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PHYSICAL THERAPY.BENEFITS. Better Access • Improved Outcomes • Reduced Cost. What’s the Problem? Health care costs are rising at an alarming rate in the U.S.

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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.
Physical Therapy.Benefits.
physical therapy benefits1
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.

physical therapy benefits2
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).

physical therapy benefits3

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
Physical Therapy.Benefits.
physical therapy benefits4
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).

physical therapy benefits5
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).

physical therapy benefits6
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.

physical therapy benefits7
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).

physical therapy benefits8
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.
physical therapy benefits9
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)

Patients

Physical therapists

National 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)
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Physical Therapy.Benefits.

Governmental Stakeholders

Medicare/Medicaid/CMS

Department of Health and Human Services (DHHS)

Virginia Department of Health (VDH)

Virginia Department of Medical Assistance Services

State governments

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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
physical therapy benefits12
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
physical therapy benefits13
Physical Therapy.Benefits.

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
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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.

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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.aspxBoodman, 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+SRRVirginia General Assembly. (2013).  Virginia House of Delegates.  Retrieved from:  http://dela.house.virginia.gov/dela/MemBios.nsf/MWebsiteCO?OpenViewVirginia General Assembly. (2013).  Senate of Virginia.  Retrieved from:  http://apps.lis.virginia.gov/sfb1/Senate/TelephoneList.aspxVirginia 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.