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SJBird55 -> Re: mad as hell and not going to take it anymore!!! (January 4, 2006 3:20:00 AM)
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The APTA, in a way, has done some things that help members to see what the APTA has done and does do. In particular the last 2-3 years, the APTA has been more diligent at communicating what the government affairs department has been actively involved in accomplishing. (The improved sharing of what the APTA does/has done began some time after Justin Elliot came on board.) For all physical therapists, the APTA has been involved at a state level - for MI - we've had issues with a new law to eliminate PTs from performing EMG services. Athletic trainers are attempting to do what we do and be paid for it. Of course the APTA has been involved with disagreeing with the Medicare cap. The APTA was involved in MI with not allowing the chiropractic scope of practice to infringe into the PT territory of physical medicine and rehabilitation. There's some crap going on now in regard to orthotics and prosthetics. The APTA has been active in attempting to reduce referral for profit situations. I'm not sure how helpful the APTA was for Michael Teston when he got into his situation in Arkansas though. It does give one pause to think - the issues the APTA tackles are those that affect each and every one of us that are PTs, whether we are members or not.
Not participating with insurance companies is a good idea. To make it successful, I would tend to believe that rallying all the independent clinics to not participate would make a very strong impression on the public in the local geographic area. My goal in 3-4 years, IF I can gain a great reputation, is going to be to not participate. Third party payers are more of a headache than I ever imagined they would be. Right now though, I won't run the risk of people not wanting to pay... I also think in 3-4 years that potentially health saving accounts may be somewhat common and that mentality of "having to pay" will be more prominent and not such a hurdle for the public as a whole.
In regard to the $17/treatment, I ask one question, why? From a business perspective, why agree to something like that? Just say no. There are two views on reimbursement. 1) a PT company can participate with every policy possible to make it easy on patients and make it easy on referral sources. In making it easy, that means some contracts will be $17/treatment... or 2) a PT company can review various contracts and only participate in contracts that meet business plan expectations. It is a business. If the reimbursement scheme doesn't mesh well with a business plan and the cost of doing business, well, say no. Why sign a contract like that?? So, from a reimbursement perspective, we've kind of done it to ourselves. In the "how low will PTs go" financial game, we've screwed ourselves and apparently we'll go pretty low - $17 does not fit in my business plan and I'd politely say "no thank you."
I don't think that we can stop referral for profit situations. We might be able to potentially convince third party payers of the conflict of interest that exists, but stop referral for profit, no. They could just as easily as we could not participate with any third party payers. But what we could do... educate the public. The freedom to choose. In my area, the physician owned practices play a lot more fairly than the hospital owned practices. In my area, the physician owned practices have an 8 1/2 by 11 referral form that has a lot of PT clinics listed by location. The hospital owned practices only leave their referral pads with only their locations on those pads. But... if one were to spend the time educating the public in one's geographical area about the freedom of choice and what to expect during the provision of physical therapy services and how to choose providers - we might be able to move business away from referral for profit situations.
Generally, if a physician orders something that is ineffective, I tend to make a phone call to that office and speak to either the triage nurse, medical assistant, physician assistant or nurse practitioner. Instead of slamming the use of the ineffective approach, I instead communicate my game plan with a time period of when I anticipate seeing outcomes and the degree of the outcomes I'm anticipating to achieve. I generally toss in that I'd prefer to try my game plan first for X amount of time and then if there is not a response then I'll go ahead and switch to whatever ineffective game plan was outlined for me. That tends to work pretty well for me - it eliminates the pissing match and headbutting. The person at the other end of the phone conversation always tends to agree with whatever I propose.
clydsdale, we do have a lot of frustration in this field. In a way, we've done it to ourselves. To move forward, will take learning from the mistakes of the past and not making them in the future. To move forward will take our voice to be heard.... both money and that "squeaky wheel" saying will be key factors. The future does have a potential of being bright.
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