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What the @#@#@????
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What the @#@#@???? - August 27, 2005 10:05:00 AM
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KIDPT23
Posts: 222
Joined: May 20, 2002
From: Illinois
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Reimbursement needs to change or P.T. is going to die, simple as that! It is an absolute embarassment to our profession! How can a 5-10 minute doctor visit be charged at around 100-150 dollars and they receive 100-150 dollars in return?? Chiropractors, i'm sure are charging a decent amount per hour and receiving a decent amount per hour for a few cracks and pops. Massage therapists charge 70-100 dollars per hour. Personal training 65-95 dollars per hour. We spend an hour with patients with much hands on, psychological encouragement, and education and we get like 40-60 dollars an hour, sometime less!! I am an APTA member so i can say this. How does the APTA allow this to happen?? Does other professions allow this??...no fricken way!! We do so much in the time we see these people compared to some of the other health care professions yet we receive the least. Someone needs to get some balls and step it up. Every year the reimbursement gets worse, so its not like someone is doing something to correct this. Any ideas??? Let's get this corrected!!
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Re: What the @#@#@???? - August 27, 2005 10:12:00 AM
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ptdan23
Posts: 224
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From: Orlando, FL
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Totally agree but why does someone have to get some balls and step it up. Why can't it be you? Please do not take that personally. I am just saying we all need to join together on issues and get things changed. Thousands of voices are much louder than just a couple.
Dan, PT.
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Re: What the @#@#@???? - August 27, 2005 10:44:00 AM
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dosrinc
Posts: 335
Joined: December 9, 2004
From: Bonita Springs
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kidpt,
the apta does not "allow it to happen". The companies that agree to accept 40-60 dollars per hour "allow it to happen". My company does not accept such contracts, our average collected per patient is around 84 dollars in a 45 min period. The only way reimbursement is going to change is if we all agree to not accept less than Medicare, no more discounts, ect.
Rick
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Re: What the @#@#@???? - August 27, 2005 10:54:00 AM
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jma
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From: NY
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Agree with you on that.
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Re: What the @#@#@???? - August 27, 2005 10:59:00 AM
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SJBird55
Posts: 2430
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From: Michigan
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I do participate with Medicare. It would be nice if Medicare's fee schedule were a bit higher, but I also see their view - they have a huge population to cover - for all sorts of things with generally the least healthy population.
BCBS here is reasonable with what my costs are. But, I refuse to participate with 4 particular plans in my geographical area - the reimubursement sucks. Generally, something is better than nothing, but in my mind, it makes no sense for me to participate with any third party payer, especially when participating won't cover the cost of service (even if it means upsetting physicians because I don't participate with every plan in the area). It's purely a business decision. Now, that doesn't mean that I don't accept cash and patients can send in for their own reimbursement. I'm really surprised a lot more clinics don't say "no" to reimbursement schedules. What I really think would be funny would be for all the clinics in our area to just flat out refuse to participate.... THAT would really create a change - true competition, free choice for consumers and more profit for the owner. AND... I would also think that technically the definition of those CPT codes would go right out the window - if we didn't participate then we wouldn't have to strictly abide by them. LOL
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Re: What the @#@#@???? - August 27, 2005 1:22:00 PM
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Randy Dixon
Posts: 744
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I always find it strange when PT's complain about their payments and then expect someone to fix it for them so they can make lots more. The market sets the price for your services, not what you think you deserve. It's not the responsibility of the legislature, APTA, Medicare or any other party.
If there is enough demand for your services then the price rises, so the question is what are you doing to increase that demand? What are you doing that lowers that demand?
Medical costs are out of control and Medicare/Medicaid costs are out of control, there will be a lot more cuts before their are significant increases. So ask what you would get paid cash for your services, if it's more than insurance is paying you, why are you dealing with insurance? If you're not making it a competitive market, then how can you complain?
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Re: What the @#@#@???? - August 27, 2005 2:08:00 PM
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Dr.Wagner
Posts: 1242
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From: Indianapolis
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I only wish I got payed exactly what I billed for! Holy crap that would be nice. So no, insurance does not reimburse 100% for physician services...far far less.
Those practices that accept primarily cash are the practices that do well, but that is few and far between (dentistry, orthodontists, plastic surgeons).
Poor reimbursement is an ever increasing issue for every and all fields.
Issues like this are on the tops of PAC's of the AMA, AOA, and each specialty college. It should be on the top of the APTA's list as well.
I can't imagine the issue of reimbursement is new.
_____________________________
Dr. Wagner DO
Moderator of Medical Complexity Forum
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Re: What the @#@#@???? - August 28, 2005 6:11:00 AM
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hmgross
Posts: 292
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From: Minnesota
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I have to agree with Dr. Wagner on this one. If you are a patient at a clinic, pay attention to your explanation of benefit statement. You will see that a portion of the fee is "reduced" just like what I have to do when I bill for my services.
BTW, always get a chuckle out of some patients who see me and joke "bet I am paying for that new car"--usually their plan is the lowest reimburser, and people don't realize that although I own my business and do OK, I have overhead: rent, ultilities, payroll, etc.
I think that people should not compare reimbursement for services to what was going on in the 80's-early 90's. Much overutilization and fraud, in many cases, caused insurance companies to change how they pay for PT services.
A visiting orthotist had a good saying the other day (it was new to me, maybe not so new to others but I liked it)
"A pig gets fed, but a hog gets slaughtered"
So go ahead and fight for what you believe is proper reimbursement, but don't expect too much.
_____________________________
Holly Gross PT
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Re: What the @#@#@???? - August 29, 2005 4:10:00 AM
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KIDPT23
Posts: 222
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From: Illinois
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PTDan- I don't take it personally because I am stepping up myself. I am an APTA member, I have written to my local state agencies/government, and we have taken measures to increase our own reimbursement. Despite all this, things keep getting worse year by year.Our reimbursements keep getting worse, owners make less, wages go down, or we cut our services = patients suffer and our profession weakens.
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Re: What the @#@#@???? - August 29, 2005 4:42:00 AM
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Dr.Wagner
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From: Indianapolis
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The AMA, the AOA, and the American Academy of Emergency Medicine all have internet based letter writing campaigns and "washington updates" that arrive virtually weekly to my inbox...doesn't the APTA have this?
I mean I hate to admit this, but this crap has been going on for 10 years, you didn't just notice it did you?
_____________________________
Dr. Wagner DO
Moderator of Medical Complexity Forum
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Re: What the @#@#@???? - August 29, 2005 4:53:00 AM
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KIDPT23
Posts: 222
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From: Illinois
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Nope, just fed up with this!!
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Re: What the @#@#@???? - August 29, 2005 9:19:00 AM
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JLS_PT_OCS
Posts: 1684
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From: USA
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Randy-
This is third party payers we're talking about. The market has nothing whatever to do with them.
:)
All-
Though I do agree with Randy in that market forces are probably the only ones that can change the healthcare market/reimbursement situation in the long run.
We can all beg and plead to the third party payers and to the government, but in the end, they will pay as little as they can get away with.
Only a system that puts cost control in the hands of the consumers will solve these problems.
People pay "out of pocket" for all types of services all the time, especially for "alternative" treatments not covered by a payer. That is a great river of money PTs can tap by providing effective, cost efficient care.
Any system that involves a third party payer (medical care is one example, car insurance/ collision repair is another) is rife with cost/value inequities, fraud, and inefficiency.
Wagner has a great insight in that he has seen this monster from two different professions.
I think making a big part of any PT practice cash-based is the best solution, not being dependent on what some beaurocrat thinks is appropriate.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: What the @#@#@???? - August 29, 2005 4:01:00 PM
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ptdan23
Posts: 224
Joined: November 6, 2003
From: Orlando, FL
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Definitely agree with Jason in the fact that if insurances don't have to pay higher prices they will not. From what I have heard when they work cash-based practices are very successful.
KIDPT23...glad you are stepping up to the plate. I have done the same many times as far as writing letters, etc. I am trying to do more as far as getting involved on different levels w/ in the APTA/FPTA (FL). I wish every PT would do this.
Dan, PT.
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Re: What the @#@#@???? - August 29, 2005 4:27:00 PM
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Dr.Wagner
Posts: 1242
Joined: January 24, 2003
From: Indianapolis
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One of the BIGGEST thing you can do is to write letters to senators or congressmen. Also, know exactly what your candidates stand for on such issues.
Battle the insurance lobbyists.
Become active in politics, hell run for office.
Lastly collect your co-pays! In my field, alot of people simply do not pay us ( I hear "I couldn't afford my FP so that is why I am here"...hell we are more expensive than a Family Practice guy or Internist). So collect the copay.
Man, we could go on and on. Reimbursement is far far more important than DPT or territorial manipulation battles.
_____________________________
Dr. Wagner DO
Moderator of Medical Complexity Forum
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Re: What the @#@#@???? - August 29, 2005 8:58:00 PM
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Randy Dixon
Posts: 744
Joined: August 6, 2004
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Randy-
This is third party payers we're talking about. The market has nothing whatever to do with them.
-Jason
I agree with what you said in your post but I think the above is a misconception. Third party payers and even Medicare have a "market" that is composed of "customers". Insurance companies will do what their customers want if they ask for it if it becomes a dealbreaker, so will senators. It probably helps to hear from a few hundred PT's but to hear from a few thousand patients supporting PT is much more effective.
I think this is the real reason chiropractors are in the position they are in, people want them, probably a good many politicians have been treated and want them, so no matter the science they are going to get them.
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Re: What the @#@#@???? - August 30, 2005 3:34:00 AM
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Diane
Posts: 1506
Joined: March 9, 2001
From: Vancouver, B.C., Canada
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[QUOTE]people want them[/QUOTE]Randy, I think that it debatable.
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Re: What the @#@#@???? - August 30, 2005 4:28:00 AM
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KIDPT23
Posts: 222
Joined: May 20, 2002
From: Illinois
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Unfortunately, I think he is right. People do want them and what we have to do is get people to want us. We need patients to want to go to physical therapy, not need to go. Anytime there may be some discomfort, patients need to be like... i want to go to my physical therapist and get this minor discomfort corrected, not like... i got this discomfort but it should work itself out, i really don't want to go back to therapy. We have to get the community familiar and comfortable with our services and educate them on what we can do for them.
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Re: What the @#@#@???? - August 30, 2005 5:20:00 AM
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Diane
Posts: 1506
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From: Vancouver, B.C., Canada
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My understanding is that only about 10% of people prefer to go to chiro. Regardless of insurance or no insurance. Regardless of how hard chiros lobby everything under the sun. Or try to "manipulateoopsImeanadjust" legislative bodies. That leaves us with a mere 90% of the rest. Not bad... altho I agree we could do much better if we tried.
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Re: What the @#@#@???? - August 30, 2005 7:48:00 AM
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drbuddy
Posts: 429
Joined: July 30, 2005
From: Pennsylvania
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You think we (chiros) are getting paid well by insurance companies? HA!
There really is no difference in what we get paid. We are all using the same codes. The only difference is the CMT codes, but $30 isnt anything to get excited about.
Sometimes we are paid even less when the chiropractic managed care companies come into the picture. Many of them try to cap fees at $30-40 per visit no matter what is performed.
PS - Can we please do something about the prejudiced comments on this board? I thought this was a professional forum.
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Re: What the @#@#@???? - August 30, 2005 9:50:00 AM
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JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
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I agree with buddy, let's not cast the DCs as the bad guys here, they are under-reimbursed for their procedures just as we are. They are suffering as much with this as we are.
I am sure some of the DCs think PTs are rolling in the insurance cash, too, but as Wags pointed out, we're all in this boat together, and all hit just as hard by reimbursement issues. It probably tops the list as the most important issue for every professional association.
That's why free market libertarian people like me look forward to the time when the inefficient Medicare and third party system falls apart, and the whole system begins to look VERY close to an entirely free market.
I can't wait for the prescription drug thing to get off the ground. That will just hasten the end of Medicare and a return to fairness for all of us, especially consumers and patients.
Randy-
I agree that there is a semblance of a market for third party payers. I should have been clearer, what I was getting at is that it's not a FREE market. Thanks for the correction, and we agree once again. :)
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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