Those PT provider “networks”

This site focuses on Workplace on-site MSD prevention consulting.  HOWEVER, many of us also have clinic practices.  And many of us encounter various Worker Comp PT provider networks.

I am not going to even try to be “nice” on this topic.  These networks are ripping off PT !

A network contacts you to inform you that, in order for you to access Worker Comp patients, you must contract through them, to coordinate care.  Rip-off.  What they are actually doing is demanding that they purchase your patient care services at a wholesale discounted rate… then they sell those services to the insurance payer at a retail rate.  It sure resmbles a kickback.   You must agree to deep discounted payment rates to access patients.  They then re-sell your billing at higher rate.   They also severely restrict the number of PT sessions you may provide, plus tons of paperwork, telephone hassles, and nonpayment of your billing.  Prostitution of PT?

These networks are so profitable, they are being bought and sold among investment companies.  Most of the PT worker comp networks are now owned by a European investment firm.  PT billing is now a commodity to be traded among investors. Some networks are actually owned by the insurance company itself, to force PT fee discounts and hassle you to shorten and compromise your care.

If one of them gets you to sign up with them, they then sub-contract that deal to the other networks (for a piece of the action) (networks collude with each other for a piece of your pie).  Thus, one obscure minor insurance network eventually infects all of your insurance payers.  And trying to cancel that bad contract is all but impossible.  The end result is your eventual bankruptcy when all your payers are now paying you below your cost of providing care.

Here in Maine, we PTs actually convinced our Worker Comp Board to severely restrict these networks, preventing PTs from being required to join these networks.  We now have no Worker Comp requirement for MD referral (direct access PT care of injured workers without MD referral), plus employees are allowed to select their PT of their own choice.  Workplaces and workers can both designate their favorite preferred PT provider.

Moral of the story… if you want to preserve the PT profession, and your practice… avoid bad network provider contracts.  Have a very good PT lawyer (such as Gwen Simons, JD, PT … gwen@simonsassociateslaw.com) screen network contract proposals to identify potential traps and ripoffs.   Yes, she is both a lawyer and a PT!

Many clinics absolutely REFUSE any network offers-demands.  When a network says you are required to go through them to access injured workers for your clinic… they are often LYING.

UPDATE on who are some of the Worker Comp PT networks… Align Networks merged with Universal SmartComp, and then acquired One Call Care Mgt (described as a ‘cost containment’company)… while Apax acquired Network Synergy, then acquired GenX…  all managed by the UK investment group Apax Partners.

Others include Coventry, Optum, MedRisk, MultiPlan, ASH Network, OrthoNet.

See how PT and our patients have become a commodity to be traded?    And where do these investors gain their profits?  They skim it off YOUR billings…. when you agree to accept their discounts and thier prior authorization ripoffs.  Some take up to 50% of your revenues.while severely liiting sessions and procedures and treatment time.

THIS IS WHY DPT SALARIES ARE SO POOR, DESPITE A DOCTORATE LEVEL EDUCATION!   THIS IS WHY PT CLINICS AROUND THE COUNTRY ARE DOWNSIZING OR CLOSING.  THIS IS WHY STAFF PT’S ARE PUSHED TO SEE TOO MANY PATIENTS PER DAY.

They re crushing PT practice… and so many PTs are allowing it to happen.   Someone said that PT practice has become “groveling in the dirt for pennies.”

 

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