Re: PT/OT/SP Negotiation Group

[Guest guest]

Hi Jim,

I thought that PTPN out of California was a PT owned business and a network

that was set up and was functioning as the entity that you describe but I

haven't heard much about them lately. I did hear a talk at a conference

from the founder probably 15 -20 years ago and from that, I know that the

company was set up for the reasons and principles you discuss, specifically

to band PT's together to give them negotiating power with the insurances.

With that said, I know that any state that does this will open eyes but will

also have to be strong enough to handle the criticism that inevitably will

come. Like unions, these entities will be called everything under the sun

including being un-American as the large corporate powers of the insurances

fight to discredit them in the public. They will be called greedy as any

and all professionals are when the band together because wages and payment

are generally higher than the general public already. The key will be that

these entities will have to have organized and powerful marketing campaigns

to counter the storm of negativity that will come and being very strong in

educating the public of why there is a need for this kind of organization.

It can be successful even in a loosely organized fashion. One thing that

insurers will respond to these days is that there will be no service from a

large group of providers in an area they serve. Physicians in Idaho have

used this negotiating tactic for years by threatening to stop taking members

with certain insurances in a large geographic area as a ploy to negotiate

better rates and it has worked well for them. For PT's it has been next to

impossible to do the same unless insurances have proposed something that is

completely unreasonable. I am not familiar with the same thing happening in

order to negotiate on a regular basis for appropriate reimbursement.

States, like Idaho, are now turning to hiring part-time payment specialists

to create relationships with insurance company representatives and act as a

payment lobbyist for the state. This is having some success in other

states(at least via verbal reports) especially in educating insurers about

what the problems are and coming up with better solutions. Before trying to

form a network as you describe, I would encourage that states look into the

payment specialist position and try it out first.

If nothing being tried works and payment continues to erode, we will be

forced to fight back or leave the profession. The key is whether we want to

fight back before we hit rock bottom or when we hit rock bottom. How we

fight will be up to us. Forming a network is a valid way to fight but not

an easy road. There are other options out there that are being tried and

are finding some success like payment specialists. Either way, the message

is that PT's are doing some good work to fight back now before we hit rock

bottom but we have to continue to see what is successful and what is not and

be open to all ideas including forming networks.

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

Howell Physical Therapy

Eagle, Idaho

thowell@...

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From: PTManager [mailto:PTManager ] On Behalf

Of JHall49629@...

Sent: Wednesday, May 18, 2011 9:27 AM

To: PTManager

Subject: PT/OT/SP Negotiation Group

All

For the last several years I have noted posts on this listserv about

different insurance companies that broker Unilateral contracts (which I

believe can be unenforceable if challenged in a court of law-but I am not an

attorney and would look forward to hearing one comment on this thread).

While most providers want to be in network with an insurer, most of the

contracts offer poor reimbursement at best and some even pay less than the

cost of the services provided. Typically the terms are one sided in favor of

the insurer and many providers feel they have to accept those terms because

they don't want to lose a good/strong/potential/fill in the blank referral

source. Additionally, these contracts roll in perpetuity with no rate

increases.

I believe I now have the desired attention to ask the question. Has anyone

thought about forming a network of providers in a geographic region to

discuss how to deal with these insurers? I know the next post will be

screaming collusion or monopoly, but if you joined a group and paid a

minimal fee then teleconferenced via Skype, Go To Meeting or some other

medium, I believe being a member of this group/community would effectively

remove the collusion/monopoly argument. Besides, banding together in such a

way gets you closer to being on equal negotiating footing with the payer.

If PT's, OT's and SP's wanted to do this, I think the best way to accomplish

this would be by state, since state laws would govern where a clinic is

located. I would suggest that the northeastern part of the United States

would be ripe for something like this, since managed care and lawmakers have

set fee schedules at artificially low reimbursement rates and held them

there for years.

In order to do things in an appropriate manner, I would recommend that a

group have the ear of an attorney from an initial phase. I remember hearing

Brodek discuss contracts at PPS in DC last fall and believe someone

like him might be good to have in the mix fairly early.

I will get off the stump now to see if this post hits a nerve.

Just trying to stir the pot,

Jim <///><

=

[Guest guest]

Jim,

I am sure you are aware that there are a number of Network organizations

around the country that have represented respective professions with some

success. In Ohio we have been operating since 1992 I got 3 other partners

and we founded our Network. It operates as a non profit organization, has

an executive director and a board of directors who are owners of their

practices. We use an attorney as needed, negotiate contracts, have a buying

agreement with equipment companies, etc. Has worked for us. We also have a

loose organization of similar networks that usually meet during the year and

at PPS.

In a message dated 5/18/2011 1:07:53 P.M. Eastern Daylight Time,

JHall49629@... writes:

All

For the last several years I have noted posts on this listserv about

different insurance companies that broker Unilateral contracts (which I believe

can be unenforceable if challenged in a court of law-but I am not an

attorney and would look forward to hearing one comment on this thread). While

most providers want to be in network with an insurer, most of the contracts

offer poor reimbursement at best and some even pay less than the cost of the

services provided. Typically the terms are one sided in favor of the

insurer and many providers feel they have to accept those terms because they

don't want to lose a good/strong/potential/fill in the blank referral source.

Additionally, these contracts roll in perpetuity with no rate increases.

I believe I now have the desired attention to ask the question. Has anyone

thought about forming a network of providers in a geographic region to

discuss how to deal with these insurers? I know the next post will be

screaming collusion or monopoly, but if you joined a group and paid a minimal

fee

then teleconferenced via Skype, Go To Meeting or some other medium, I

believe being a member of this group/community would effectively remove the

collusion/monopoly argument. Besides, banding together in such a way gets you

closer to being on equal negotiating footing with the payer.

If PT's, OT's and SP's wanted to do this, I think the best way to

accomplish this would be by state, since state laws would govern where a clinic

is

located. I would suggest that the northeastern part of the United States

would be ripe for something like this, since managed care and lawmakers have

set fee schedules at artificially low reimbursement rates and held them

there for years.

In order to do things in an appropriate manner, I would recommend that a

group have the ear of an attorney from an initial phase. I remember hearing

Brodek discuss contracts at PPS in DC last fall and believe someone

like him might be good to have in the mix fairly early.

I will get off the stump now to see if this post hits a nerve.

Just trying to stir the pot,

Jim <///><

=

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

[Guest guest]

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

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[Guest guest]

Great post Armin. I could not agree more!

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. It is evident when I interview a new graduate who

expects to make 80k per year or when a recruiting agency believes I can afford

to pay them 18% on top of what it costs to hire and retain a new therapist. So

many of us are willing to devalue our profession by accepting all of this and

cutting corners on quality to squeeze out a 5% profit margin that the masses are

not awake to the realities of what is happening to our profession. It is time

for organization, it is time for leadership, it is time to take ownership. We

have to stop fighting each other for market share and to instead use our numbers

and our DEMAND to our advantage. We can only do it together,

E s, PT, DPT, OCS, FAAOMPT

www.douglasspt,com

>

> 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

>

>