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.

Computer costs for physical therapy falling

Physical therapy computer costs are falling. Mine especially.

This article from CNN Money talks about the Obama stimulus plan and the huge expense of training the labor force to implement a computerized health infrastructure.

$100 billion of the $800 billion Obama stimulus plan is proposed to be spent on making all health records standard and electronic by 2014.

17% of physicians and physical therapists now use electronic medical records. 8% of all hospitals use them.

We started a new electronic medical records system last week at Medical Arts Rehabilitation, Inc. in Manatee County, Florida.

Costs have really come down.

The first system I priced two years ago was $60,000 and I would have had to buy two servers to host it all.

The system I bought in December 2008 cost $4,800 and we are up and running in two weeks. It's called Clinic Controller by A2C Medical.

I'll blog my results regularly to keep the physical therapy community updated on our efforts.

We set it up ourselves (I paid an IT guy 2 thousand to configure the system and set the backups - I think I overpaid).

Now, I'm building templates of my

1. Evaluation


2. Progress Notes


3. Daily Notes


4. Re-certification Notes


5. Superbill


6. Patient schedule/calendar

The system is quick and intuitive.

I'm sure I haven't seen the glitches yet or the workarounds that inevitably come with any mechanical device but we're better off than we were with our old DOS-based system (yes, DOS).

We are running both systems in tandem for the time being.

Today, we shut down the old scheduling system but we still have to collect money and post accounts to the old system, probably for three-to-six more months.

I wont see any increase in revenue by switching but I guess I'm getting ready for the new health care infrastructure from the Obama administration.

I figure we'll have our new computers running smoothly before Obama has fixed the health care system.