Thoughts, what are yours?

[helloteenah]

"Anthem Blue Cross drew ire from President Obama on down this month after informing individual policy holders of premium increases of up to 39 percent. But physical therapists are also upset over cuts in reimbursement for Blue Cross patients. Beginning March 1, Blue Cross will pay physical therapists $75 per visit for all treatment, regardless of the duration or type of care provided. The California Physical Therapy Association says PTs will loss as much as 50 percent of their previous fees.
Andrew Vertson, a physical therapist at Foothill Ranch Physical Therapy, said Blue Cross patients make up 20 percent of his practice. He said he can't afford to drop Blue Cross, even with the cut.
"One thing I've been proud of in my practice is the quality of care," he said. "We treat a patient every half hour. I may need to change that to to every 15 or 20 minutes. The one-on-one, hands-on time will be limited. We just don't have the capacity any more to spend with patients at that price."
Blue Cross issued a statement saying the company strives to "balance the need to compensate providers fairly with the goal of keeping coverage as affordable as possible for our members."
"Anthem recently made adjustments to its physical therapy reimbursement rates to standardize the pricing structure and to help contain escalating health care costs. Under the new structure if the amount paid to the therapist is reduced then the member will experience a corresponding decrease in their out-of-pocket expense."


http://healthyliving.freedombloggin...-therapists-upset-over-blue-cross-cuts/16635/

What do you guys think? This really worries me.

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[lee9786]

I honestly think its going to be tough in the near future on private PT outpatient clinics. They seem to be constantly fighting caps and cuts in reimbursement. I've heard PTs state there is a possibility these clinics become cash-services only while insurance companies would still reimburse for hospital, SNFs, and home health settings. It looks like the possibility is there so I'd be prepared to work in these settings.

 

[lee9786]

http://www.thedailysound.com/News/02232010-ANTHEM

“Should this new policy stay in effect, the difference in reimbursement rates becomes the patient’s financial responsibility, which has already started to cause higher out-of-pocket expenses for the patients,” said Dr. Maury Hayashida, physical therapist and owner of Hayashida & Associates Physical Therapy, Inc., which has had offices for 10 years in Santa Barbara, Montecito and Goleta.

He feels the therapy reimbursement reduction is another example of why the nation's health insurance system is in need of reform. “Unfortunately, I think this is a trend that has been going on and will continue. People being able to rely on their health-insurance policy to provide the quality and specialization of care they desire and deserve is a thing of the past.”

“This pattern of declining reimbursements by insurance companies to health-care providers raises a fundamental question: What is quality physical therapy and how much is it worth?’ Hayashida asked. “Since insurance companies have the control regarding premiums to the public and fee schedules to providers, it will be up to the public to decide its worth since more and more of the costs will have to come directly out of their pockets if Anthem Blue Cross is allowed to cut reimbursements to this level.”

 

[helloteenah]

"On Jan. 1, the clock started ticking for those patients who need physical, occupational or speech therapy, which is now subject to an annual limit on benefits. Healthcare reform legislation included language to block the so-called therapy caps, but with that bill sidelined, beneficiaries and therapy providers are seeking other means to keep the money flowing.

Medicare beneficiaries now face annual limits of $1,860 for physical and speech therapy and $1,860 for occupational therapy. Those therapy caps apply to services provided at therapists’ offices, physicians’ offices, at home, or in nursing homes — but not therapy provided in hospitals on an outpatient basis.The caps would hit hardest those patients who have the greatest need for rehabilitation therapy services, such as those who have suffered strokes or serious physical injuries and people with disabilities. Lawmakers have contacted the Obama administration saying some of their constituents have already exhausted their annual benefit just one month into the year."


http://thehill.com/business-a-lobby...s-over-patients-and-providers?page=2#comments


"

Just lost my job because of the therapy cap! Therapy companies are really panicing!! Low caseload and patients that need therapy have already met the cap and are not elligible for more therapy til 2011, even though they need it now! This is disgusting!BY Jill- therapist on 02/04/2010 at 22:14"

"This is so wrong on many levels. An entire segment of Healthcare Outpatient PT OT and ST will be destroyed. So much for PT being a hot field Get ready to shake and bake at a hospital or change diapers for a living. Nice job Obama…screw the elderly in need and destroy jobs at the same time.BY Andy Glickman on 02/08/2010 at 12:28"

Lee, sounds like you're right about private practice.

 

[myzougrad]

ksiem, Have you heard from Missouri State yet? They said interviews would take place in Jan and Feb. Since I haven't heard, I guess I won't get one there.

 

[ksiem]

Hey guys, sorry I was gone.. I didn't know this thread was still alive. I'm excited.. Thanks for all those posts about insurance cuts. That's why this profession makes me a bit nervous. I do love it. I did get an interview with MSU, they called me Thursday to tell me my interview was on Saturday (lol short notice). This was their last series of interviews to my knowledge.. sorry man. I should find out soon if I'm in. Have you heard from anyone else?

As far as profession goes, I don't know what I'm going to do yet.. I'm still mauling over things. All of this is a real hard decision.

 

[ksiem]

Wow check this qoute from above

"This is so wrong on many levels. An entire segment of Healthcare Outpatient PT OT and ST will be destroyed. So much for PT being a hot field Get ready to shake and bake at a hospital or change diapers for a living. Nice job Obama…screw the elderly in need and destroy jobs at the same time.BY Andy Glickman on 02/08/2010 at 12:28"

Not sounding good, what do you think Truth Seeker? (I know it's his opinion and I'm not taking it to heart but it seems some clinicians are concerned)

 

[ksiem]

Myzougrad.. btw Arkansas State University is still taking apps until March 1st if you want to apply.

 

[truthseeker]

Wow check this qoute from above

"This is so wrong on many levels. An entire segment of Healthcare Outpatient PT OT and ST will be destroyed. So much for PT being a hot field Get ready to shake and bake at a hospital or change diapers for a living. Nice job Obama…screw the elderly in need and destroy jobs at the same time.BY Andy Glickman on 02/08/2010 at 12:28"

Not sounding good, what do you think Truth Seeker? (I know it's his opinion and I'm not taking it to heart but it seems some clinicians are concerned)

The cap has been in the books for years. Every year they pass a moratorium on it for the next year. I am not really that worried about it. The thing is, it is PT plus speech has a cap, OT has their own cap. That's how stupid the lawmakers are. They probably wrote "OT, PT and speech shall have a . . ." and they interpreted that as PT and speech should be combined.

It shouldn't really affect many outpatient clinics since they are seeing primarily ortho patients and if they aren't getting them better before for less than $1800, they aren't getting many referrals.

Personally, I think the fees that PTs charge far exceed their value in most cases. I learned that the charges that we bill are almost half of what area hospitals charge. That is outrageous! People have health care choices and if they are going to pay double what chiropractors charge, it better be twice as good. We have to compete to some degree, with 8 chiropractors in our small town and competition is keeping our fees more reasonable.

Let that be an example to the *****s that write the reform policy. Let the people decide which is the best, protect them from scams by not paying for things that don't work, and the prices will set themselves.

If you have to get to work, you can by a Yugo or a Mercedes. You get what you pay for, or at least you should.

 

[jesspt]

As the article on The Hill web site (which was posted in an earlier entry) states, the cap was enacted in 1997. There was a moratorium placed on it for several years, but there was no moratorium for the last two or three years. So, I'm a little surprised at all of the outrage. Freestanding (not hospital-based) PT clinics have been dealing with this for several years. I think the biggest change for 2010 has been the absence of the automatic exceptions process. Prior to 2010 patients who had certain conditions such as total knee replacements, hip replacements, etc. were automatically exempt from the cap. That is no longer the case for 2010.

Personally, I think the fees that PTs charge far exceed their value in most cases. I learned that the charges that we bill are almost half of what area hospitals charge. That is outrageous! People have health care choices and if they are going to pay double what chiropractors charge, it better be twice as good. We have to compete to some degree, with 8 chiropractors in our small town and competition is keeping our fees more reasonable.

Truth-what we charge has no bearing on what we recieve for the most part. Are you stating that what you are reimbursed is less than half of what the local, hospital-based PT is reimbursed?

 

[truthseeker]

As the article on The Hill web site (which was posted in an earlier entry) states, the cap was enacted in 1997. There was a moratorium placed on it for several years, but there was no moratorium for the last two or three years. So, I'm a little surprised at all of the outrage. Freestanding (not hospital-based) PT clinics have been dealing with this for several years. I think the biggest change for 2010 has been the absence of the automatic exceptions process. Prior to 2010 patients who had certain conditions such as total knee replacements, hip replacements, etc. were automatically exempt from the cap. That is no longer the case for 2010.


Truth-what we charge has no bearing on what we recieve for the most part. Are you stating that what you are reimbursed is less than half of what the local, hospital-based PT is reimbursed?

I work at a critical access hospital so we basically get paid what we bill. A PT that used to work with me but now is at a neighboring town shoed me a bill that her father got at a slightly larger facility (ours is 24 beds, the other is about 35) and the itemized bills were exactly double. I don't know what they get reimbursed, all I know is what was on the bill.

This is a hijacking of the thread, but . . .

If we billed what we are worth and got paid that amount, think of the cost savings. If you have to bill $100 to get $50, you have to hire accountants, billing specialists etc . . . If you billed $50 and got $50 health care costs would drop by 50% What a simple way to reform healthcare. But no, because some people don't pay, we have to pay $6 for an antibiotic pill when in the hospital. Do people not see the absurdity of this????

How much do you get paid an hour? My charges are, as I said, very low regionally. We charge (and get) $112 for an evaluation. That is usually less than 30 minutes, then we charge $54 for 15 minutes of therapeutic activity, and $67 for 15 minutes of manual therapy (joint mob or whatever) That is, by my math, $223 per hour. I don't get paid that, but the hospital does. True there is housekeeping, billing, admin, HR, food service, and a slew of other non-revenue generating employees that need to be paid but geez. If other area hospitals are charging double, that is $443 per hour.

Even if they don't get paid that much (and I am sure that they don't) the uninsured people have to pay that. That much goes to your deductible before insurance kicks in if you have it. It would kill a medical savings account. It is outrageous that ANY PT thinks that they are worth that much per hour.

 

[myzougrad]

Thanks for the info ksiem. I have an interview Friday with my first choice school. We'll see. After reading all the posts I ran some numbers on student loan payments, potential salary etc. It's a scary thought. I want to be able to send my kids to college someday.

 

[ksiem]

No problem man, happy to help. How old are you? Also, how are loan amounts and payments looking?

TruthSeeker, don't worry about thread hijacking. This is all valuable info.

 

[ksiem]

Jess what do you mean by "what we charge has no bearing on what we recieve for the most part."

 

[myzougrad]

Looks like 70k in student loans for everything if I get into my first choice school. That's monthly payment of around $800 unless I want to be in debt forever and pay almost as much in interest as the tuition.

 

[Marcelo183]

The cap has been in the books for years. Every year they pass a moratorium on it for the next year. I am not really that worried about it. The thing is, it is PT plus speech has a cap, OT has their own cap. That's how stupid the lawmakers are. They probably wrote "OT, PT and speech shall have a . . ." and they interpreted that as PT and speech should be combined.

It shouldn't really affect many outpatient clinics since they are seeing primarily ortho patients and if they aren't getting them better before for less than $1800, they aren't getting many referrals.

Personally, I think the fees that PTs charge far exceed their value in most cases. I learned that the charges that we bill are almost half of what area hospitals charge. That is outrageous! People have health care choices and if they are going to pay double what chiropractors charge, it better be twice as good. We have to compete to some degree, with 8 chiropractors in our small town and competition is keeping our fees more reasonable.

Let that be an example to the *****s that write the reform policy. Let the people decide which is the best, protect them from scams by not paying for things that don't work, and the prices will set themselves.

If you have to get to work, you can by a Yugo or a Mercedes. You get what you pay for, or at least you should.

Very well said, I just hope Congress doesn't hinder or completely stop the PTs' professional value progression.

 

[FLsurferDPT]

.

 

[myzougrad]

Got my rejection from MSU. ksiem, have you heard from them? Are you planning to go to school in Mo or Ark?

Still hoping all goes well at Mizzou.

 

[ksiem]

Surfer, I understand man. It's a tough decision. However, as a DPT it will be easy to find a job and the salary will be ok so it's not as bleak as people think but it's not as attractive as PA or Pharm school. The PT profession may gain some ground in the years to come and end up making a nicer niche, who knows. When do you graduate with your bachelors? and what other classes would you have to take for PA/Pharm school?

I'm on the alternate list at MSU and my deadline to accept at SBU is today... I'm trying to find out from MSU how far I am down the alternate list so I can know if I need to go ahead an accept at SBU. Have you heard anything from Mizzou yet?

 

[myzougrad]

Interview today. Don't like my chances. GRE is low and competition is tough. It's my alma matter and so they know my story. Don't know if that will help or hurt.

 

[jesspt]

Jess what do you mean by "what we charge has no bearing on what we recieve for the most part."

I mean that any contracted amount for reimbursement that we have with an insurance company supersedes what we charge for our services. For example, the company I work for charges $75 for one unit (15 minutes) of manual therapy. Our contract with Cigna pays us $65 for the entire visit. Since most visits are 45-60 minutes in length, you can see that what I may have billed out in services doesn't effect what I am reimbursed in this example. This is true for many third party payors.

 

[ksiem]

Thanks. What's the point of charging so much then if you will never get close to receiving it? and how much would you charge for someone who's uninsured?

 

[truthseeker]

Thanks. What's the point of charging so much then if you will never get close to receiving it? and how much would you charge for someone who's uninsured?

If you need $100/hour to keep your doors open and make a good living, you need to charge enough so that you will get that amount. If ins company A will accept you but gets a discount of 40% for the "privilege" of treating their patients, then you have to charge $140 in order to get $100. If you charge $100, you only get $60 and you go broke.

Often clinics will offer discounts for people who pay cash since it saves a whole bunch of processing fees and other administrative red tape.

 

[ksiem]

Still doesn't make sense to me. Insurance would bill for 1 unit of exercise, 1 unit of traction, etc. etc. at set cost amount per unit of exercise of modality. If you charge more, they are only going to pay you the set agreed cost anyway. So why would there be benefit in charging more if they are only going to pay you say $50. If you charge $100 you still are going to get $50.. and if you charge $50 your still only going to get $50

 

[jesspt]

Still doesn't make sense to me. Insurance would bill for 1 unit of exercise, 1 unit of traction, etc. etc. at set cost amount per unit of exercise of modality. If you charge more, they are only going to pay you the set agreed cost anyway. So why would there be benefit in charging more if they are only going to pay you say $50. If you charge $100 you still are going to get $50.. and if you charge $50 your still only going to get $50

Because not all insurance companies give you a set amount per unit of intervention that you bill. Some pay you a percentage, as in Truth's example above.

 

[myzougrad]

Did you accept at SBU? They wanted me to send in hard copies of my Observation hours verifications. I sent them last week. Should know something from Mizzou by Friday. How long did MSU take to get back with you after the interview. Did you find out where you are on alternate list?

 

[ksiem]

Well at what point does what you charge become unethical? If it's just a percentage it seems like the skies the limit ( you could definately inflate charges ). There must be some caps in addition to the percentages, right?

On MSU's waiting list I'm like in the 30th position or something (not very hopeful). They took a week to two weeks to get back to me. I had one letter of recommendation that wasn't stellar and I think MSU puts a lot of weight on recommendations.

 

[myzougrad]

Why would you have an alternate list with 30 people on it for a class size of 30? Seems crazy unless you aren't confident your program is good enough to keep candidates.

 

[truthseeker]

Well at what point does what you charge become unethical? If it's just a percentage it seems like the skies the limit ( you could definately inflate charges ). There must be some caps in addition to the percentages, right?

On MSU's waiting list I'm like in the 30th position or something (not very hopeful). They took a week to two weeks to get back to me. I had one letter of recommendation that wasn't stellar and I think MSU puts a lot of weight on recommendations.

Where I live, someone can choose to go to a PT, usually through their primary care doc, or go to a chiropractor. Many don't know the difference. My fees must be competitive with what the chiros charge or people will just look at the number and go elsewhere. I think they get more bang for their healthcare dollar with me so I am higher than the chiros but it isn't double or anything like that.

You can charge all you want, but if people don't pay (or won't pay) it doesn't matter what you charge.

 

[ksiem]

Truth I'm confused because PTs aren't like chiros. The clinics I've observed at, very few pay with cash. Since most pay through insurance.. why does it matter how competitive you are if it's not coming out of the clients pocket anyway.

If you are talking about variable charges then I could see how that would play in. People who come in w/out a deductible met or don't have insurance, charge a certain fee to compete with the Chiros and then for people with insurance, charge more (Although it's illegal).

 

[ksiem]

TruthSeeker, I have another question for you. You are pretty knowledgeable so I thought you may know the answer. If I switched to Pharmacy I would have have two more years of schooling (one for pre requisites and one for the 4th year of pharm school). Are there any PT specialties out there that I could get within two years that would impact my salary in a large way and what would those specialties be? If there are, maybe I should just stick with PT school (I know I'll enjoy it) and I can get a seperate certification and make more money if need be. Thanks.

If anyone else knows the answer feel free to chime in too.

 

[truthseeker]

Truth I'm confused because PTs aren't like chiros. The clinics I've observed at, very few pay with cash. Since most pay through insurance.. why does it matter how competitive you are if it's not coming out of the clients pocket anyway.

If you are talking about variable charges then I could see how that would play in. People who come in w/out a deductible met or don't have insurance, charge a certain fee to compete with the Chiros and then for people with insurance, charge more (Although it's illegal).

Your first point: correct, very few PT clinics are cash based. However, the patient sees the bill, and they see the numbers, and they think that because chiro is less expensive per visit, they should go there and often ultimately end up spending more based upon the number of visits. Just last week I had a patient who was seeing a chiro 2 times per week for two years for headaches. I asked her how her headaches were and she still gets them 2-3 times per week. I said "so you have seen your chiropractor 48 times and you still have headaches 2-3 times per week?" She said "yeah." She didn't get it. She limited to 24 visits per year because that is what her insurance limited her to.

Last point:
You are right, you can't charge different amounts to different insurance companies. That is, in part why the charges are so high. Clinicians (all types) want to maximize their reimbursement and not leave money on the table. No insurance company ever gave an "attaboy" for not charging them as much.

 

[ksiem]

So you basically just charge a little more than the insurance to make sure all the money is taken off the table. I also had one more question right above your last post about PT specialty.

 

[truthseeker]

TruthSeeker, I have another question for you. You are pretty knowledgeable so I thought you may know the answer. If I switched to Pharmacy I would have have two more years of schooling (one for pre requisites and one for the 4th year of pharm school). Are there any PT specialties out there that I could get within two years that would impact my salary in a large way and what would those specialties be? If there are, maybe I should just stick with PT school (I know I'll enjoy it) and I can get a seperate certification and make more money if need be. Thanks.

If anyone else knows the answer feel free to chime in too.

To become a clinical specialist you have to work in a setting with a designated population type (orthopedic, neurological, geriatric etc . . .) and work a certain number of hours. Then you have to take a test. If you pass you are a certified clnical specialist in _____. I don't think that it dramatically impacts your salary directly. That said, you will have demonstrated more expertise in one area by putting extra letters after your name and it may enhance your marketablility and it will certainly make you a better clinician. So the short answer is no but the long term answer is probably.

Clear as mud?

 

[lee9786]

I think the biggest factors affecting salary in PT is setting, years experience, and supply and demand concepts. The highest paid settings are home health and skilled nursing facilities because they are less desirable settings. Right now traveling positions are good paying positions as well. Salary is associated with how much revenue you can generate. Revenue is generated from third party payers. This is why there is a salary cap in PT. There's only so much revenue you can generate to be an effective PT.