

they taking your membership dues for, if not to represent you in everyway

possible and to push the envelope screaming on the “impossible�)

- Medicare rules are somewhat golden standard

- That a PT owned “contract negotiator exclusive club†somewhat would be any

different than anybody else profiting from our work, like anything else, as in

“network negotiators†are there to fight the insurance for you and that

insurance payers give a damn (until affects their business of course).

“Contract negotiator clubs†do not constitute Physiotherapists Organizing.

Means another business. Working to make a buck like anyone else. Not to get

our profession off the dark ages.

- That somehow we (PT) are a staple in healthcare, when the hands down majority

of this country doesn’t have a clue what a PT is or does (including many PTs

themselves).

- That somehow we are part of this “medical community†and that somehow we

should enjoy equal benefits to other members of this community, when in fact, if

we were to wake up one day, we would realize we would be their worse nightmare,

their biggest competitor hands down and even though we don’t see it ourselves,

they do and it remains the reason number one why they (MDs)(and others – i.e.

Chiropracotrs) all bar direct access from us through out the country, fight to

perpetuate the prostitution of our profession (POPTs) in spite of ourselves and

we still waste time concerned if we are being ethical enough, policing ourselves

enough and ensuring we are not bullying anybody while we comply with an absurd

number of nonsensical rules.

We need to take care of one another.

We need to step out of this “medical community†where we are marginalized,

we need to grow up, team up and gear up, get heavy and then throw our weight

around, after all, it is not like we (PT community) don’t want to offer a

good service for a reasonable price.

We need to give “the medical community†the competition they need.

For the “PT contract negotiators of this worldâ€, when they impose

geographical exclusivity to “fight for youâ€, they are not fighting for PTs,

they are gimmicking you into paying them so they can get you what you could get

yourself but didn’t know it.

We are still asking for an English duel, with white gloves and all, but we are

in the middle of a bar fight and don’t know it. The sooner we see it, the

sooner we may get out without being stabbed.

“By, the way, you all can buy our PT leather vest and our removable PT clan

tattoo at the gift shop. It is in the shelf next to the English punch and the

razor blades, by the Kevlar vests.â€

Every day we go anywhere in this country without full and unrestricted direct

access I go to sleep completely and utterly ashamed and embarrassed of who we

still allow others make of us. (yes, it has a lot to do with it).

I am sure I missed a point here and there and I sure could go on for another 10

pages, possibly exploring every possible tangent our collective amateur

technician status would allow me, single spaced, but its getting hard to hold

the timer while I apply this ultrasound for 8.5 min so It can be long enough and

skilled enough so I can get paid $3.46 for it and at the end of the 60 min I

allotted to this patient it will all add up mathematically and I can collect

$53.00 without offending any of the 3000 rules that regulate me, 3 1/2 months

from now if my biller knows what hoops to jump.

Peace ; )

Armin Loges, PT

Tampa, FL

From: Dick Hillyer

Sent: Thursday, May 26, 2011 10:40 AM

To: PTManager

Subject: RE: Re: PT/OT/SP Negotiation Group

Jim -

Helsinki Syndrome? The victims eventually identify with their oppressors,

and may actually work to further the oppressor's goals.

There is also a wrong view point that " They " (the oppressor) are smarter

than " We " (the victims) are, and that they should therefore be allowed to

make decisions about what is in our best interest. That never goes well.

I once lived and worked for a great company in a small town (as did you) in

which there was only one cable TV company. We had to pay whatever they told

us that we had to pay: They were " Deal Makers " , and we were " Deal Takers " .

That happens when one party has far too much power. When satellite TV came

along, things changed because there was competition and customers had

choices.

Because therapists have traditionally been willing to accept bad contracts

rather than have none at all, we have allowed ourselves to be " deal takers "

rather than " deal makers " . This has been our road to serfdom and will be

our path to extinction. In the interest of survival, therapy providers

should match insurors in every negotiation tactic. Of course we should

organize. We are far more interested in compassion than insurance companies

are, and we owe it to our communities to be as strong in our business skills

as we are with neurons and myofibrils.

Warm regards,

Dr. Dick Hillyer

Dr. Hillyer, PT,DPT,MBA,MSM

Hillyer Consulting

Cape Coral, FL 33914

_____

From: mailto:PTManager%40yahoogroups.com

[mailto:mailto:PTManager%40yahoogroups.com] On Behalf

Of mailto:JHall49629%40aol.com

Sent: Wednesday, May 25, 2011 12:30 PM

To: mailto:PTManager%40yahoogroups.com

Subject: Re: Re: PT/OT/SP Negotiation Group

All

I am disappointed there hasn't been much interest in this thread. While I

have received a few responses, it is apparent that less than $60 for

treating a patient is acceptable reimbursement in the Northeast US (and less

than that in other markets). Maybe there are a couple of reasons for this:

1. Providers are spending less time in treatment of these patients (although

contracts are usually written to state you cannot treat these patients any

differently than other patients entering your clinic.

2. You are passing treatment off to an LPTA/COTA after initial eval (see

statement in #1 above).

3. $60 or less is acceptable reimbursement.

4. Clinic is too busy and we don't have time to fight.

5. My clinic cannot cancel the contract or we risk losing referrals to

competitors that will accept this contract.

6. Other reasons

A group like PTPN is effective if it provides enough clinic/provider

density. However, my experience in past dealings with PTPN is that it was

expensive and gives too many providers sticker shock. I know that State APTA

and AOTA organizations have reimbursement committees, but these are

volunteer positions and state associations may not be willing to use their

organization as a bully pulpit. I am curious as to whether a particular

state has the numbers of therapists that are willing to set aside the time

and resources necessary to MAKE change happen? I would think that PA, NY,

NJ, and nearby states might be a ripe climate for this type of groundswell.

Less than $60 per patient treatment for going on 10 years with no change in

reimbursement and no hope of an increase..., that seems to be a good enough

reason to organize and begin discussion.

Jim <///><

Re: PT/OT/SP Negotiation Group

Great suggestion Jim - in fact, what you describe is what PTPN has been

doing in many states for years, beginning in California in 1985. PTPN is

a network of therapist-owned private practices whose original goal was

to get independent therapists a seat at the table as managed care was

emerging in the 80s, and that continues to advocate for the private

practitioner today with many entities - payers, state legislatures, CMS

and many others. You're right on target with your thoughts: It is

important to do at a state-by-state level, given the variations among

state laws and regulations, which is why PTPN has regional offices and

officers across the country that focus on state-specific issues. In

addition, you're correct that it's important to have legal guidance to

avoid collusion/monopoly activities, and PTPN has worked with leading

healthcare lawyers throughout our history to ensure that we're

maximizing our ability to advocate for our providers while staying on

the right side of all relevant laws. If you'd like more information,

please contact me, and if you let me know what state you're in, I can

put you in touch with the PTPN folks in your area if it's a state in

which we operate.

Mitch

Mitchel Kaye, P.T.

Director, Quality Assurance

PTPN

telephone

800-766-PTPN

fax

Please visit us at ptpn.com <http://www.ptpn.com/> and physiquality.com

<http://www.physiquality.com/>

<http://www.facebook.com/PTPNInc> Like PTPN

<http://www.facebook.com/PTPNInc> on Facebook

<http://www.facebook.com/physiquality> Like Physiquality

<http://www.facebook.com/physiquality> on Facebook

[Guest guest]

Oops! " Stockholm Syndrome " is the name of the phenomenon. Sorry for the

error. Most sincere apologies to the Fins!

When there's only one seller in an area, such as the electric company, they

call that a " monopoly " . The monopoly sets the terms of the deal.

When there's only one hospital in a small town, to O.R. nurses this is a

" monopsony " . There's only one buyer, and the term for that is " monopsony " .

In that case, the hospital/buyer sets the terms of its deal with its nurses.

PTs have created several venues in which to see our patients. If we don't

want to work at the hospital, then we can work at an SNF or HHA. We can

start a private practice.

So, in every one of our trading relationships, are we the " deal taker " , or

can we be a " deal maker " ? If we find ways to have a negotiating platform,

we may be able to influence our circumstances. If not, we'll be suppressed.

The budget will be emailed to us, rather than our being asked to participate

in its development.

Dr. Dick Hillyer

Dr. Hillyer, PT,DPT,MBA,MSM

Hillyer Consulting

Cape Coral, FL 33914

_____

From: PTManager [mailto:PTManager ] On Behalf

Of Dick Hillyer

Sent: Thursday, May 26, 2011 10:40 AM

To: PTManager

Subject: RE: Re: PT/OT/SP Negotiation Group

Jim -

Helsinki Syndrome? The victims eventually identify with their oppressors,

and may actually work to further the oppressor's goals.

There is also a wrong view point that " They " (the oppressor) are smarter

than " We " (the victims) are, and that they should therefore be allowed to

make decisions about what is in our best interest. That never goes well.

I once lived and worked for a great company in a small town (as did you) in

which there was only one cable TV company. We had to pay whatever they told

us that we had to pay: They were " Deal Makers " , and we were " Deal Takers " .

That happens when one party has far too much power. When satellite TV came

along, things changed because there was competition and customers had

choices.

Because therapists have traditionally been willing to accept bad contracts

rather than have none at all, we have allowed ourselves to be " deal takers "

rather than " deal makers " . This has been our road to serfdom and will be

our path to extinction. In the interest of survival, therapy providers

should match insurors in every negotiation tactic. Of course we should

organize. We are far more interested in compassion than insurance companies

are, and we owe it to our communities to be as strong in our business skills

as we are with neurons and myofibrils.

Warm regards,

Dr. Dick Hillyer

Dr. Hillyer, PT,DPT,MBA,MSM

Hillyer Consulting

Cape Coral, FL 33914

_____

From: PTManager <mailto:PTManager%40yahoogroups.com>

[mailto:PTManager <mailto:PTManager%40yahoogroups.com> ] On

Behalf

Of JHall49629@... <mailto:JHall49629%40aol.com>

Sent: Wednesday, May 25, 2011 12:30 PM

To: PTManager <mailto:PTManager%40yahoogroups.com>

Subject: Re: Re: PT/OT/SP Negotiation Group

All

I am disappointed there hasn't been much interest in this thread. While I

have received a few responses, it is apparent that less than $60 for

treating a patient is acceptable reimbursement in the Northeast US (and less

than that in other markets). Maybe there are a couple of reasons for this:

1. Providers are spending less time in treatment of these patients (although

contracts are usually written to state you cannot treat these patients any

differently than other patients entering your clinic.

2. You are passing treatment off to an LPTA/COTA after initial eval (see

statement in #1 above).

3. $60 or less is acceptable reimbursement.

4. Clinic is too busy and we don't have time to fight.

5. My clinic cannot cancel the contract or we risk losing referrals to

competitors that will accept this contract.

6. Other reasons

A group like PTPN is effective if it provides enough clinic/provider

density. However, my experience in past dealings with PTPN is that it was

expensive and gives too many providers sticker shock. I know that State APTA

and AOTA organizations have reimbursement committees, but these are

volunteer positions and state associations may not be willing to use their

organization as a bully pulpit. I am curious as to whether a particular

state has the numbers of therapists that are willing to set aside the time

and resources necessary to MAKE change happen? I would think that PA, NY,

NJ, and nearby states might be a ripe climate for this type of groundswell.

Less than $60 per patient treatment for going on 10 years with no change in

reimbursement and no hope of an increase..., that seems to be a good enough

reason to organize and begin discussion.

Jim <///><

Re: PT/OT/SP Negotiation Group

Great suggestion Jim - in fact, what you describe is what PTPN has been

doing in many states for years, beginning in California in 1985. PTPN is

a network of therapist-owned private practices whose original goal was

to get independent therapists a seat at the table as managed care was

emerging in the 80s, and that continues to advocate for the private

practitioner today with many entities - payers, state legislatures, CMS

and many others. You're right on target with your thoughts: It is

important to do at a state-by-state level, given the variations among

state laws and regulations, which is why PTPN has regional offices and

officers across the country that focus on state-specific issues. In

addition, you're correct that it's important to have legal guidance to

avoid collusion/monopoly activities, and PTPN has worked with leading

healthcare lawyers throughout our history to ensure that we're

maximizing our ability to advocate for our providers while staying on

the right side of all relevant laws. If you'd like more information,

please contact me, and if you let me know what state you're in, I can

put you in touch with the PTPN folks in your area if it's a state in

which we operate.

Mitch

Mitchel Kaye, P.T.

Director, Quality Assurance

PTPN

telephone

800-766-PTPN

fax

Please visit us at ptpn.com <http://www.ptpn.com/> and physiquality.com

<http://www.physiquality.com/>

<http://www.facebook.com/PTPNInc> Like PTPN

<http://www.facebook.com/PTPNInc> on Facebook

<http://www.facebook.com/physiquality> Like Physiquality

<http://www.facebook.com/physiquality> on Facebook

[Guest guest]

All

As I examine these posts, it appears that organization might be fragmented. I

have had a response from someone wishing to remain anonymous that indicated in

the state where they do business, 75% of the payments come from 3 insurance

companies. These 3 have dictated terms, and I believe the rates are at less

than the Medicare fee schedule-take it or leave it. Also, this individual has

noted a couple of practices have closed their doors because they could no longer

afford to pay their bills based upon the reimbursement they were receiving.

That statement alone causes me concern because in certain areas of the country,

I expect to see this pattern replicating itself. While all of us are concerned

about the cost of healthcare, I am not sure I have seen any comprehensive data

that indicates therapy is causing the cost pool to exponentially expand. I

weighed in a little over a year ago at 210 pounds. While I would like to

picture myself as the starting tailback for my favorite college football team,

the truth is that I am not 21. As a matter of fact, I was old and fat and my

son told me he was buff..., and I was barf (rotten damn kid). At any rate, I

didn't go the gastric bypass route, I choose to join a gym and adjust my diet.

The path I chose was one that didn't spend healthcare dollars. But had I done

so, I would have been adding to the cost of healthcare. And my costs would not

have been from the result of therapists working on the system. My point is that

insurers are cutting costs wherever they can (even though I don't see that

translating into paycuts or no pay raises at the insurers). Because Hospitals

and MD's are better organized, I am not sure they are affected as much as

therapists are. So, I think the key is in how to organize for what therapists

would like to accomplish.

While I am not sure how organization might happen, it would need to be on a

state by state basis or, in a given metropolitan area. I find it interesting

that this weekend is Memorial Day weekend. A time when we all take a day to

remember those who fought for our freedom..., as well as those who presently

serve to protect us in the event that our freedom is threatened.

If a group where to form, to take a stand and fight, it should have as many

individuals and clinics/hospitals therapy depts/rehab agencies as possible. The

greater the volume, the greater the chance of success. I would envision a list

be started by state, with people signing up on a list or petetion. Once the

petition had enough density, a spokesperson would be appointed to represent the

collective voice of the signees. At that point, all parties that signed up

would be asked to begin communicating to patients and employers that have

underpaying insurance, that they are part of a collective organization that is

trying to negotiate a fair reimbursement for their services. At the same time,

the spokesperson for the therapy group would contact the insurance company(s) to

let them know that a group of therapy clinics, hospitals, rehab agencies,

private practitioners, etc. are forming to obtain fair reimbursement. If the

insurance companies were not willing to negotiate, this block would be

cancelling their UNILATERAL contracts within a period of time. Obviously, the

insurance company(s) would need to be confronted with the fact that $X doesn't

cover the cost of therapy services and that Y number of years without a pay

increase is not acceptable. And it they are not willing to negotiate, their

overall payments will increase once everyone drops out of their network. When

they try and strongarm the group, it could be pointed out that even though

patients might be unwilling to pay high copays and deductibles, people and

employers select an insurer by their comprehensive insurance product and the

collective group is educating their patients on the insurance company's facts.

So if an insurer cannot offer fair coverage for therapy services, employers and

patients will eventually catch on and shop around for an insurer that has this

coverage.

While I know that this particular solution will create a great deal of friction

and financial pain, it will also cause people to look hard at the discussions to

see why it is occuring. I believe that ultimately, the therapy group will have

a receptive audience. I know that I have not addressed everything perfectly in

this email. For instance, what about collusion, monopoly, etc. The sign up

would be to gauge the level of interest. Once the interest is there, I expect

the group could meet and decide what to pay to become part of this " collective

bargaining " group. My personnal opinion would be that any fees would be kept to

a minimum so that the providers would not hesitate to join. After all, the

greater the number of therapists, the better chance to fight this successfully.

I am not a Civil War buff, but during that War I think you would be hard pressed

to find a greater General than E. Lee. Union Generals constantly battled

him and lost. And because they lost, they weren't anxious to carry on the

fight. However, General Grant (Union General) realized that he had about 3

times the number of soldiers and also had northern manufacturing behind him. So

he took the numbers and went into battle. While losing a greater number of

soldiers in the process than Lee did, he knew that the battle of attrition was

on his side. Not necessarily a pleasant analogy, but definitely one that bears

making. The greater the numbers of PT/OT/SP's on board with this, the better

the opportunity of success.

Jim <///><

Re: PT/OT/SP Negotiation Group

>

> Great suggestion Jim - in fact, what you describe is what PTPN has been

> doing in many states for years, beginning in California in 1985. PTPN is

> a network of therapist-owned private practices whose original goal was

> to get independent therapists a seat at the table as managed care was

> emerging in the 80s, and that continues to advocate for the private

> practitioner today with many entities - payers, state legislatures, CMS

> and many others. You're right on target with your thoughts: It is

> important to do at a state-by-state level, given the variations among

> state laws and regulations, which is why PTPN has regional offices and

> officers across the country that focus on state-specific issues. In

> addition, you're correct that it's important to have legal guidance to

> avoid collusion/monopoly activities, and PTPN has worked with leading

> healthcare lawyers throughout our history to ensure that we're

> maximizing our ability to advocate for our providers while staying on

> the right side of all relevant laws. If you'd like more information,

> please contact me, and if you let me know what state you're in, I can

> put you in touch with the PTPN folks in your area if it's a state in

> which we operate.

>

> Mitch

>

> Mitchel Kaye, P.T.

> Director, Quality Assurance

> PTPN

> telephone

> 800-766-PTPN

>

> fax

> Please visit us at ptpn.com <http://www.ptpn.com/> and physiquality.com

> <http://www.physiquality.com/>

>

> <http://www.facebook.com/PTPNInc> Like PTPN

> <http://www.facebook.com/PTPNInc> on Facebook

>

> <http://www.facebook.com/physiquality> Like Physiquality

> <http://www.facebook.com/physiquality> on Facebook

>

>

[Guest guest]

, you are correct, as a profession we have/don't share information on

this topic in any meaningful manner, and are often told we can't, which

further divides us. I realize the cost of living is different in various

places, but the " going rate " for care under some contracts is more than 40-50%

lower in places like the Southeast compared to other parts of the country.

The legislators in NC were given data that therapists costs were something

like 55-$60 but " specialists collected an average of $90 per visit, so it

was perceived we could " give " in state health plan development meetings

(even though that.group included cardiologists, internists, orthopedists, etc)

Some of the other rates are routinely less than $50 per visit (with $30+

copay). Not even judging, but just comparing, folks there didn't often

" know " how to support colleagues more geographically left fighting for twice

that amount.

I have heard " non-PTs " /non medical professionals indicate a 3rd party group

could independently collect info on plans/costs, etc. but am not sure " how

successful " any group has been in developing a picture we can work from as

individuals or non association groups.... of if we can build critical

density to use it.

Can any one recommend a program on how not to be scared by antitrust

allegations or education programs on on what is a " threat " to a group about

antitrust, vs. truly approaching a legal line. Anyone know any good speakers

on the topic? Should we start by seeking to educate ourselves?

Happy weekend all,

Dee

Deirdre Daley, PT, DPT

WorkWell Systems

New Ipswich, NH

wrote

In further response to Jim, one of the huge obstacles we face is that only

a very small percentage of PT's feel the direct impact of that 60$/visit

that so many seem content with. We have a vast majority of our ranks who are

blind to the fact that reimbusement continues to dwindle as the cost of

doing what we do continues to escalate. E s, PT, DPT, OCS, FAAOMPT

www.douglasspt,com

[Guest guest]

, you are correct, as a profession we have/don't share information on

this topic in any meaningful manner, and are often told we can't, which

further divides us. I realize the cost of living is different in various

places, but the " going rate " for care under some contracts is more than 40-50%

lower in places like the Southeast compared to other parts of the country.

The legislators in NC were given data that therapists costs were something

like 55-$60 but " specialists collected an average of $90 per visit, so it

was perceived we could " give " in state health plan development meetings

(even though that.group included cardiologists, internists, orthopedists, etc)

Some of the other rates are routinely less than $50 per visit (with $30+

copay). Not even judging, but just comparing, folks there didn't often

" know " how to support colleagues more geographically left fighting for twice

that amount.

I have heard " non-PTs " /non medical professionals indicate a 3rd party group

could independently collect info on plans/costs, etc. but am not sure " how

successful " any group has been in developing a picture we can work from as

individuals or non association groups.... of if we can build critical

density to use it.

Can any one recommend a program on how not to be scared by antitrust

allegations or education programs on on what is a " threat " to a group about

antitrust, vs. truly approaching a legal line. Anyone know any good speakers

on the topic? Should we start by seeking to educate ourselves?

Happy weekend all,

Dee

Deirdre Daley, PT, DPT

WorkWell Systems

New Ipswich, NH

wrote

In further response to Jim, one of the huge obstacles we face is that only

a very small percentage of PT's feel the direct impact of that 60$/visit

that so many seem content with. We have a vast majority of our ranks who are

blind to the fact that reimbusement continues to dwindle as the cost of

doing what we do continues to escalate. E s, PT, DPT, OCS, FAAOMPT

www.douglasspt,com

[Guest guest]

, you are correct, as a profession we have/don't share information on

this topic in any meaningful manner, and are often told we can't, which

further divides us. I realize the cost of living is different in various

places, but the " going rate " for care under some contracts is more than 40-50%

lower in places like the Southeast compared to other parts of the country.

The legislators in NC were given data that therapists costs were something

like 55-$60 but " specialists collected an average of $90 per visit, so it

was perceived we could " give " in state health plan development meetings

(even though that.group included cardiologists, internists, orthopedists, etc)

Some of the other rates are routinely less than $50 per visit (with $30+

copay). Not even judging, but just comparing, folks there didn't often

" know " how to support colleagues more geographically left fighting for twice

that amount.

I have heard " non-PTs " /non medical professionals indicate a 3rd party group

could independently collect info on plans/costs, etc. but am not sure " how

successful " any group has been in developing a picture we can work from as

individuals or non association groups.... of if we can build critical

density to use it.

Can any one recommend a program on how not to be scared by antitrust

allegations or education programs on on what is a " threat " to a group about

antitrust, vs. truly approaching a legal line. Anyone know any good speakers

on the topic? Should we start by seeking to educate ourselves?

Happy weekend all,

Dee

Deirdre Daley, PT, DPT

WorkWell Systems

New Ipswich, NH

wrote

In further response to Jim, one of the huge obstacles we face is that only

a very small percentage of PT's feel the direct impact of that 60$/visit

that so many seem content with. We have a vast majority of our ranks who are

blind to the fact that reimbusement continues to dwindle as the cost of

doing what we do continues to escalate. E s, PT, DPT, OCS, FAAOMPT

www.douglasspt,com

[Guest guest]

Hi everyone,

Hope you all have a great holiday weekend!

There are a couple of ways to group together. One has been done multiple times

using the power of the state APTA Chapter that gathers grass root support and

challenges both political and insurance problems. That method has been

successful and the information on how it was successful is available. This is

limited though by the fact that many states only run 50% or less licensed

therapists that are members. A second way that has been suggested is the

formation of an Independent Private Practice group that would have as its main

purpose to lobby both political and insurance interests on behalf of its

members. I took a survey trying to see how much interest there was in a group

like this a year or two ago but have heard nothing about it. The other way

would be to form unions like the nurses have had and have used successfully,

though limited by state rules. This is a tough one because any time you shut

down health care, the public does not take a positive view of the union.

There are significant problems and risks with all of these and those risks and

difficulties have prevented the widespread formation of the groups beyond a

state APTA chapter reacting to unpleasant political or insurance problems. The

other problem is that we have not had a leader, a visionary that stepped outside

the normal associations and spearheaded the formation of the kind of group you

talk about and without that, this kind of group is hard to form and even harder

to keep going (to use your context, we have had no General Grant, no General Lee

or no President Lincoln).

This is not to say that nothing is going on. Despite the recent rants, both

positive and negative, on this, there are a lot of good people in the profession

working on our behalf day in and day out at the APTA, at the local chapter

level, as paid payment specialists and paid lobbyists to do just what you are

asking for-standing up for what is appropriate payment for our skills and our

role as a health care professional. And as I always have said, we also have to

remember that healthcare is still a business. Some will prosper and others will

not. It is always sad to hear people going out of business but that is

business. When you see 8000 – 9000 PT’s and PTA’s able to attend APTA

national conferences from around the country and hear of all the practices doing

this and that, I can’t say that I think our profession is anywhere near the

dire position that we sometimes see on the lists. It is not what it was and

adaptation to new realities is hard but it is still a business to be proud of

and one that accomplishes so much good. And it is one that still allows the

best and brightest at the business of healthcare to survive and thrive.

Which also brings me to a final point before this long weekend. As you get

farther into a career, to maintain your job, you have to find ways to make

yourself indispensible. Part of the reason that our payment keeps getting cut

is that we haven’t, as a profession, done that well enough. The good news is

that more and more evidence is surfacing, finally, that is showing our value.

If it continues then we will reach that tipping point where our services are

considered by a majority to be so valuable that we will be indispensible at

which time we will see more respect for our profession and hopefully better

reimbursement for our services. I’d like to go into this weekend keeping

that positive thought in mind.

M. Howell, P.T., M.P.T.

Howell Physical Therapy

Eagle, Idaho

thowell@...

This email and any files transmitted with it may contain PRIVILEGED or

CONFIDENTIAL information and may be read or used only by the intended recipient.

If you are not the intended recipient of the email or any of its attachments,

please be advised that you have received this email in error and that any use,

dissemination, distribution, forwarding, printing or copying of this email or

any attached files is strictly prohibited. If you have received this email in

error, please immediately purge it and all attachments and notify the sender by

reply email.

From: PTManager [mailto:PTManager ] On Behalf Of

JHall49629@...

Sent: Friday, May 27, 2011 10:21 AM

To: PTManager

Subject: Re: Re: PT/OT/SP Negotiation Group

All

As I examine these posts, it appears that organization might be fragmented. I

have had a response from someone wishing to remain anonymous that indicated in

the state where they do business, 75% of the payments come from 3 insurance

companies. These 3 have dictated terms, and I believe the rates are at less than

the Medicare fee schedule-take it or leave it. Also, this individual has noted a

couple of practices have closed their doors because they could no longer afford

to pay their bills based upon the reimbursement they were receiving. That

statement alone causes me concern because in certain areas of the country, I

expect to see this pattern replicating itself. While all of us are concerned

about the cost of healthcare, I am not sure I have seen any comprehensive data

that indicates therapy is causing the cost pool to exponentially expand. I

weighed in a little over a year ago at 210 pounds. While I would like to picture

myself as the starting tailback for my favorite college football team, the truth

is that I am not 21. As a matter of fact, I was old and fat and my son told me

he was buff..., and I was barf (rotten damn kid). At any rate, I didn't go the

gastric bypass route, I choose to join a gym and adjust my diet. The path I

chose was one that didn't spend healthcare dollars. But had I done so, I would

have been adding to the cost of healthcare. And my costs would not have been

from the result of therapists working on the system. My point is that insurers

are cutting costs wherever they can (even though I don't see that translating

into paycuts or no pay raises at the insurers). Because Hospitals and MD's are

better organized, I am not sure they are affected as much as therapists are. So,

I think the key is in how to organize for what therapists would like to

accomplish.

While I am not sure how organization might happen, it would need to be on a

state by state basis or, in a given metropolitan area. I find it interesting

that this weekend is Memorial Day weekend. A time when we all take a day to

remember those who fought for our freedom..., as well as those who presently

serve to protect us in the event that our freedom is threatened.

If a group where to form, to take a stand and fight, it should have as many

individuals and clinics/hospitals therapy depts/rehab agencies as possible. The

greater the volume, the greater the chance of success. I would envision a list

be started by state, with people signing up on a list or petetion. Once the

petition had enough density, a spokesperson would be appointed to represent the

collective voice of the signees. At that point, all parties that signed up would

be asked to begin communicating to patients and employers that have underpaying

insurance, that they are part of a collective organization that is trying to

negotiate a fair reimbursement for their services. At the same time, the

spokesperson for the therapy group would contact the insurance company(s) to let

them know that a group of therapy clinics, hospitals, rehab agencies, private

practitioners, etc. are forming to obtain fair reimbursement. If the insurance

companies were not willing to negotiate, this block would be cancelling their

UNILATERAL contracts within a period of time. Obviously, the insurance

company(s) would need to be confronted with the fact that $X doesn't cover the

cost of therapy services and that Y number of years without a pay increase is

not acceptable. And it they are not willing to negotiate, their overall payments

will increase once everyone drops out of their network. When they try and

strongarm the group, it could be pointed out that even though patients might be

unwilling to pay high copays and deductibles, people and employers select an

insurer by their comprehensive insurance product and the collective group is

educating their patients on the insurance company's facts. So if an insurer

cannot offer fair coverage for therapy services, employers and patients will

eventually catch on and shop around for an insurer that has this coverage.

While I know that this particular solution will create a great deal of friction

and financial pain, it will also cause people to look hard at the discussions to

see why it is occuring. I believe that ultimately, the therapy group will have a

receptive audience. I know that I have not addressed everything perfectly in

this email. For instance, what about collusion, monopoly, etc. The sign up would

be to gauge the level of interest. Once the interest is there, I expect the

group could meet and decide what to pay to become part of this " collective

bargaining " group. My personnal opinion would be that any fees would be kept to

a minimum so that the providers would not hesitate to join. After all, the

greater the number of therapists, the better chance to fight this successfully.

I am not a Civil War buff, but during that War I think you would be hard pressed

to find a greater General than E. Lee. Union Generals constantly battled

him and lost. And because they lost, they weren't anxious to carry on the fight.

However, General Grant (Union General) realized that he had about 3 times the

number of soldiers and also had northern manufacturing behind him. So he took

the numbers and went into battle. While losing a greater number of soldiers in

the process than Lee did, he knew that the battle of attrition was on his side.

Not necessarily a pleasant analogy, but definitely one that bears making. The

greater the numbers of PT/OT/SP's on board with this, the better the opportunity

of success.

Jim <///><

Re: PT/OT/SP Negotiation Group

>

> Great suggestion Jim - in fact, what you describe is what PTPN has been

> doing in many states for years, beginning in California in 1985. PTPN is

> a network of therapist-owned private practices whose original goal was

> to get independent therapists a seat at the table as managed care was

> emerging in the 80s, and that continues to advocate for the private

> practitioner today with many entities - payers, state legislatures, CMS

> and many others. You're right on target with your thoughts: It is

> important to do at a state-by-state level, given the variations among

> state laws and regulations, which is why PTPN has regional offices and

> officers across the country that focus on state-specific issues. In

> addition, you're correct that it's important to have legal guidance to

> avoid collusion/monopoly activities, and PTPN has worked with leading

> healthcare lawyers throughout our history to ensure that we're

> maximizing our ability to advocate for our providers while staying on

> the right side of all relevant laws. If you'd like more information,

> please contact me, and if you let me know what state you're in, I can

> put you in touch with the PTPN folks in your area if it's a state in

> which we operate.

>

> Mitch

>

> Mitchel Kaye, P.T.

> Director, Quality Assurance

> PTPN

> telephone

> 800-766-PTPN

>

> fax

> Please visit us at ptpn.com <http://www.ptpn.com/> and physiquality.com

> <http://www.physiquality.com/>

>

> <http://www.facebook.com/PTPNInc> Like PTPN

> <http://www.facebook.com/PTPNInc> on Facebook

>

> <http://www.facebook.com/physiquality> Like Physiquality

> <http://www.facebook.com/physiquality> on Facebook

>

>

[Guest guest]

Hi everyone,

Hope you all have a great holiday weekend!

There are a couple of ways to group together. One has been done multiple times

using the power of the state APTA Chapter that gathers grass root support and

challenges both political and insurance problems. That method has been

successful and the information on how it was successful is available. This is

limited though by the fact that many states only run 50% or less licensed

therapists that are members. A second way that has been suggested is the

formation of an Independent Private Practice group that would have as its main

purpose to lobby both political and insurance interests on behalf of its

members. I took a survey trying to see how much interest there was in a group

like this a year or two ago but have heard nothing about it. The other way

would be to form unions like the nurses have had and have used successfully,

though limited by state rules. This is a tough one because any time you shut

down health care, the public does not take a positive view of the union.

There are significant problems and risks with all of these and those risks and

difficulties have prevented the widespread formation of the groups beyond a

state APTA chapter reacting to unpleasant political or insurance problems. The

other problem is that we have not had a leader, a visionary that stepped outside

the normal associations and spearheaded the formation of the kind of group you

talk about and without that, this kind of group is hard to form and even harder

to keep going (to use your context, we have had no General Grant, no General Lee

or no President Lincoln).

This is not to say that nothing is going on. Despite the recent rants, both

positive and negative, on this, there are a lot of good people in the profession

working on our behalf day in and day out at the APTA, at the local chapter

level, as paid payment specialists and paid lobbyists to do just what you are

asking for-standing up for what is appropriate payment for our skills and our

role as a health care professional. And as I always have said, we also have to

remember that healthcare is still a business. Some will prosper and others will

not. It is always sad to hear people going out of business but that is

business. When you see 8000 – 9000 PT’s and PTA’s able to attend APTA

national conferences from around the country and hear of all the practices doing

this and that, I can’t say that I think our profession is anywhere near the

dire position that we sometimes see on the lists. It is not what it was and

adaptation to new realities is hard but it is still a business to be proud of

and one that accomplishes so much good. And it is one that still allows the

best and brightest at the business of healthcare to survive and thrive.

Which also brings me to a final point before this long weekend. As you get

farther into a career, to maintain your job, you have to find ways to make

yourself indispensible. Part of the reason that our payment keeps getting cut

is that we haven’t, as a profession, done that well enough. The good news is

that more and more evidence is surfacing, finally, that is showing our value.

If it continues then we will reach that tipping point where our services are

considered by a majority to be so valuable that we will be indispensible at

which time we will see more respect for our profession and hopefully better

reimbursement for our services. I’d like to go into this weekend keeping

that positive thought in mind.

M. Howell, P.T., M.P.T.

Howell Physical Therapy

Eagle, Idaho

thowell@...

This email and any files transmitted with it may contain PRIVILEGED or

CONFIDENTIAL information and may be read or used only by the intended recipient.

If you are not the intended recipient of the email or any of its attachments,

please be advised that you have received this email in error and that any use,

dissemination, distribution, forwarding, printing or copying of this email or

any attached files is strictly prohibited. If you have received this email in

error, please immediately purge it and all attachments and notify the sender by

reply email.

From: PTManager [mailto:PTManager ] On Behalf Of

JHall49629@...

Sent: Friday, May 27, 2011 10:21 AM

To: PTManager

Subject: Re: Re: PT/OT/SP Negotiation Group

All

As I examine these posts, it appears that organization might be fragmented. I

have had a response from someone wishing to remain anonymous that indicated in

the state where they do business, 75% of the payments come from 3 insurance

companies. These 3 have dictated terms, and I believe the rates are at less than

the Medicare fee schedule-take it or leave it. Also, this individual has noted a

couple of practices have closed their doors because they could no longer afford

to pay their bills based upon the reimbursement they were receiving. That

statement alone causes me concern because in certain areas of the country, I

expect to see this pattern replicating itself. While all of us are concerned

about the cost of healthcare, I am not sure I have seen any comprehensive data

that indicates therapy is causing the cost pool to exponentially expand. I

weighed in a little over a year ago at 210 pounds. While I would like to picture

myself as the starting tailback for my favorite college football team, the truth

is that I am not 21. As a matter of fact, I was old and fat and my son told me

he was buff..., and I was barf (rotten damn kid). At any rate, I didn't go the

gastric bypass route, I choose to join a gym and adjust my diet. The path I

chose was one that didn't spend healthcare dollars. But had I done so, I would

have been adding to the cost of healthcare. And my costs would not have been

from the result of therapists working on the system. My point is that insurers

are cutting costs wherever they can (even though I don't see that translating

into paycuts or no pay raises at the insurers). Because Hospitals and MD's are

better organized, I am not sure they are affected as much as therapists are. So,

I think the key is in how to organize for what therapists would like to

accomplish.

While I am not sure how organization might happen, it would need to be on a

state by state basis or, in a given metropolitan area. I find it interesting

that this weekend is Memorial Day weekend. A time when we all take a day to

remember those who fought for our freedom..., as well as those who presently

serve to protect us in the event that our freedom is threatened.

If a group where to form, to take a stand and fight, it should have as many

individuals and clinics/hospitals therapy depts/rehab agencies as possible. The

greater the volume, the greater the chance of success. I would envision a list

be started by state, with people signing up on a list or petetion. Once the

petition had enough density, a spokesperson would be appointed to represent the

collective voice of the signees. At that point, all parties that signed up would

be asked to begin communicating to patients and employers that have underpaying

insurance, that they are part of a collective organization that is trying to

negotiate a fair reimbursement for their services. At the same time, the

spokesperson for the therapy group would contact the insurance company(s) to let

them know that a group of therapy clinics, hospitals, rehab agencies, private

practitioners, etc. are forming to obtain fair reimbursement. If the insurance

companies were not willing to negotiate, this block would be cancelling their

UNILATERAL contracts within a period of time. Obviously, the insurance

company(s) would need to be confronted with the fact that $X doesn't cover the

cost of therapy services and that Y number of years without a pay increase is

not acceptable. And it they are not willing to negotiate, their overall payments

will increase once everyone drops out of their network. When they try and

strongarm the group, it could be pointed out that even though patients might be

unwilling to pay high copays and deductibles, people and employers select an

insurer by their comprehensive insurance product and the collective group is

educating their patients on the insurance company's facts. So if an insurer

cannot offer fair coverage for therapy services, employers and patients will

eventually catch on and shop around for an insurer that has this coverage.

While I know that this particular solution will create a great deal of friction

and financial pain, it will also cause people to look hard at the discussions to

see why it is occuring. I believe that ultimately, the therapy group will have a

receptive audience. I know that I have not addressed everything perfectly in

this email. For instance, what about collusion, monopoly, etc. The sign up would

be to gauge the level of interest. Once the interest is there, I expect the

group could meet and decide what to pay to become part of this " collective

bargaining " group. My personnal opinion would be that any fees would be kept to

a minimum so that the providers would not hesitate to join. After all, the

greater the number of therapists, the better chance to fight this successfully.

I am not a Civil War buff, but during that War I think you would be hard pressed

to find a greater General than E. Lee. Union Generals constantly battled

him and lost. And because they lost, they weren't anxious to carry on the fight.

However, General Grant (Union General) realized that he had about 3 times the

number of soldiers and also had northern manufacturing behind him. So he took

the numbers and went into battle. While losing a greater number of soldiers in

the process than Lee did, he knew that the battle of attrition was on his side.

Not necessarily a pleasant analogy, but definitely one that bears making. The

greater the numbers of PT/OT/SP's on board with this, the better the opportunity

of success.

Jim <///><

Re: PT/OT/SP Negotiation Group

>

> Great suggestion Jim - in fact, what you describe is what PTPN has been

> doing in many states for years, beginning in California in 1985. PTPN is

> a network of therapist-owned private practices whose original goal was

> to get independent therapists a seat at the table as managed care was

> emerging in the 80s, and that continues to advocate for the private

> practitioner today with many entities - payers, state legislatures, CMS

> and many others. You're right on target with your thoughts: It is

> important to do at a state-by-state level, given the variations among

> state laws and regulations, which is why PTPN has regional offices and

> officers across the country that focus on state-specific issues. In

> addition, you're correct that it's important to have legal guidance to

> avoid collusion/monopoly activities, and PTPN has worked with leading

> healthcare lawyers throughout our history to ensure that we're

> maximizing our ability to advocate for our providers while staying on

> the right side of all relevant laws. If you'd like more information,

> please contact me, and if you let me know what state you're in, I can

> put you in touch with the PTPN folks in your area if it's a state in

> which we operate.

>

> Mitch

>

> Mitchel Kaye, P.T.

> Director, Quality Assurance

> PTPN

> telephone

> 800-766-PTPN

>

> fax

> Please visit us at ptpn.com <http://www.ptpn.com/> and physiquality.com

> <http://www.physiquality.com/>

>

> <http://www.facebook.com/PTPNInc> Like PTPN

> <http://www.facebook.com/PTPNInc> on Facebook

>

> <http://www.facebook.com/physiquality> Like Physiquality

> <http://www.facebook.com/physiquality> on Facebook

>

>

[Guest guest]

Hi everyone,

Hope you all have a great holiday weekend!

There are a couple of ways to group together. One has been done multiple times

using the power of the state APTA Chapter that gathers grass root support and

challenges both political and insurance problems. That method has been

successful and the information on how it was successful is available. This is

limited though by the fact that many states only run 50% or less licensed

therapists that are members. A second way that has been suggested is the

formation of an Independent Private Practice group that would have as its main

purpose to lobby both political and insurance interests on behalf of its

members. I took a survey trying to see how much interest there was in a group

like this a year or two ago but have heard nothing about it. The other way

would be to form unions like the nurses have had and have used successfully,

though limited by state rules. This is a tough one because any time you shut

down health care, the public does not take a positive view of the union.

There are significant problems and risks with all of these and those risks and

difficulties have prevented the widespread formation of the groups beyond a

state APTA chapter reacting to unpleasant political or insurance problems. The

other problem is that we have not had a leader, a visionary that stepped outside

the normal associations and spearheaded the formation of the kind of group you

talk about and without that, this kind of group is hard to form and even harder

to keep going (to use your context, we have had no General Grant, no General Lee

or no President Lincoln).

This is not to say that nothing is going on. Despite the recent rants, both

positive and negative, on this, there are a lot of good people in the profession

working on our behalf day in and day out at the APTA, at the local chapter

level, as paid payment specialists and paid lobbyists to do just what you are

asking for-standing up for what is appropriate payment for our skills and our

role as a health care professional. And as I always have said, we also have to

remember that healthcare is still a business. Some will prosper and others will

not. It is always sad to hear people going out of business but that is

business. When you see 8000 – 9000 PT’s and PTA’s able to attend APTA

national conferences from around the country and hear of all the practices doing

this and that, I can’t say that I think our profession is anywhere near the

dire position that we sometimes see on the lists. It is not what it was and

adaptation to new realities is hard but it is still a business to be proud of

and one that accomplishes so much good. And it is one that still allows the

best and brightest at the business of healthcare to survive and thrive.

Which also brings me to a final point before this long weekend. As you get

farther into a career, to maintain your job, you have to find ways to make

yourself indispensible. Part of the reason that our payment keeps getting cut

is that we haven’t, as a profession, done that well enough. The good news is

that more and more evidence is surfacing, finally, that is showing our value.

If it continues then we will reach that tipping point where our services are

considered by a majority to be so valuable that we will be indispensible at

which time we will see more respect for our profession and hopefully better

reimbursement for our services. I’d like to go into this weekend keeping

that positive thought in mind.

M. Howell, P.T., M.P.T.

Howell Physical Therapy

Eagle, Idaho

thowell@...

This email and any files transmitted with it may contain PRIVILEGED or

CONFIDENTIAL information and may be read or used only by the intended recipient.

If you are not the intended recipient of the email or any of its attachments,

please be advised that you have received this email in error and that any use,

dissemination, distribution, forwarding, printing or copying of this email or

any attached files is strictly prohibited. If you have received this email in

error, please immediately purge it and all attachments and notify the sender by

reply email.

From: PTManager [mailto:PTManager ] On Behalf Of

JHall49629@...

Sent: Friday, May 27, 2011 10:21 AM

To: PTManager

Subject: Re: Re: PT/OT/SP Negotiation Group

All

As I examine these posts, it appears that organization might be fragmented. I

have had a response from someone wishing to remain anonymous that indicated in

the state where they do business, 75% of the payments come from 3 insurance

companies. These 3 have dictated terms, and I believe the rates are at less than

the Medicare fee schedule-take it or leave it. Also, this individual has noted a

couple of practices have closed their doors because they could no longer afford

to pay their bills based upon the reimbursement they were receiving. That

statement alone causes me concern because in certain areas of the country, I

expect to see this pattern replicating itself. While all of us are concerned

about the cost of healthcare, I am not sure I have seen any comprehensive data

that indicates therapy is causing the cost pool to exponentially expand. I

weighed in a little over a year ago at 210 pounds. While I would like to picture

myself as the starting tailback for my favorite college football team, the truth

is that I am not 21. As a matter of fact, I was old and fat and my son told me

he was buff..., and I was barf (rotten damn kid). At any rate, I didn't go the

gastric bypass route, I choose to join a gym and adjust my diet. The path I

chose was one that didn't spend healthcare dollars. But had I done so, I would

have been adding to the cost of healthcare. And my costs would not have been

from the result of therapists working on the system. My point is that insurers

are cutting costs wherever they can (even though I don't see that translating

into paycuts or no pay raises at the insurers). Because Hospitals and MD's are

better organized, I am not sure they are affected as much as therapists are. So,

I think the key is in how to organize for what therapists would like to

accomplish.

While I am not sure how organization might happen, it would need to be on a

state by state basis or, in a given metropolitan area. I find it interesting

that this weekend is Memorial Day weekend. A time when we all take a day to

remember those who fought for our freedom..., as well as those who presently

serve to protect us in the event that our freedom is threatened.

If a group where to form, to take a stand and fight, it should have as many

individuals and clinics/hospitals therapy depts/rehab agencies as possible. The

greater the volume, the greater the chance of success. I would envision a list

be started by state, with people signing up on a list or petetion. Once the

petition had enough density, a spokesperson would be appointed to represent the

collective voice of the signees. At that point, all parties that signed up would

be asked to begin communicating to patients and employers that have underpaying

insurance, that they are part of a collective organization that is trying to

negotiate a fair reimbursement for their services. At the same time, the

spokesperson for the therapy group would contact the insurance company(s) to let

them know that a group of therapy clinics, hospitals, rehab agencies, private

practitioners, etc. are forming to obtain fair reimbursement. If the insurance

companies were not willing to negotiate, this block would be cancelling their

UNILATERAL contracts within a period of time. Obviously, the insurance

company(s) would need to be confronted with the fact that $X doesn't cover the

cost of therapy services and that Y number of years without a pay increase is

not acceptable. And it they are not willing to negotiate, their overall payments

will increase once everyone drops out of their network. When they try and

strongarm the group, it could be pointed out that even though patients might be

unwilling to pay high copays and deductibles, people and employers select an

insurer by their comprehensive insurance product and the collective group is

educating their patients on the insurance company's facts. So if an insurer

cannot offer fair coverage for therapy services, employers and patients will

eventually catch on and shop around for an insurer that has this coverage.

While I know that this particular solution will create a great deal of friction

and financial pain, it will also cause people to look hard at the discussions to

see why it is occuring. I believe that ultimately, the therapy group will have a

receptive audience. I know that I have not addressed everything perfectly in

this email. For instance, what about collusion, monopoly, etc. The sign up would

be to gauge the level of interest. Once the interest is there, I expect the

group could meet and decide what to pay to become part of this " collective

bargaining " group. My personnal opinion would be that any fees would be kept to

a minimum so that the providers would not hesitate to join. After all, the

greater the number of therapists, the better chance to fight this successfully.

I am not a Civil War buff, but during that War I think you would be hard pressed

to find a greater General than E. Lee. Union Generals constantly battled

him and lost. And because they lost, they weren't anxious to carry on the fight.

However, General Grant (Union General) realized that he had about 3 times the

number of soldiers and also had northern manufacturing behind him. So he took

the numbers and went into battle. While losing a greater number of soldiers in

the process than Lee did, he knew that the battle of attrition was on his side.

Not necessarily a pleasant analogy, but definitely one that bears making. The

greater the numbers of PT/OT/SP's on board with this, the better the opportunity

of success.

Jim <///><

Re: PT/OT/SP Negotiation Group

>

> Great suggestion Jim - in fact, what you describe is what PTPN has been

> doing in many states for years, beginning in California in 1985. PTPN is

> a network of therapist-owned private practices whose original goal was

> to get independent therapists a seat at the table as managed care was

> emerging in the 80s, and that continues to advocate for the private

> practitioner today with many entities - payers, state legislatures, CMS

> and many others. You're right on target with your thoughts: It is

> important to do at a state-by-state level, given the variations among

> state laws and regulations, which is why PTPN has regional offices and

> officers across the country that focus on state-specific issues. In

> addition, you're correct that it's important to have legal guidance to

> avoid collusion/monopoly activities, and PTPN has worked with leading

> healthcare lawyers throughout our history to ensure that we're

> maximizing our ability to advocate for our providers while staying on

> the right side of all relevant laws. If you'd like more information,

> please contact me, and if you let me know what state you're in, I can

> put you in touch with the PTPN folks in your area if it's a state in

> which we operate.

>

> Mitch

>

> Mitchel Kaye, P.T.

> Director, Quality Assurance

> PTPN

> telephone

> 800-766-PTPN

>

> fax

> Please visit us at ptpn.com <http://www.ptpn.com/> and physiquality.com

> <http://www.physiquality.com/>

>

> <http://www.facebook.com/PTPNInc> Like PTPN

> <http://www.facebook.com/PTPNInc> on Facebook

>

> <http://www.facebook.com/physiquality> Like Physiquality

> <http://www.facebook.com/physiquality> on Facebook

>

>

[Guest guest]

Dick,

I couldn't agree with you more. You get it. Unfortunately, many others don't.

They're willing to give their hard earned money away to insurance executives who

laugh at them. They're willing to give their money away to physicians owning

POPTS. They're willing to give their money to Wall Street types who are raiding

their profession just like these type have raided other businesses over the

years (figuratively telling the victims it's raining while they're p***ing on

their backs). They're willing to give their money to personal trainers, massage

therapists, and others (with less training, less knowledge, and lesser skills)

via relinquishment of market share. And they're willing to give their money to

their government, most noticeably via the currency de-evaluation which is

occurring, shrinking the value of their dollar year by year.

They keep thinking in the same very small box with the result that they keep

getting the same dismal results. Their educational costs are going up while

their reimbursements are steadily and irrevocably shrinking as is their

marketshare as is the value of the dollar they are earning. The situation is

simply unsustainable with business conducted in the present manner.

Tom,

The situations you describe are just some of the reasons why we are experiencing

many of the problems our profession has.

For all too long, too many PTs have juggled multiple patients at the same time,

over overdelegated their responsibilities to care extenders (and sometimes very

poorly trained care extenders such as one facility I know of that used untrained

high school students), overutilized modality " time management " tools like hot

packs, overutilized exercise " time management " tools like stationary bicycles

and treadmills, overemphasized mindless exercise to the exclusive of mindful

movement interventions, utilized a limited repertoire of manual interventions

(and often in a somewhat perfunctory, overly brief, and marginally effective

fashion), etc. These behaviors have affected the perception of PT in the

public's mind to the detriment of us all. I just had a patient this morning who

expressed the sentiment that she never had too much respect for PT until she

came to our clinic because of her previous experiences with the therapist

behaviors noted above.

Also, too many PTs don't have their financial priorities straight. They are

often unwilling to spend the money to join the APTA or other support

organizations or spend money on continuing education or other educational self

development resources yet you'll see them spending money on Starbucks, BMWs,

expensive vacations, etc.. If the loss of income even for a short time so

financially incapacitates them that they can't absorb it, something is awry with

their financial planning and management skills. I remember having a $13K income

my first year as a PT and spending $3K of my own money on books, journals, and

CE courses yet hearing people whine about having to spend $50 on a single book.

To use one of your favored expressions, WTF?

Also, is it fair that " successful clinic owners can balance patient types and

fill in costs with work comp and third party which still may pay full price

rates in some states and they can absorb the low cost " ? In my opinion,

something is inherently disingenuous about this situation.

The attitude that " we are living with less (which may not be a bad thing) " would

be acceptable if everyone else were living with less but I can assure you that

the insurance executives, Wall Street raider types, and physicians with POPTS

most assuredly are not. They want you to live with less so that they can live

with more. Always remember, no matter what they tell you, the reality is that

we're dealing with a floating zero sum game here.

The " new reality " is only a reality because we have accepted it as such and

allowed it to occur. If we're willing to be rugs, we'll be walked on.

Armin,

You are so very right. Unfortunately, I seriously wonder if our profession has

the collective cojones to take the action that is necessary. Witness the people

who write in anonymously or semi-anonymously on this forum. There's a lot of

fear. If it was up to some of these folks to implement an American Revolution,

we'd still be singing God Save The Queen.

Jim,

Your points about organization and collective action are appreciated and

theoretically correct. The difficulty is that in the real world, fighting just

isn't fair. A rich and powerful lobby such as the insurance industry can act in

a monopolistic fashion but because of its financial power, it wields the

political power to deflect any enforcement action. In fact, its political power

enables it to influence regulation which will favor them and put us at a

distinct disadvantage. D. Rockefeller used this form of influence

prodigiously and JP Chase and Goldman Sachs are but two of the present day

entities using this same form of influence nowadays. Witness the complete

absence of prosecution of anyone for the recent (and continuing) Great Financial

Crisis and realize that these enormously powerful entities are largely above the

law except for occasional token enforcement actions designed more to temporarily

assuage the concerns of the public than to effect meaningful and lasting change.

Conversely, we, as a much weaker and poorer organization, would be hit with an

onslaught of legal and regulatory actions if anything we did even hinted of

collusion.

To All,

As a profession, we need to expand our knowledge beyond the limited scope of

physical therapy. We need to understand what is occurring nationally and

globally in financial, economic, political, and geopolitical spheres. What is

occurring is macro systemic and pervasive and ranges far beyond the micro issues

we struggle with in the physical therapy world but these larger issues will

nevertheless influence our professional world and our future tremendously.

Among other things, we are seeing:

1) simultaneous exponential changes in the economy, energy, and environment

(Martenson's 3Es) creating a perfect global storm of epic proportions

2) massive and insurmountable debt loads inexorably overwhelming an increasing

number of municipal and county governments, most state governments, and the

federal government as well as the governments of most of the developed nations

3) pension funds and retirement funds which are unsustainable

4) a Social Security system which is unsustainable.

5) a Medicare/Medicaide system which is unsustainable

6) steadily increasing energy costs which affect every aspect of our lives and

which cannot be effectively countered by any foreseeable developments in

alternative energy systems

7) steadily increasing food costs related to factors noted above as well as

other factors

8) increasing government intervention, interference, and control of every aspect

of our lives with a concomitant progressive decrease in privacy and liberty

9) ongoing wars sustained ostensibly to spread freedom and democracy but

primarily conducted to ensure access to resources and especially to enrich

certain corporate and banking interests

10) central banks steadily devaluing the fiat currencies of the world (including

the US dollar) meaning, among many other things, that most of you will not have

the standard of living nor the retirement you were hoping to have and your

children will most certainly not have the standard of living nor the retirement

of their grandparents

11) a " leveling of the playing field " as described and promulgated by Carroll

Quigley (Bill Clinton's mentor) in the classic " Tragedy and Hope " which is

bringing about a rise of the standard of living in the East and a fall in the

standard of living in the West

12) a media promoting MOPE (Management of Perspective Economics) and a

predetermined agenda that is increasingly controlled and influenced by a very

small but powerful elite which is oriented more towards entertainment and

distraction rather than news and information

13) infrastructure that was largely built during a cheap energy period ranging

from the 1930s to the 1950s that is deteriorating and with increasing societal

complexity will become overwhelming expensive to maintain and upgrade

14) increasing societal fractionation, polarization, and acrimony due to factors

ranging from financial to sociological

15) debt loads for higher education surpassing credit card debt which condemns a

substantial percentage of the younger generations to life long debt servitude

(approaching $1 trillion)

16) the use of regulation by government and powerful corporate interests not

only as a tool but also as a weapon to manage and suppress any challenges to

their power and control while the use of regulation to protect the middle class

has been diluted (as evidenced by the impotent financial reform bill, the repeal

of the Glass-Steagall Act, the minimal to non-existent enforcement action of the

SEC and CFTC against widespread abuses, etc.)

17) inflation rates running well above official government statistics (over 6% -

see ' Shadow Government Statistics)

18) unemployment rates running well above official government statistics (over

22%)

19) growing long term loss of certain key sectors of employment

20) growing numbers of Americans on food stamps (over 44 million)

21) over 50% of Americans dependent upon some form of government employment

(whether municipal, county, state, or federal)

22) 18% of Americans dependent upon some form of government support

Etc., etc.

This isn't doom and gloom. These aren't beliefs or opinions. These aren't

conspiracy theories. These are facts backed by real life occurrences and in

many cases, by hard data. If we fail to understand the implications of these

situations for ourselves, our children, and our profession, our future is dim

indeed.

, PT, OCS

Re: PT/OT/SP Negotiation Group

Great suggestion Jim - in fact, what you describe is what PTPN has been

doing in many states for years, beginning in California in 1985. PTPN is

a network of therapist-owned private practices whose original goal was

to get independent therapists a seat at the table as managed care was

emerging in the 80s, and that continues to advocate for the private

practitioner today with many entities - payers, state legislatures, CMS

and many others. You're right on target with your thoughts: It is

important to do at a state-by-state level, given the variations among

state laws and regulations, which is why PTPN has regional offices and

officers across the country that focus on state-specific issues. In

addition, you're correct that it's important to have legal guidance to

avoid collusion/monopoly activities, and PTPN has worked with leading

healthcare lawyers throughout our history to ensure that we're

maximizing our ability to advocate for our providers while staying on

the right side of all relevant laws. If you'd like more information,

please contact me, and if you let me know what state you're in, I can

put you in touch with the PTPN folks in your area if it's a state in

which we operate.

Mitch

Mitchel Kaye, P.T.

Director, Quality Assurance

PTPN

telephone

800-766-PTPN

fax

Please visit us at ptpn.com <http://www.ptpn.com/> and physiquality.com

<http://www.physiquality.com/>

<http://www.facebook.com/PTPNInc> Like PTPN

<http://www.facebook.com/PTPNInc> on Facebook

<http://www.facebook.com/physiquality> Like Physiquality

<http://www.facebook.com/physiquality> on Facebook

[Guest guest]

Dick,

I couldn't agree with you more. You get it. Unfortunately, many others don't.

They're willing to give their hard earned money away to insurance executives who

laugh at them. They're willing to give their money away to physicians owning

POPTS. They're willing to give their money to Wall Street types who are raiding

their profession just like these type have raided other businesses over the

years (figuratively telling the victims it's raining while they're p***ing on

their backs). They're willing to give their money to personal trainers, massage

therapists, and others (with less training, less knowledge, and lesser skills)

via relinquishment of market share. And they're willing to give their money to

their government, most noticeably via the currency de-evaluation which is

occurring, shrinking the value of their dollar year by year.

They keep thinking in the same very small box with the result that they keep

getting the same dismal results. Their educational costs are going up while

their reimbursements are steadily and irrevocably shrinking as is their

marketshare as is the value of the dollar they are earning. The situation is

simply unsustainable with business conducted in the present manner.

Tom,

The situations you describe are just some of the reasons why we are experiencing

many of the problems our profession has.

For all too long, too many PTs have juggled multiple patients at the same time,

over overdelegated their responsibilities to care extenders (and sometimes very

poorly trained care extenders such as one facility I know of that used untrained

high school students), overutilized modality " time management " tools like hot

packs, overutilized exercise " time management " tools like stationary bicycles

and treadmills, overemphasized mindless exercise to the exclusive of mindful

movement interventions, utilized a limited repertoire of manual interventions

(and often in a somewhat perfunctory, overly brief, and marginally effective

fashion), etc. These behaviors have affected the perception of PT in the

public's mind to the detriment of us all. I just had a patient this morning who

expressed the sentiment that she never had too much respect for PT until she

came to our clinic because of her previous experiences with the therapist

behaviors noted above.

Also, too many PTs don't have their financial priorities straight. They are

often unwilling to spend the money to join the APTA or other support

organizations or spend money on continuing education or other educational self

development resources yet you'll see them spending money on Starbucks, BMWs,

expensive vacations, etc.. If the loss of income even for a short time so

financially incapacitates them that they can't absorb it, something is awry with

their financial planning and management skills. I remember having a $13K income

my first year as a PT and spending $3K of my own money on books, journals, and

CE courses yet hearing people whine about having to spend $50 on a single book.

To use one of your favored expressions, WTF?

Also, is it fair that " successful clinic owners can balance patient types and

fill in costs with work comp and third party which still may pay full price

rates in some states and they can absorb the low cost " ? In my opinion,

something is inherently disingenuous about this situation.

The attitude that " we are living with less (which may not be a bad thing) " would

be acceptable if everyone else were living with less but I can assure you that

the insurance executives, Wall Street raider types, and physicians with POPTS

most assuredly are not. They want you to live with less so that they can live

with more. Always remember, no matter what they tell you, the reality is that

we're dealing with a floating zero sum game here.

The " new reality " is only a reality because we have accepted it as such and

allowed it to occur. If we're willing to be rugs, we'll be walked on.

Armin,

You are so very right. Unfortunately, I seriously wonder if our profession has

the collective cojones to take the action that is necessary. Witness the people

who write in anonymously or semi-anonymously on this forum. There's a lot of

fear. If it was up to some of these folks to implement an American Revolution,

we'd still be singing God Save The Queen.

Jim,

Your points about organization and collective action are appreciated and

theoretically correct. The difficulty is that in the real world, fighting just

isn't fair. A rich and powerful lobby such as the insurance industry can act in

a monopolistic fashion but because of its financial power, it wields the

political power to deflect any enforcement action. In fact, its political power

enables it to influence regulation which will favor them and put us at a

distinct disadvantage. D. Rockefeller used this form of influence

prodigiously and JP Chase and Goldman Sachs are but two of the present day

entities using this same form of influence nowadays. Witness the complete

absence of prosecution of anyone for the recent (and continuing) Great Financial

Crisis and realize that these enormously powerful entities are largely above the

law except for occasional token enforcement actions designed more to temporarily

assuage the concerns of the public than to effect meaningful and lasting change.

Conversely, we, as a much weaker and poorer organization, would be hit with an

onslaught of legal and regulatory actions if anything we did even hinted of

collusion.

To All,

As a profession, we need to expand our knowledge beyond the limited scope of

physical therapy. We need to understand what is occurring nationally and

globally in financial, economic, political, and geopolitical spheres. What is

occurring is macro systemic and pervasive and ranges far beyond the micro issues

we struggle with in the physical therapy world but these larger issues will

nevertheless influence our professional world and our future tremendously.

Among other things, we are seeing:

1) simultaneous exponential changes in the economy, energy, and environment

(Martenson's 3Es) creating a perfect global storm of epic proportions

2) massive and insurmountable debt loads inexorably overwhelming an increasing

number of municipal and county governments, most state governments, and the

federal government as well as the governments of most of the developed nations

3) pension funds and retirement funds which are unsustainable

4) a Social Security system which is unsustainable.

5) a Medicare/Medicaide system which is unsustainable

6) steadily increasing energy costs which affect every aspect of our lives and

which cannot be effectively countered by any foreseeable developments in

alternative energy systems

7) steadily increasing food costs related to factors noted above as well as

other factors

8) increasing government intervention, interference, and control of every aspect

of our lives with a concomitant progressive decrease in privacy and liberty

9) ongoing wars sustained ostensibly to spread freedom and democracy but

primarily conducted to ensure access to resources and especially to enrich

certain corporate and banking interests

10) central banks steadily devaluing the fiat currencies of the world (including

the US dollar) meaning, among many other things, that most of you will not have

the standard of living nor the retirement you were hoping to have and your

children will most certainly not have the standard of living nor the retirement

of their grandparents

11) a " leveling of the playing field " as described and promulgated by Carroll

Quigley (Bill Clinton's mentor) in the classic " Tragedy and Hope " which is

bringing about a rise of the standard of living in the East and a fall in the

standard of living in the West

12) a media promoting MOPE (Management of Perspective Economics) and a

predetermined agenda that is increasingly controlled and influenced by a very

small but powerful elite which is oriented more towards entertainment and

distraction rather than news and information

13) infrastructure that was largely built during a cheap energy period ranging

from the 1930s to the 1950s that is deteriorating and with increasing societal

complexity will become overwhelming expensive to maintain and upgrade

14) increasing societal fractionation, polarization, and acrimony due to factors

ranging from financial to sociological

15) debt loads for higher education surpassing credit card debt which condemns a

substantial percentage of the younger generations to life long debt servitude

(approaching $1 trillion)

16) the use of regulation by government and powerful corporate interests not

only as a tool but also as a weapon to manage and suppress any challenges to

their power and control while the use of regulation to protect the middle class

has been diluted (as evidenced by the impotent financial reform bill, the repeal

of the Glass-Steagall Act, the minimal to non-existent enforcement action of the

SEC and CFTC against widespread abuses, etc.)

17) inflation rates running well above official government statistics (over 6% -

see ' Shadow Government Statistics)

18) unemployment rates running well above official government statistics (over

22%)

19) growing long term loss of certain key sectors of employment

20) growing numbers of Americans on food stamps (over 44 million)

21) over 50% of Americans dependent upon some form of government employment

(whether municipal, county, state, or federal)

22) 18% of Americans dependent upon some form of government support

Etc., etc.

This isn't doom and gloom. These aren't beliefs or opinions. These aren't

conspiracy theories. These are facts backed by real life occurrences and in

many cases, by hard data. If we fail to understand the implications of these

situations for ourselves, our children, and our profession, our future is dim

indeed.

, PT, OCS

Re: PT/OT/SP Negotiation Group

Great suggestion Jim - in fact, what you describe is what PTPN has been

doing in many states for years, beginning in California in 1985. PTPN is

a network of therapist-owned private practices whose original goal was

to get independent therapists a seat at the table as managed care was

emerging in the 80s, and that continues to advocate for the private

practitioner today with many entities - payers, state legislatures, CMS

and many others. You're right on target with your thoughts: It is

important to do at a state-by-state level, given the variations among

state laws and regulations, which is why PTPN has regional offices and

officers across the country that focus on state-specific issues. In

addition, you're correct that it's important to have legal guidance to

avoid collusion/monopoly activities, and PTPN has worked with leading

healthcare lawyers throughout our history to ensure that we're

maximizing our ability to advocate for our providers while staying on

the right side of all relevant laws. If you'd like more information,

please contact me, and if you let me know what state you're in, I can

put you in touch with the PTPN folks in your area if it's a state in

which we operate.

Mitch

Mitchel Kaye, P.T.

Director, Quality Assurance

PTPN

telephone

800-766-PTPN

fax

Please visit us at ptpn.com <http://www.ptpn.com/> and physiquality.com

<http://www.physiquality.com/>

<http://www.facebook.com/PTPNInc> Like PTPN

<http://www.facebook.com/PTPNInc> on Facebook

<http://www.facebook.com/physiquality> Like Physiquality

<http://www.facebook.com/physiquality> on Facebook

[Guest guest]

Dick,

I couldn't agree with you more. You get it. Unfortunately, many others don't.

They're willing to give their hard earned money away to insurance executives who

laugh at them. They're willing to give their money away to physicians owning

POPTS. They're willing to give their money to Wall Street types who are raiding

their profession just like these type have raided other businesses over the

years (figuratively telling the victims it's raining while they're p***ing on

their backs). They're willing to give their money to personal trainers, massage

therapists, and others (with less training, less knowledge, and lesser skills)

via relinquishment of market share. And they're willing to give their money to

their government, most noticeably via the currency de-evaluation which is

occurring, shrinking the value of their dollar year by year.

They keep thinking in the same very small box with the result that they keep

getting the same dismal results. Their educational costs are going up while

their reimbursements are steadily and irrevocably shrinking as is their

marketshare as is the value of the dollar they are earning. The situation is

simply unsustainable with business conducted in the present manner.

Tom,

The situations you describe are just some of the reasons why we are experiencing

many of the problems our profession has.

For all too long, too many PTs have juggled multiple patients at the same time,

over overdelegated their responsibilities to care extenders (and sometimes very

poorly trained care extenders such as one facility I know of that used untrained

high school students), overutilized modality " time management " tools like hot

packs, overutilized exercise " time management " tools like stationary bicycles

and treadmills, overemphasized mindless exercise to the exclusive of mindful

movement interventions, utilized a limited repertoire of manual interventions

(and often in a somewhat perfunctory, overly brief, and marginally effective

fashion), etc. These behaviors have affected the perception of PT in the

public's mind to the detriment of us all. I just had a patient this morning who

expressed the sentiment that she never had too much respect for PT until she

came to our clinic because of her previous experiences with the therapist

behaviors noted above.

Also, too many PTs don't have their financial priorities straight. They are

often unwilling to spend the money to join the APTA or other support

organizations or spend money on continuing education or other educational self

development resources yet you'll see them spending money on Starbucks, BMWs,

expensive vacations, etc.. If the loss of income even for a short time so

financially incapacitates them that they can't absorb it, something is awry with

their financial planning and management skills. I remember having a $13K income

my first year as a PT and spending $3K of my own money on books, journals, and

CE courses yet hearing people whine about having to spend $50 on a single book.

To use one of your favored expressions, WTF?

Also, is it fair that " successful clinic owners can balance patient types and

fill in costs with work comp and third party which still may pay full price

rates in some states and they can absorb the low cost " ? In my opinion,

something is inherently disingenuous about this situation.

The attitude that " we are living with less (which may not be a bad thing) " would

be acceptable if everyone else were living with less but I can assure you that

the insurance executives, Wall Street raider types, and physicians with POPTS

most assuredly are not. They want you to live with less so that they can live

with more. Always remember, no matter what they tell you, the reality is that

we're dealing with a floating zero sum game here.

The " new reality " is only a reality because we have accepted it as such and

allowed it to occur. If we're willing to be rugs, we'll be walked on.

Armin,

You are so very right. Unfortunately, I seriously wonder if our profession has

the collective cojones to take the action that is necessary. Witness the people

who write in anonymously or semi-anonymously on this forum. There's a lot of

fear. If it was up to some of these folks to implement an American Revolution,

we'd still be singing God Save The Queen.

Jim,

Your points about organization and collective action are appreciated and

theoretically correct. The difficulty is that in the real world, fighting just

isn't fair. A rich and powerful lobby such as the insurance industry can act in

a monopolistic fashion but because of its financial power, it wields the

political power to deflect any enforcement action. In fact, its political power

enables it to influence regulation which will favor them and put us at a

distinct disadvantage. D. Rockefeller used this form of influence

prodigiously and JP Chase and Goldman Sachs are but two of the present day

entities using this same form of influence nowadays. Witness the complete

absence of prosecution of anyone for the recent (and continuing) Great Financial

Crisis and realize that these enormously powerful entities are largely above the

law except for occasional token enforcement actions designed more to temporarily

assuage the concerns of the public than to effect meaningful and lasting change.

Conversely, we, as a much weaker and poorer organization, would be hit with an

onslaught of legal and regulatory actions if anything we did even hinted of

collusion.

To All,

As a profession, we need to expand our knowledge beyond the limited scope of

physical therapy. We need to understand what is occurring nationally and

globally in financial, economic, political, and geopolitical spheres. What is

occurring is macro systemic and pervasive and ranges far beyond the micro issues

we struggle with in the physical therapy world but these larger issues will

nevertheless influence our professional world and our future tremendously.

Among other things, we are seeing:

1) simultaneous exponential changes in the economy, energy, and environment

(Martenson's 3Es) creating a perfect global storm of epic proportions

2) massive and insurmountable debt loads inexorably overwhelming an increasing

number of municipal and county governments, most state governments, and the

federal government as well as the governments of most of the developed nations

3) pension funds and retirement funds which are unsustainable

4) a Social Security system which is unsustainable.

5) a Medicare/Medicaide system which is unsustainable

6) steadily increasing energy costs which affect every aspect of our lives and

which cannot be effectively countered by any foreseeable developments in

alternative energy systems

7) steadily increasing food costs related to factors noted above as well as

other factors

8) increasing government intervention, interference, and control of every aspect

of our lives with a concomitant progressive decrease in privacy and liberty

9) ongoing wars sustained ostensibly to spread freedom and democracy but

primarily conducted to ensure access to resources and especially to enrich

certain corporate and banking interests

10) central banks steadily devaluing the fiat currencies of the world (including

the US dollar) meaning, among many other things, that most of you will not have

the standard of living nor the retirement you were hoping to have and your

children will most certainly not have the standard of living nor the retirement

of their grandparents

11) a " leveling of the playing field " as described and promulgated by Carroll

Quigley (Bill Clinton's mentor) in the classic " Tragedy and Hope " which is

bringing about a rise of the standard of living in the East and a fall in the

standard of living in the West

12) a media promoting MOPE (Management of Perspective Economics) and a

predetermined agenda that is increasingly controlled and influenced by a very

small but powerful elite which is oriented more towards entertainment and

distraction rather than news and information

13) infrastructure that was largely built during a cheap energy period ranging

from the 1930s to the 1950s that is deteriorating and with increasing societal

complexity will become overwhelming expensive to maintain and upgrade

14) increasing societal fractionation, polarization, and acrimony due to factors

ranging from financial to sociological

15) debt loads for higher education surpassing credit card debt which condemns a

substantial percentage of the younger generations to life long debt servitude

(approaching $1 trillion)

16) the use of regulation by government and powerful corporate interests not

only as a tool but also as a weapon to manage and suppress any challenges to

their power and control while the use of regulation to protect the middle class

has been diluted (as evidenced by the impotent financial reform bill, the repeal

of the Glass-Steagall Act, the minimal to non-existent enforcement action of the

SEC and CFTC against widespread abuses, etc.)

17) inflation rates running well above official government statistics (over 6% -

see ' Shadow Government Statistics)

18) unemployment rates running well above official government statistics (over

22%)

19) growing long term loss of certain key sectors of employment

20) growing numbers of Americans on food stamps (over 44 million)

21) over 50% of Americans dependent upon some form of government employment

(whether municipal, county, state, or federal)

22) 18% of Americans dependent upon some form of government support

Etc., etc.

This isn't doom and gloom. These aren't beliefs or opinions. These aren't

conspiracy theories. These are facts backed by real life occurrences and in

many cases, by hard data. If we fail to understand the implications of these

situations for ourselves, our children, and our profession, our future is dim

indeed.

, PT, OCS

Re: PT/OT/SP Negotiation Group

Great suggestion Jim - in fact, what you describe is what PTPN has been

doing in many states for years, beginning in California in 1985. PTPN is

a network of therapist-owned private practices whose original goal was

to get independent therapists a seat at the table as managed care was

emerging in the 80s, and that continues to advocate for the private

practitioner today with many entities - payers, state legislatures, CMS

and many others. You're right on target with your thoughts: It is

important to do at a state-by-state level, given the variations among

state laws and regulations, which is why PTPN has regional offices and

officers across the country that focus on state-specific issues. In

addition, you're correct that it's important to have legal guidance to

avoid collusion/monopoly activities, and PTPN has worked with leading

healthcare lawyers throughout our history to ensure that we're

maximizing our ability to advocate for our providers while staying on

the right side of all relevant laws. If you'd like more information,

please contact me, and if you let me know what state you're in, I can

put you in touch with the PTPN folks in your area if it's a state in

which we operate.

Mitch

Mitchel Kaye, P.T.

Director, Quality Assurance

PTPN

telephone

800-766-PTPN

fax

Please visit us at ptpn.com <http://www.ptpn.com/> and physiquality.com

<http://www.physiquality.com/>

<http://www.facebook.com/PTPNInc> Like PTPN

<http://www.facebook.com/PTPNInc> on Facebook

<http://www.facebook.com/physiquality> Like Physiquality

<http://www.facebook.com/physiquality> on Facebook

[Guest guest]

You do a nice job of making points. So, now that you have weighed in, what are

you suggesting? We all begin a 3 year study of all the literature to research

these topics as you have? Or, do we just read your post and come to the

conclusion that we cannot do anything but sit tight and take what is being

offered. Or, do we all need to buy pitchforks and march against the PAC's that

are controlling our legislative bodies. I appreciate your perspective, but what

are you recommending for action. Granted, from the number of comments posted,

it doesn't seem anyone is overly concerned about this issue. So maybe I am

nothing more than a distraction on a three day weekend. But I am seeing and

hearing about clinics that have been in business for a good, long time that are

struggling. These are clinic owners with good reputations, that have good

management skills and they are so busy with patient care they really don't have

time to step away from their clinics to fight. And the insurers are UNWILLING

to re-negotiate with them. I suspect that their competitors in a 25 mile radius

are experiencing the same thing. But the pattern is not going to break unless

someone steps up to the starting gate.

I will be the first to tell you that I am not the sharpest knife in the

silverware drawer. However, I have seen enough people that will spend time

analyzing, re-analyzing and then commiting to study the issue some more because

they don't feel that they have enough data. While I agree that no one (except

possibly insurance companies) has the data to understand where therapy fits into

the rising healthcare cost equation, there are times when there is enough data

to justify taking a stand. In the northeastern area of the country, insurance

companies have been paying less than $60 per visit to physical therapists. This

is not a single payer, it is multiple payers. Based upon what I see, the

patients being treated receive an average of between a 30-45 minute treatment.

If a PT/OT/SP clinic were doing the math, that is not enough to keep the doors

of a clinic open permanently. So what happens? Do they make it up on W/C cases

with better reimbursement? Do they bill fraudulently? Do they re-negotiate

their lease to cut their costs? Do they take paycuts? Something has got to

give.

From where I sit, these issues are beginning to spread into other states.

Because insurers are having success in one area of the country, they are now

starting to spread..., similar to a cancer growing within the body. As it

spreads, it kills. Therapy Clinics go out of business every day. Some because

they do not have the business to sustain themselves. Others because they are

poorly managed. That makes sense to me. But when clinics are treating at full

capacity and reimbursement is not enough to sustain them, then it is a problem.

A corporate therapy chain may have deeper pockets than the average Clinic owner

to hold off closing. But they cannot hold out forever. So what is the answer.

My opinion is that therapists MUST band together and organize in a meaningful

manner. Is this organization required in all states? No, reimbursement in some

areas of the country are doing just fine. But what I see is the northeastern

reimbursement creeping into markets with higher populations in other areas of

the country. And I nothing happening to arrest this cancer. The APTA is a

tremendous resource and has paid staff. But I think they are working on policy

issues on a national scale and regardless, do not have enough staff to fight

insurance companies in multiple markets, in multiple states. I believe if such

a fight were to occur, the APTA might be able to assist with the battle plan,

but the fight might come from the State organization. While there are several

good field generals around the country, they need to be able to know troop

strength before they develop a battle plan. So, for example, if there were

reimbursement problems in Idaho, Mr. Howell might be similar to General Bradley

or Patton, but he would need to know how many troops were backing him before he

went into battle. I would also suggest that Mr. Howell would not be a suitable

General for this fight. Not because he's not capable, but because he doesn't

live in the Northeast and hasn't been living in this reimbursement arena. I

believe that leader would have to be someone willing to step up from that area.

I also believe before a leader would be selected that numbers would need to be

determined. So..., would therapists from NJ, NY, CT, PA, OH or some other

state be willing to organize a petition drive? Is there something that the rest

of us could do to help? Or, do members in these states not think there is a

problem?

Jim <///><

Re: Re: PT/OT/SP Negotiation Group

Dick,

I couldn't agree with you more. You get it. Unfortunately, many others don't.

They're willing to give their hard earned money away to insurance executives who

laugh at them. They're willing to give their money away to physicians owning

POPTS. They're willing to give their money to Wall Street types who are raiding

their profession just like these type have raided other businesses over the

years (figuratively telling the victims it's raining while they're p***ing on

their backs). They're willing to give their money to personal trainers, massage

therapists, and others (with less training, less knowledge, and lesser skills)

via relinquishment of market share. And they're willing to give their money to

their government, most noticeably via the currency de-evaluation which is

occurring, shrinking the value of their dollar year by year.

They keep thinking in the same very small box with the result that they keep

getting the same dismal results. Their educational costs are going up while

their reimbursements are steadily and irrevocably shrinking as is their

marketshare as is the value of the dollar they are earning. The situation is

simply unsustainable with business conducted in the present manner.

Tom,

The situations you describe are just some of the reasons why we are experiencing

many of the problems our profession has.

For all too long, too many PTs have juggled multiple patients at the same time,

over overdelegated their responsibilities to care extenders (and sometimes very

poorly trained care extenders such as one facility I know of that used untrained

high school students), overutilized modality " time management " tools like hot

packs, overutilized exercise " time management " tools like stationary bicycles

and treadmills, overemphasized mindless exercise to the exclusive of mindful

movement interventions, utilized a limited repertoire of manual interventions

(and often in a somewhat perfunctory, overly brief, and marginally effective

fashion), etc. These behaviors have affected the perception of PT in the

public's mind to the detriment of us all. I just had a patient this morning who

expressed the sentiment that she never had too much respect for PT until she

came to our clinic because of her previous experiences with the therapist

behaviors noted above.

Also, too many PTs don't have their financial priorities straight. They are

often unwilling to spend the money to join the APTA or other support

organizations or spend money on continuing education or other educational self

development resources yet you'll see them spending money on Starbucks, BMWs,

expensive vacations, etc.. If the loss of income even for a short time so

financially incapacitates them that they can't absorb it, something is awry with

their financial planning and management skills. I remember having a $13K income

my first year as a PT and spending $3K of my own money on books, journals, and

CE courses yet hearing people whine about having to spend $50 on a single book.

To use one of your favored expressions, WTF?

Also, is it fair that " successful clinic owners can balance patient types and

fill in costs with work comp and third party which still may pay full price

rates in some states and they can absorb the low cost " ? In my opinion, something

is inherently disingenuous about this situation.

The attitude that " we are living with less (which may not be a bad thing) " would

be acceptable if everyone else were living with less but I can assure you that

the insurance executives, Wall Street raider types, and physicians with POPTS

most assuredly are not. They want you to live with less so that they can live

with more. Always remember, no matter what they tell you, the reality is that

we're dealing with a floating zero sum game here.

The " new reality " is only a reality because we have accepted it as such and

allowed it to occur. If we're willing to be rugs, we'll be walked on.

Armin,

You are so very right. Unfortunately, I seriously wonder if our profession has

the collective cojones to take the action that is necessary. Witness the people

who write in anonymously or semi-anonymously on this forum. There's a lot of

fear. If it was up to some of these folks to implement an American Revolution,

we'd still be singing God Save The Queen.

Jim,

Your points about organization and collective action are appreciated and

theoretically correct. The difficulty is that in the real world, fighting just

isn't fair. A rich and powerful lobby such as the insurance industry can act in

a monopolistic fashion but because of its financial power, it wields the

political power to deflect any enforcement action. In fact, its political power

enables it to influence regulation which will favor them and put us at a

distinct disadvantage. D. Rockefeller used this form of influence

prodigiously and JP Chase and Goldman Sachs are but two of the present day

entities using this same form of influence nowadays. Witness the complete

absence of prosecution of anyone for the recent (and continuing) Great Financial

Crisis and realize that these enormously powerful entities are largely above the

law except for occasional token enforcement actions designed more to temporarily

assuage the concerns of the public than to effect meaningf ul and lasting

change. Conversely, we, as a much weaker and poorer organization, would be hit

with an onslaught of legal and regulatory actions if anything we did even hinted

of collusion.

To All,

As a profession, we need to expand our knowledge beyond the limited scope of

physical therapy. We need to understand what is occurring nationally and

globally in financial, economic, political, and geopolitical spheres. What is

occurring is macro systemic and pervasive and ranges far beyond the micro issues

we struggle with in the physical therapy world but these larger issues will

nevertheless influence our professional world and our future tremendously.

Among other things, we are seeing:

1) simultaneous exponential changes in the economy, energy, and environment

(Martenson's 3Es) creating a perfect global storm of epic proportions

2) massive and insurmountable debt loads inexorably overwhelming an increasing

number of municipal and county governments, most state governments, and the

federal government as well as the governments of most of the developed nations

3) pension funds and retirement funds which are unsustainable

4) a Social Security system which is unsustainable.

5) a Medicare/Medicaide system which is unsustainable

6) steadily increasing energy costs which affect every aspect of our lives and

which cannot be effectively countered by any foreseeable developments in

alternative energy systems

7) steadily increasing food costs related to factors noted above as well as

other factors

8) increasing government intervention, interference, and control of every aspect

of our lives with a concomitant progressive decrease in privacy and liberty

9) ongoing wars sustained ostensibly to spread freedom and democracy but

primarily conducted to ensure access to resources and especially to enrich

certain corporate and banking interests

10) central banks steadily devaluing the fiat currencies of the world (including

the US dollar) meaning, among many other things, that most of you will not have

the standard of living nor the retirement you were hoping to have and your

children will most certainly not have the standard of living nor the retirement

of their grandparents

11) a " leveling of the playing field " as described and promulgated by Carroll

Quigley (Bill Clinton's mentor) in the classic " Tragedy and Hope " which is

bringing about a rise of the standard of living in the East and a fall in the

standard of living in the West

12) a media promoting MOPE (Management of Perspective Economics) and a

predetermined agenda that is increasingly controlled and influenced by a very

small but powerful elite which is oriented more towards entertainment and

distraction rather than news and information

13) infrastructure that was largely built during a cheap energy period ranging

from the 1930s to the 1950s that is deteriorating and with increasing societal

complexity will become overwhelming expensive to maintain and upgrade

14) increasing societal fractionation, polarization, and acrimony due to factors

ranging from financial to sociological

15) debt loads for higher education surpassing credit card debt which condemns a

substantial percentage of the younger generations to life long debt servitude

(approaching $1 trillion)

16) the use of regulation by government and powerful corporate interests not

only as a tool but also as a weapon to manage and suppress any challenges to

their power and control while the use of regulation to protect the middle class

has been diluted (as evidenced by the impotent financial reform bill, the repeal

of the Glass-Steagall Act, the minimal to non-existent enforcement action of the

SEC and CFTC against widespread abuses, etc.)

17) inflation rates running well above official government statistics (over 6% -

see ' Shadow Government Statistics)

18) unemployment rates running well above official government statistics (over

22%)

19) growing long term loss of certain key sectors of employment

20) growing numbers of Americans on food stamps (over 44 million)

21) over 50% of Americans dependent upon some form of government employment

(whether municipal, county, state, or federal)

22) 18% of Americans dependent upon some form of government support

Etc., etc.

This isn't doom and gloom. These aren't beliefs or opinions. These aren't

conspiracy theories. These are facts backed by real life occurrences and in many

cases, by hard data. If we fail to understand the implications of these

situations for ourselves, our children, and our profession, our future is dim

indeed.

, PT, OCS

Re: PT/OT/SP Negotiation Group

Great suggestion Jim - in fact, what you describe is what PTPN has been

doing in many states for years, beginning in California in 1985. PTPN is

a network of therapist-owned private practices whose original goal was

to get independent therapists a seat at the table as managed care was

emerging in the 80s, and that continues to advocate for the private

practitioner today with many entities - payers, state legislatures, CMS

and many others. You're right on target with your thoughts: It is

important to do at a state-by-state level, given the variations among

state laws and regulations, which is why PTPN has regional offices and

officers across the country that focus on state-specific issues. In

addition, you're correct that it's important to have legal guidance to

avoid collusion/monopoly activities, and PTPN has worked with leading

healthcare lawyers throughout our history to ensure that we're

maximizing our ability to advocate for our providers while staying on

the right side of all relevant laws. If you'd like more information,

please contact me, and if you let me know what state you're in, I can

put you in touch with the PTPN folks in your area if it's a state in

which we operate.

Mitch

Mitchel Kaye, P.T.

Director, Quality Assurance

PTPN

telephone

800-766-PTPN

fax

Please visit us at ptpn.com <http://www.ptpn.com/> and physiquality.com

<http://www.physiquality.com/>

<http://www.facebook.com/PTPNInc> Like PTPN

<http://www.facebook.com/PTPNInc> on Facebook

<http://www.facebook.com/physiquality> Like Physiquality

<http://www.facebook.com/physiquality> on Facebook

[Guest guest]

Jim,

I think you're a lot sharper than you give yourself credit for. I didn't

" fill-in-the-blanks " specifically on all the issues because, obviously, I don't

have all the answers. But if you go through my replies, there're some

suggestions imbedded therein.

1) We need to get close to 100% membership in APTA to get the funds we need to

fight the battles we need to fight. I'm not a leader nor an organizer type but

I'm sure folks more talented than me in those areas could come up with answers.

If I'm not mistaken, our rate of membership is far lower than that of MDs in the

AMA or DCs in the ACA. How is it they can have the memberships rates they have

but we can't?

2) We need to have PTs stop participating in POPTS. If no one would work in

them, they couldn't exist. But it's become politically correct not to put apply

any professional " social pressure " to get them to change their ways.

3) We need to stop going in with the Wall Street types who are promising some a

big payday at the expense of others (and I think we all know what and who I mean

here).

4) We need to give patients value for their money. The days of asking patients

and/or insurances to pay for heat and ice that a patient could put on at home,

treadmill walking and stationary bicycling that a patient could do in a gym,

exercises that a patient can learn online, limited manual and movement

re-education skills, limited knowledge of complementary therapies, juggling

simultaneous patients on overpacked schedules, etc. are over. I always have

found it astounding that during my private practice career, I've only treated

one patient at a time while other clinics would have a therapist treating

multiple patients at the same time and those patients and insurances would pay

the same amount of money for shorter and lower quality interventions.

Consider someone like Moshe Feldenkrais who in the early 1980s had patients pay

$200 cash for a treatment and he was booked up for days in advance. Therapists

need to ask themselves if they have the skills to have a patient be willing to

pay cash for their services (even if the patient had insurance) due to the value

of those services. I realize this is not a viable option for patients of all

income levels nor in areas of lower socioeconomic status but it's an ideal to

strive for and an example we should think about. Have you ever had a patient

tell you that you should raise your prices because of the value you offer? It

happens because I've experienced it. Think of all the massage therapists who

have patients paying cash. Why have we become so dependent upon insurances and

how can we change that?

5) We need to trim overhead. Oversized clinics in overpriced buildings

utilizing overly expensive equipment will become increasingly difficult to

support. I remember back in the mid 80s when our practice had spent $50K on

getting one of the first Biodex machines in the Northeast, one of the principals

in our practice spent 3 months in New Zealand studying with the likes of

McKenzie, Mulligan, etc. He remarked that they didn't have a fraction of the

equipment we had but the quality of their physical therapy was every bit as good

if not much better than that in the US. We need to use our brains and our hands

and stop relying on overly expensive machines and devices, as nice or as helpful

as they may be.

6) We need to be more wise in our use of financial resources on a personal

level. If you don't have a personal emergency fund or a financial " war chest " ,

it's hard to support a cause and wage a battle. As I mentioned, if one is

splurging on luxury haircuts, manicures, clothing, jewelry, cars, homes, etc.

(all of which I've seen) but complaining about not having enough money to

support your profession and improve your knowledge and skills, something is

dreadfully wrong.

7) We need to present a unified front to insurance companies and stop

undercutting one another. Insurance companies know they can apply the screws

and get what they want out of PTs because PTs are not unified and most PTs don't

have any financial cushion to fall back on. They will bleed us dry, guaranteed,

if we allow them to. Eventually though, if no one would provide services at the

prices they are offering, they would have to capitulate. We've become addicted

to the cash cow of insurance and danced to their tune for too long. Truthfully,

I would like cut out this very costly middle man (i.e. the insurances) and do an

end run around them by developing a mechanism whereby we could present our

services directly to the consumer or the party that would be paying for the

consumer's insurance. While a number of practices would fall by the wayside,

the system would ultimately be much healthier because it.

The situation in the Northeast indeed sounds very serious. I no longer live

there so I don't know firsthand what is going on. I have heard though (and I

think it was mentioned at one time on this forum) that independent private

practices were frustrated at the lack of results obtained by the APTA and were

banding together in NJ to address these issues. I don't know how successful

they have been but it sounded like they were moving forward. This " disease "

will, as you state, spread to the rest of the country if it remains unchecked.

Organization and unification are the key. I'm reminded of the words of Ben

lin when, at the signing of the Declaration of Independence, he stated

" Gentleman, we must all hang together, or we shall most assuredly all hang

separately " . We face a similar dilemma. United we stand, divided we fall.

On a personal level, I see very small, very efficient, very effective, niche

practices being the answer to survival for some. Applying outside-the-box

thinking, I can see a whole shift of certain members of the profession from a

physical therapist to a manual and movement therapist being another answer.

Another outside-the-box alternative is the use of an electronic media, algorithm

driven approach for hands off remote PT for musculoskeletal problems amenable to

that type of approach being another answer. The first is the way I have

practiced for many years and the second and third are areas that I will be

exploring in the not too distant future as I approach semi-retirement.

For individuals to develop some level of financial security outside the

immediate realm of PT, you may want to consider some of the following options:

1) Make your home, vehicle, and lifestyle as energy efficient as possible.

Energy is the master resource and will become progressively more expensive.

There are numerous steps that can be taken which will yield double digit annual

returns on your investment and are a far wiser use of your cash than stashing it

in a low interest bearing account.

2) Make yourself as food independent as possible. Food will cost progressively

more and if worst case scenarios manifest themselves (as they could as soon as

the period between 2012 and 2015), food costs could rise very high (even

potentially as high as 90% of your income as occurred in the past in Weimar

Republic Germany and as has been occurring in many of the Arab countries for the

poor and middle class provoking the so-called " Arab spring " , a misnomer if I

ever heard one). There's a reason Iowa farm land has skyrocketed in value and

greenhouses and gardens are springing up all over the country.

3) Develop multiple income streams so that, if your primary income stream is

diminished or fails, you're not left high and dry.

4) Do not rely fully on traditional investments such as the ubiquitous stock and

bond funds offered through 401Ks, for example. Wall Street will bleed you again

and again in cyclical fashion if you do given the changes that have occurred in

recent years including high frequency trading. Research alternative

investments.

5) Shift at least some of your wealth out of dollar denominated assets. The

dollar will still show periods of surprising strength but will inevitably

decline in both influence and value.

6) Consider putting 5-10% of your liquid net worth into precious metals such as

gold and silver. This was a standard practice for high net worth individuals

prior to the recent bull market in equities than began in the early 1980s.

Consider it " currency insurance " . If there is a collapse of the dollar (which

is not probable but definitely possible), your stocks, bonds, and cash will

become worthless and you'll thank your lucky stars you have some wealth in PMs.

I could go on and on but it's a holiday weekend and I'd like to enjoy it. Let's

remember who gave us our freedom and the sacrifices they made and not let them

have been made in vain.

, PT, OCS

Re: PT/OT/SP Negotiation Group

Great suggestion Jim - in fact, what you describe is what PTPN has been

doing in many states for years, beginning in California in 1985. PTPN is

a network of therapist-owned private practices whose original goal was

to get independent therapists a seat at the table as managed care was

emerging in the 80s, and that continues to advocate for the private

practitioner today with many entities - payers, state legislatures, CMS

and many others. You're right on target with your thoughts: It is

important to do at a state-by-state level, given the variations among

state laws and regulations, which is why PTPN has regional offices and

officers across the country that focus on state-specific issues. In

addition, you're correct that it's important to have legal guidance to

avoid collusion/monopoly activities, and PTPN has worked with leading

healthcare lawyers throughout our history to ensure that we're

maximizing our ability to advocate for our providers while staying on

the right side of all relevant laws. If you'd like more information,

please contact me, and if you let me know what state you're in, I can

put you in touch with the PTPN folks in your area if it's a state in

which we operate.

Mitch

Mitchel Kaye, P.T.

Director, Quality Assurance

PTPN

telephone

800-766-PTPN

fax

Please visit us at ptpn.com <http://www.ptpn.com/> and physiquality.com

<http://www.physiquality.com/>

<http://www.facebook.com/PTPNInc> Like PTPN

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