Measurable Solutions

Measurable Solutions asked one of their clients in California, Ida Hirst, of her experience with the rate reductions that Anthem has put forth.

"This has been a hot topic among practice owners since this only effects private practices, not hospital or physician owned clinics.  Many clinics have opted to terminate their provider relationships with Anthem BC.

I have decided to stay in.  A careful search through EOBs coming through my office finds that many of our PPO contracts and certainly our Work Comp visits are paying below the $75 per visit.  I then took an average of what we receive currently from our Anthem BC visits and found that due to the way they cascade for reimbursement that we have a hard time getting a significant amount more than this for the average visit if we are completely honest with our coding.  The only way to consistently get the good payment would be to perform the same procedure for a full 45 to 60 minutes every time.  This rarely happens.

I am not happy about this change, but it has spurred me to make decisions to gradually drop other low paying insurance contracts and to plug a way at converting to a cash based practice where people get a great service in a short amount of time for a very reasonable fee.  We will provide them with a super bill to submit directly to their carrier if they wish.  Unfortunately to drop Anthem BC would mean a drop in patient volume by almost 40% and we can not handle that dramatic of a change right now.  I am respectful of those practices who were able to either never depend on Anthem or are now ready to do so."

Ida Hirst
Pleasanton, CA

A tentative agreement was at Tuesday night reached by Senior Senate Democrats. The agreement intends to eliminate a big barrier to getting a bill that can pass congress by expanding Medicare Coverage for some people in ages between 55 and 65 and thereby abandoning the government-run insurance plan. Measurable Solutions also read on usatoday.com that this compromise was backed up by President Obama.

Sources:
Usatoday.com
wsj.com

A research program conducted in physical therapy outpatient clinics on patients that had undergone single-level lumbar microdiskectomy was recently competed. The report from this research was published in the November issue of the APTA Physical Therapy journal and it concluded that the program -- with intensive, progressive exercise in combination with education -- improved function and reduced disabilites amongst the ninety-eight participants. 


You can read more at APTA’s PTjournal


To get the latest information about the upcoming Owners Conference powered by Measurable Solutions -- www.measurable-solutions.net/owners_conference/

The National MS Society just committed close to $10 million dollars on new projects in their effort to stop and terminate Multiple Sclerosis.

One of the projects is a Physical Therapy project that will test a type of physical therapy known as “Constraint-Induced Movement” therapy to improve function in daily activities of people with progressive Multiple Sclerosis.

The funding of the Physical Therapy project is a research grant of $701K for the University of Alabama at Birmingham (Victor Mark, MD, Associate Professor, Department of Physical Medicine and Rehabilitation, ABPN recertified in 2006).

Measurable Solutions Source: nationalmssociety.org

Medicare patients came closer to have direct access to Physical Therapy when the Senate Finance Committee unanimously passed an amendment to health care reform legislation called “America’s Healthy Future Act.” This amendment gave the authorization to a program at a new “Innovation Center” to research the benefits of providing direct access for Medicare patients to Physical Therapy access in rural areas.

This progress is the result of APTAs effort to lobby the Congress to include provisions in the national health care reform act.



Sources:  citytowninfo.com, APTA Blog