Re: Re: PT/OT/SP Negotiation Group

[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

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

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