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PHYSICAL THERAPY.BENEFITS. Better Access • Improved Outcomes • Reduced Cost

PHYSICAL THERAPY.BENEFITS. Better Access Improved Outcomes Reduced Cost

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Page 1: PHYSICAL THERAPY.BENEFITS. Better Access Improved Outcomes Reduced Cost

PHYSICAL THERAPY.BENEFITS. Better Access • Improved Outcomes • Reduced Cost

Page 2: PHYSICAL THERAPY.BENEFITS. Better Access Improved Outcomes Reduced Cost

Physical Therapy.Benefits.

What’s the Problem?

Health care costs are rising at an alarming rate in the U.S.

There has been an increasing trend of shifting payment for health care services back to the consumer in the form of high co-pays or co-insurance rates.

Page 3: PHYSICAL THERAPY.BENEFITS. Better Access Improved Outcomes Reduced Cost

Physical Therapy.Benefits.

What’s the Problem?High co-pays often results in the patient

being unable to afford to receive necessary health care services such as physical therapy.

Studies show a high rate of poor health care literacy rate which correlates to poorer health status and higher health care costs.

Page 4: PHYSICAL THERAPY.BENEFITS. Better Access Improved Outcomes Reduced Cost

Physical Therapy.Benefits.

Where’s the Evidence?

“One in three patients has ‘basic ‘ or ‘below-basic’ health literacy” (O’Reilly, 2012).

Studies have indicated a positive correlation between poor health literacy and increased health care costs and poorer health status (Boodman, 2011).

Page 5: PHYSICAL THERAPY.BENEFITS. Better Access Improved Outcomes Reduced Cost

Physical Therapy.Benefits.

Where’s the evidence?

The IOM has recommended finding ways to improve health literacy and communication of health information in order to improve (Kaiser Health News, 2004):

Health and well-being Health care costs Ability to save lives

Page 6: PHYSICAL THERAPY.BENEFITS. Better Access Improved Outcomes Reduced Cost

Physical Therapy.Benefits.

Where’s the evidence?

Given the rising costs of health care, “it is only fair and logical to ensure that consumers have the information they need about quality and cost to make informed decisions…to seek care” (Health Care Incentives Improvement Institute, 2013).

Page 7: PHYSICAL THERAPY.BENEFITS. Better Access Improved Outcomes Reduced Cost

Physical Therapy.Benefits.

How does it relate to PT?

Physical therapy is a medical profession that focuses on promoting and restoring the best possible movement and functional mobility.

Physical therapists are the practitioners of choice for the “prevention of impairments, functional limitations, and disabilities related to movement, function, and health” (APTA, 2012).

Page 8: PHYSICAL THERAPY.BENEFITS. Better Access Improved Outcomes Reduced Cost

Physical Therapy.Benefits.

Physical therapy co-pays are typically that of a ‘specialist’ which is a 2nd tier co-pay.

Physical therapy reimbursement rates are not comparable to other ‘specialist’ reimbursement rates.

Physical therapy co-pays are often more than 50% of the total cost of the physical therapy services.

Higher co-pays correspond to patients reducing or avoiding the physical therapy that they need to regain functional mobility again.

This lack of access to physical therapy services leads to poorer health, increased disability, and increased long-term health care costs.

Page 9: PHYSICAL THERAPY.BENEFITS. Better Access Improved Outcomes Reduced Cost

Physical Therapy.Benefits.

Solution

Health insurance companies must become more accountable and transparent.

Co-payments for physical therapy should be proportional to the total cost of service.

Legislation has been passed in 4 other states (Missouri, Kentucky, South Dakota, Arkansas limiting the co-payment amount. Similar legislation is still pending in Pennsylvania and New York (Appleby, 2012).

Page 10: PHYSICAL THERAPY.BENEFITS. Better Access Improved Outcomes Reduced Cost

Physical Therapy.Benefits.

Where Do We Start?Change Virginia law to decrease the financial burden

of physical therapy services and make insurers more accountable.

Amend 38.25812 of the Virginia Code as follows:

A. Co-payment for services rendered by physical therapists A health carrier or health benefit plan shall not impose a co-payment

or co-insurance percentage charged to the insured for services rendered for each date of service by a physical therapist licensed under 18VAC112-20-40 that is greater than the co-payment or co-insurance percentage amount charged to the insured for the services of a primary care physician licensed under 18VAC85-20-120 for an office visit.

Page 11: PHYSICAL THERAPY.BENEFITS. Better Access Improved Outcomes Reduced Cost

Physical Therapy.Benefits.

Who’s with us?

Virginia Physical Therapy Association (VPTA)

American Physical Therapy Association (APTA)

Virginia Health Information (VHI)

Catalyst for Payment Reform (CPR)

PatientsPhysical therapistsNational Business Coalition

on Health

Who’s not?

Insurance companies with established business in Virginia

Blue Cross/Blue Shield Anthem OptimaHealth Coventry Aetna

America’s Health Insurance Plans (AHIP)

Page 12: PHYSICAL THERAPY.BENEFITS. Better Access Improved Outcomes Reduced Cost

Physical Therapy.Benefits.

Governmental Stakeholders

Medicare/Medicaid/CMSDepartment of Health and Human Services

(DHHS)Virginia Department of Health (VDH)Virginia Department of Medical Assistance

ServicesState governments

Page 13: PHYSICAL THERAPY.BENEFITS. Better Access Improved Outcomes Reduced Cost

Physical Therapy.Benefits.

How do we get there from here?

Utilize social media and website to provide educational information and a means of communication with the public

Network with other medical professionals to garner additional support

Occupational Therapists Speech-Language Pathologists Physicians and Chiropractors

Page 14: PHYSICAL THERAPY.BENEFITS. Better Access Improved Outcomes Reduced Cost

Physical Therapy.Benefits.

How do we get there from here?Partner with advocacy organizations to promote

the policy with policymakers: VPTA/APTA Virginia Health Information Catalyst for Payment Reform National Business

Coalition on Health

Organize a lobbying day in Richmond

Page 15: PHYSICAL THERAPY.BENEFITS. Better Access Improved Outcomes Reduced Cost

Potential Senate Supporters

Potential Delegate Supporters

Senator Ralph Northam Sits on the Senate Health

and Education Committee Sits on the Health Care

subcommittee Sits on the Health

Professions subcommittee

Senator Mark Herring Sits on the Senate

Commerce and Labor Committee

Sits on the Health Insurance subcommittee

Delegate Patrick Hope Sits on the Health Welfare

and Institutions Committee

Delegate Benjamin Cline Sits on the Commerce and

Labor Committee Supportive of other

transparency issues

Delegate Thomas Davis Rust

Sits on the Commerce and Labor Committee

Physical Therapy.Benefits.

Page 16: PHYSICAL THERAPY.BENEFITS. Better Access Improved Outcomes Reduced Cost

Physical Therapy.Benefits.

Who do we contact?

Contact your district Delegate and Senator to encourage support.

Contact other potential supporters within the Virginia House of Delegates or Senate.

Page 17: PHYSICAL THERAPY.BENEFITS. Better Access Improved Outcomes Reduced Cost

Physical Therapy.Benefits.

REFERENCES

American Physical Therapy Association. (July 2013).  Fair Physical Therapy Co-Pays.  Retrieved from:  http://www.apta.org/StateIssues/FairCopays/

American Physical Therapy Association.  (2013).  New Missouri Law Limits Patient Co-Pays for Physical Therapy.  Retrieved from:  http://www.apta.org/Media/Releases/Legislative/2013/7/9/

American Physical Therapy Association.  (2013).  New Legislation Means Reduced Out-of-Pocket Expenses for Patients in Arkansas.  Retrieved from:  http://www.apta.org/Media/Releases/Legislative/2013/3/21/

American Physical Therapy Association.  (July 2013).  State Laws Governing Fair Co-Pays.  In Fair Physical Therapy Co-Pays.  Retrieved from:  http://www.apta.org/StateIssues/FairCopays/

American Physical Therapy Association.  (July 2013).  Sample Opposition Talking Points:  What to Expect from Opponents PT to Co-Pay Legislation.  In Fair Physical Therapy Co-Pays.  Retrieved from:  http://www.apta.org/StateIssues/FairCopays/

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Physical Therapy.Benefits.

American Physical Therapy Association.  (2012).  South Dakota Law Limits Physical Therapy Co-Pays.  Retrieved from:  http://www.apta.org/Media/Releases/Legislative/2012/2/27/

Appleby, J. (2012).  States Consider Limiting Costs for Physical, Speech, and Occupational Therapy.  Kaiser Health News.  Retrieved from:  http://www.kaiserhealthnews.org/Stories/2012/April/23/patient-physical-therapy-payments.aspx

Boodman, S.G. (2011).  Helping Patients Understand Their Medical Treatment.  Kaiser Health News.  Retrieved from:  http://www.kaiserhealthnews.org/stories/2011/march/01/health-literacy-understanding-medical-treatment.aspx?referrer=search

Health Care Incentives Improvement Institute. (2013). Most States Fail to Make the Grade in Health Care Transparency for Consumers. Retrieved from: http://www.hci3.org/content/most-states-fail-make-grade-health-care-price-transparency-consumers

Kaiser Health News. (2004) 90M U.S. Adults Have ‘Limited Health Literacy’ IOM Says. Retrieved from: http://www.kaiserhealthnews.org/daily-reports/2004/april/09/dr00023143.aspx?referrer=search

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Physical Therapy.Benefits.

O’Reilly, K.B. (2012). The ABC’s of Health Literacy. Posted on amednews.com. Retrieved from: http://www.amednews.com/article/20120319/profession/303199949/4/

Virginia General Assembly. (2013). Code of Virginia.  Retrieved from: http://lis.virginia.gov/000/src.htm

Virginia General Assembly. (2013).  Virginia Administrative Code.  Retrieved from:  http://lis.virginia.gov/cgi-bin/legp604.exe?000+men+SRR

Virginia General Assembly. (2013).  Virginia House of Delegates.  Retrieved from:  http://dela.house.virginia.gov/dela/MemBios.nsf/MWebsiteCO?OpenView

Virginia General Assembly. (2013).  Senate of Virginia.  Retrieved from:  http://apps.lis.virginia.gov/sfb1/Senate/TelephoneList.aspx

Virginia General Assembly. (2013).  Who's My Legislator?  Retrieved from: http://conview.state.va.us/whosmy.nsf/VGAMain?openform

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Physical Therapy Benefits

Thank you for your support.