New on PTManager

December 24, 2011

Kovacek, PT, DPT, MSA

PKovacek@...

Cell (313) 492-4293

Personal Fax

www.PTManager.com

---------- Forwarded message ----------

Date: Sat, Dec 24, 2011 at 7:00 AM

Subject: Your Daily Posterous Spaces Update

To: peter@...

[image: Posterous Spaces]

[image: Your daily Update] December 24th, 2011 So let's do

something about this: An unstable environment troubles independent

PTs<http://ptmanagerblog.com/so-lets-do-something-about-this-an-unstable-e>

Posted about 17 hours ago by [image: _portrait_thumb] Kovacek,

PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to

PTManager<http://ptmanagerblog.com>

[image: Like this

post]<http://posterous.com/likes/create?post_id=88717839>

An unstable environment troubles independent PTs

<http://thedailynewsonline.com/content/tncms/live/#>

Posted: Thursday, December 22, 2011 11:56 am

By Mike Pettinella Daily News Correspondent | 1 comment

<http://thedailynewsonline.com/news/article_1fb12f5a-2cbe-11e1-af30-001871e3ce6c\

..html#user-comment-area>

LE ROY — Privately-owned physical therapy practices are receiving

inadequate treatment when it comes to issues such as health insurance

co-pays, physical therapy as an alternative to surgery, workers

compensation laws and freedom of choice, according to a local physical

therapist and leader of a Western New York PT coalition.

“It all comes down to being treated equitably and fairly,” said

Privatera, president of Le Roy Physical Therapy & Village Fitness and

president of the Physical Therapy Alliance of Upstate New York.

“Insurers categorize physical therapists as ‘specialists’ just like

orthopedists, neurologists, cardiologists, and other physician specialists

but they fail to appreciate that our practice patterns are very different.

A patient might see a physician specialist two to three times per year to

treat a given condition, but patients might see a physical therapist two to

three times per week during an episode of care. When specialist co-pays are

set at $40 per visit, you’re seeing very unequal coverage.”

In recent years, insurance companies have raised premiums charged to

employers and subscribers. Despite this trend, Privatera said, costs of

care are being shifted back onto the consumers.

“Co-pays for physical therapy are a great example,” he said. “There has

been very little change over the past 10 years in the fees insurers pay or

allow for a physical therapy visit, but insurance premiums seem to increase

by 10 percent every year, and co-pays for PT have risen from $5 to 10 per

visit to up to $50 to $60 per visit.”

Privatera said that patients may think that physical therapists are making

more money due to the higher co-pays, but that’s not the case.

“Ten years ago, a patient might have had a $10 co-pay on a visit with a $42

allowance, meaning the insurance company paid us $32. Now, the patient

might have a $40 co-pay on a visit that pays us $42. The insurance company

pays us only $2. In more and more cases, the insurance company pays zero as

the co-pay is more than we are allowed by contract, but tells the patient

they have a physical therapy benefit.”

He also said that Kentucky recently passed legislation that caps the

patient’s responsibility of physical therapy costs to 20 percent. “That’s

what we’re hoping to achieve,” Privatera said. “It should be co-pay; right

now it’s ‘me-pay’.”

Privatera said he also is concerned about the perception that physical

therapists aren’t qualified to diagnose injuries.

“Today’s PTs graduate with a six-year clinical doctorate degree, and

several studies have established that a physical therapist’s clinical

diagnostic ability parallels or exceeds that of a primary care physician,”

he said.

Furthermore, Privatera said physical therapy treatments often are more cost

effective.

“There is a lot of data to support the efficacy of PT over many traditional

and more costly treatment options,” he offered. “Billions are spent each

year on unnecessary surgery, diagnostic imaging, injections, and

pharmaceuticals ... and physical therapists are in a position to curb these

costs.”

He cited osteoarthritis as an example of this.

“With a large increase in total hip and knee joint replacements forecasted

as the baby boomers age over the next five years, and with costs in excess

of $25,000 per surgery, PT should be much more engaged in disease

management algorithms,” he said. “Our alliance has tried to meet with

insurers to discuss this, and they seem to pay us lip service in support,

but have been unwilling to collaborate on our innovative ideas or to make

any significant changes to policies or procedures.”

Privatera said that physical therapy has historically been viewed as a

commodity — “a thing instead of the experts that we are. We’re working hard

to change that misconception of the profession.”

The patient’s freedom to choose his or her physical therapist is essential

to the future of privately-owned practices, Privatera contends.

“Some physicians will tell patients that they need to go to a specific PT

office to receive treatment, and sometimes it is because the physician has

a financial interest in the physical therapy practice to which he is

referring,” Privatera said. “We want people to know that they are free to

choose. Just like physicians, physical therapists have different levels or

areas of expertise and people need to know they can choose.”

Physicians who own physical therapy practices have justified this on the

grounds that it eliminates delays in getting treatment, and that patients

will receive better care from therapists that they supervise, Privatera

said. However, a June 2010 report by the Medicare Payment Advisory

Commission (MedPac) found these justifications largely unfounded and cited

potential “conflicts of interest” in physician self-referral.

“Fortunately for us in the Batavia and Rochester areas, there are not a lot

of physician-owned practices, but there are at least a dozen in the Buffalo

area. It’s a huge problem there,” he said.

Additionally, New York State Workers Compensation regulations have placed

burdens upon the physical therapy profession, Privatera indicated.

“The current medical treatment guidelines were intended to eliminate both

delays in care for injured workers and costly, unnecessary procedures, but

they have had the opposite effect,” he said. “There is additional

administrative paperwork and a ‘variance process’ that delays care and

keeps people out of work longer than necessary. To make matters worse, NYS

has not allowed a fee increase for physical therapists since 1994, although

physicians received an increase of 30 percent which coincided with the

guidelines implementation.”

As a result, many physicians and physical therapists are opting not to

accept workers compensation insurance, leaving injured workers with fewer

alternatives to receive health care, Privatera said.

“Our alliance has been active in trying to rectify these issues,” Privatera

said, adding that he has met with state legislators, including Steve

Hawley, who is a member of the NYS Assembly insurance committee.

Looking ahead, Privatera hopes that increased dialogue will lead to a

greater understanding of his profession.

“As the debate surrounding health care reform continues, physical

therapists are in a unique position to deliver better, more cost-effective

outcomes for musculoskeletal conditions,” he said. “At the end of the day,

we’re just hoping to eliminate the barriers which prevent us from doing

this.”

Make an informed judgment on the abilities of your

surgeon<http://ptmanagerblog.com/make-an-informed-judgment-on-the-abilities-of>

Posted about 12 hours ago by [image: _portrait_thumb] Kovacek,

PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to

PTManager<http://ptmanagerblog.com>

[image: Like this

post]<http://posterous.com/likes/create?post_id=88774146>

View full page:

www.kevinmd.com/blog/2011/12/informed-judgment-abilities-surgeon.html

A A <#1346ff21d35aea9c_>

close <#1346ff21d35aea9c_>

defaults <#1346ff21d35aea9c_>

– <#1346ff21d35aea9c_> A A + <#1346ff21d35aea9c_> <#1346ff21d35aea9c_>

<#1346ff21d35aea9c_> G <#1346ff21d35aea9c_> T

<#1346ff21d35aea9c_> H<#1346ff21d35aea9c_>

V <#1346ff21d35aea9c_>

Make an informed judgment on the abilities of your surgeon

-

About<http://www.instapaper.com/m?u=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2Fabout-\

kevin-md>

-

Contact<http://www.instapaper.com/m?u=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2Fcont\

act-kevin>

- Guest

Post<http://www.instapaper.com/m?u=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2Fheard-s\

ocial-medias-leading-physician-voice>

-

Opinion<http://www.instapaper.com/m?u=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2Fopin\

ion-commentary-kevinmd>

-

Speaking<http://www.instapaper.com/m?u=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2Fsoc\

ial-media-physician-speaker-kevin-pho-md>

MD.com<http://www.instapaper.com/m?u=http%3A%2F%2Fwww.kevinmd.com%2Fblog>

- All<http://www.instapaper.com/m?u=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F>

-

Pho<http://www.instapaper.com/m?u=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2Fcategory\

%2Fpho>

-

Physician<http://www.instapaper.com/m?u=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2Fca\

tegory%2Fphysician>

-

Patient<http://www.instapaper.com/m?u=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2Fcate\

gory%2Fpatient>

-

Policy<http://www.instapaper.com/m?u=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2Fcateg\

ory%2Fpolicy>

-

Tech<http://www.instapaper.com/m?u=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2Fcategor\

y%2Ftech>

- Social

media<http://www.instapaper.com/m?u=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2Fcatego\

ry%2Fsocial-media>

-

Conditions<http://www.instapaper.com/m?u=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2Fc\

ategory%2Fconditions>

-

Meds<http://www.instapaper.com/m?u=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2Fcategor\

y%2Fmeds>

-

Education<http://www.instapaper.com/m?u=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2Fca\

tegory%2Feducation>

');<http://www.instapaper.com/m?u=http%3A%2F%2Fa.collective-media.net%2Fjump%2Fk\

evinmd%2Fpatients%3Bcat%3Dpatients%3Bpos%3Dtop%3Bugc%3D0%3Bsu%3D1%3Bsu%3D2%3Bcmn\

%3Dwfm%3B%21c%3Dmpt%3Btile%3D1%3Bsz%3D728x90%3Bord%3D123456789%3F>SubscribeFollo\

w

@kevinmd <http://www.instapaper.com/m?u=http%3A%2F%2Ftwitter.com%2Fkevinmd>

-

<http://www.instapaper.com/m?u=https%3A%2F%2Fwww.facebook.com%2Fkevinmdblog>

-

<http://www.instapaper.com/m?u=https%3A%2F%2Ftwitter.com%2F%23%21%2Fkevinmd>

-

<http://www.instapaper.com/m?u=http%3A%2F%2Ffeeds.feedburner.com%2FMd-Medic\

alWeblog>

-

<http://www.instapaper.com/m?u=http%3A%2F%2Fwww.linkedin.com%2Fin%2Fkevinmd>

-

<http://www.instapaper.com/m?u=http%3A%2F%2Ffeeds2.feedburner.com%2FMd-Medi\

calWeblog>

<http://www.instapaper.com/m?u=http%3A%2F%2Ftwittercounter.com%2Fkevinmd%3Ffrom%\

3Dbutton>

Make

an informed judgment on the abilities of your surgeon by

Ruggieri,

MD<http://www.instapaper.com/m?u=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2Fpost-auth\

or%2Fpaul-ruggieri>|

in

Physician<http://www.instapaper.com/m?u=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2Fca\

tegory%2Fphysician>|

no responses

-

- Tweet <http://www.instapaper.com/m?u=http%3A%2F%2Ftwitter.com%2Fshare>

-

How many of the 40 million plus patients undergoing an operation this year

are truly informed of their surgeon’s track record? I suspect the vast

majority of patients entering the operating room today are unaware of

existing, vital information that would enable them to make an informed

judgment on the professional abilities of their surgeon.

Most patients who end up in a surgeon’s office are there because their

primary care physician sent them to the “best” surgeon in town. They

arrive, blindly trusting the judgment of their primary care physician.

What I find even more intriguing is that most primary care physicians are

also unaware of the same existing, vital information necessary for them to

make an informed decision on the “best” surgeon in town.

When you sign (and probably do not read) that consent form for your

upcoming hysterectomy, knee replacement, heart bypass, or laparoscopic

cholecystectomy, you consent to knowing the what, why, and potential what

if’s of the operation. However, are you informed enough to consent to

knowing the “who” of the operation?

Patients undergoing surgery today do not have access to compiled

performance data and because of this, I believe, are prevented from making

informed decisions on the competency of their surgeon. Today’s medical

(and legal) system intentionally blocks patient access to pertinent

performance information, information readily available to hospitals,

insurance companies, and federal government agencies.

Why is this? Why do hospitals have access to specific data on every

surgeon’s performance in your community when patients about to enter the

operating room do not? Why is the patient, the one most directly affected

by it, prevented from accessing this data? For that matter, how does a

patient begin to research the “real”experience of their surgeon, uncover

the “real” performance data. The diplomas, residency, fellowship training,

board certification, and societal memberships only touch the surface. Many

of these questions asked have no good answer yet.

I believe in total transparency in the surgical profession and it is time

to open up the hospital/insurance company books and take a look at

information the public is craving for … information necessary to give a

real informed consent.

Ruggieri is a general surgeon and author of Confessions of a

Surgeon<http://www.instapaper.com/m?u=http%3A%2F%2Fwww.paulruggieri.com%2Fconfes\

sions%2F>

..

Submit a guest post and be

heard<http://www.instapaper.com/m?u=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2Fheard-\

social-medias-leading-physician-voice>on

social media’s leading physician voice.

-

- Tweet <http://www.instapaper.com/m?u=http%3A%2F%2Ftwitter.com%2Fshare>

-

Tagged as:

Patients<http://www.instapaper.com/m?u=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2Ftag\

%2Fpatients>,

Surgery<http://www.instapaper.com/m?u=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2Ftag%\

2Fsurgery>

- Clinical judgment and when neurologists should order an

MRI<http://www.instapaper.com/m?u=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2010%2F0\

6%2Fclinical-judgment-neurologists-order-mri.html>

- ABIM: Maintenance of Certification (MOC) exams assess clinical

judgment<http://www.instapaper.com/m?u=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F201\

1%2F03%2Fabim-maintenance-certification-moc-exams-assess-clinical-judgement.html\

>

- A balanced approach to informed

consent<http://www.instapaper.com/m?u=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2011\

%2F02%2Fbalanced-approach-informed-consent.html>

- Implications of the surgical buy in when discussing informed

consent<http://www.instapaper.com/m?u=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2011\

%2F03%2Fimplications-surgical-buy-discussing-informed-consent.html>

- An informed screening choice for breast

cancer<http://www.instapaper.com/m?u=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2011%\

2F09%2Finformed-screening-choice-breast-cancer.html>

- Genetically informed therapy and technical innovations in

cardiology<http://www.instapaper.com/m?u=http%3A%2F%2Fwww.kevinmd.com%2Fblog%2F2\

011%2F10%2Fgenetically-informed-therapy-technical-innovations-cardiology.html>

Sign In

New on PTManager

Recommended Posts

Guest guest

Link to comment

Share on other sites

Join the conversation

Activity