"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Sunday, March 15, 2009

United 'fired' by physical therapist

I 'fired' United Health Care today.

United is the lowest paying insurance company in America,  for many physical therapist private practices like mine.

We kept United for many years mainly because their members are my friends, neighbors and fellow small business persons in my community.

Two years ago United paid me $40 per patient per day.

I was able to keep my doors open because I "cross subsidized" (APTA-Members Only) my friends, neighbors and fellow small business persons who were on United with higher-paying Medicare patients.

I had to fire United because, since early 2008, my average payment per patient has declined even though my patient volumes are up (+7.6% February 2009).

The reason is Medicare Advantage.

Medicare Advantage pays just as poorly as United.

Medicare Advantage has, since 2008, decimated my high-margin, high-volume Medicare caseload by transferring these patients to insurance plans that pay, on average, about 60-65% of traditional Medicare.

Funny thing, the US government pays Medicare Advantage $1.30 for every dollar CMS spends on traditional Medicare.

Today, President Obama said that the US could not afford to continue to support the Medicare Advantage program in his Town Hall speech from Costa Mesa, California.

When I wrote United to opt-out of my contract they quickly called me back to offer $60 per visit because I do such a "good job controlling utilization".

Maybe you can try this tactic to your advantage - if you still haven't fired United.

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Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

"Make Decisions like Doctors"

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Consistent with the American Physical Therapy Association Vision Statement for Physical Therapy 2020, the American Physical Therapy Association supports exclusive physical therapist ownership and operation of physical therapy services.