Robert Hall

The payment consortium (PC), a collaborative group of physical therapist leaders dedicated to access to PT for all, is hard at work supporting State advocacy efforts for APTA Private Practice and AOPT. After its initial meeting in February, the PC decided to focus on three major issues.

The first issue is administrative burden. Both the AOPT and APTA Private Practice filed multiple comment letters to federal regulators in February and March to try and improve utilization management and decrease its impact on patients in PT practices hoping to access medically necessary care. These comments have been supplemented by the work of working groups under the purview of the Payment Policy Committee for APTA Private Practice and AOPT’s Practice committee. The results of their work can be found within the State Payer Advocacy Resource Center and its multiple resources to help PTs fight back against unnecessary administrative burden. The PC is also updating materials on a real time basis, analyzing state legislation designed to rein in utilization management overuse, as well as considering the benefits offered by certain “gold carding” practices that some insurers have started to implement. PT payment experts have also been considering some of the pitfalls inherent in gold carding legislation to help provide a map for advocates to help implement the best policies in their states.

Second, the PC is concerned with contracting by PT practices and is hopeful to “up the game” of PT practice negotiators across the country. Leaders within the PC realize that PTs often do not attempt to negotiate their contracts, believing that they will not be able to move insurers in terms of payment rates or other contract terms. However, experienced PTs have shown that you can negotiate your contracts and you owe it to yourself and your patients to spend time attempting to improve rates and other contract terms. Many resources on SPARC are available to help improve your chances for successful negotiations and these resources are being refreshed throughout the year. Leaders within the payment consortium urge every PT to locate their contracts and set the stage to negotiate better rates and terms at the earliest opportunity.

The third issue is Medicaid. Medicaid is oftentimes a low or slow payer. The PC wants to help every PT who contracts with Medicaid to be paid adequately to help ensure access to services that Medicaid covered populations need. Unfortunately, the populations served by Medicaid including children, pregnant women, frail elderly, and low-income adults are all in need of even more robust advocacy than those covered by private insurance. Equity in healthcare depends on a strong Medicaid program, and the health outcomes that were laid bare by the COVID-19 pandemic confirm the centrality of Medicaid in addressing health disparities across the country. APTA has been conducting a state-by-state analysis of payment rates to help you advocate with Medicaid offices armed with accurate information, and is also working on the production of a model benefit for children in Medicaid, whose benefits under Medicaid are different than any other population. The payment consortium is poised to provide support to state level advocates on Medicaid and other programs that can have a real impact on PT practice, bottom lines, and ultimately, patience.

If you need help with utilization management, private contracting, or Medicaid advocacy, please contact Payment Consortium staff at rhall@ppsapta.org. Also, consider bookmarking this page to easily come back to learn about other ways to engage. The PC can help you and your patients with state payer advocacy.