Network's Steps Irk Private Physical Therapists

Article excerpt

Gregory Waite has run his physical therapy private practice in Waterford, Erie County, for 10 years.

Waterford Physical Therapy and Sports Rehab has had a steady business of people seeking help to recover from injury and illness. It even got a boost a few years ago when it became a designated provider for UPMC Health Plan patients.

Now Mr. Waite is wondering how many of those patients will stay with him.

A few months ago, Mr. Waite -- who is also president of the 3,500- member Pennsylvania Physical Therapists Association -- learned that UPMC Health Plan had designated Waterford a "Level 2" provider for some of its plans, which means higher costs for his patients. Under these plans, he said, only UPMC-owned physical therapy practices are "Level 1" and will cost patients less.

For example: A patient seeking treatment at a Level 1 provider may face a $30 copayment each visit, or $600 if they have 20 visits per year. Under Level 2, a patient may pay about $100 per visit until they met their yearly deductible -- typically $750 or so -- after which they would pay $20 to $25 per visit.

Steering patients to its own physical therapists "makes good business sense on [UPMC's] part," Mr. Waite allowed, "but, at the same time, you have to look at whether the patient is being provided that choice."

He added that some studies have found that in self-referral situations, "the services are used twice as often and the length of stay is 2 1/2 times longer."

Closer to home, independent physical therapists in Pittsburgh worry that Erie, with its two major hospitals now part of either UPMC or Highmark's Allegheny Health Network, may be a harbinger of what's to come.

Local physical therapists "are very concerned about where this fight [between Highmark and UPMC] is going to lead," said attorney J. Kent Culley of the Downtown firm Tucker Arensberg, which represents more than a dozen Pittsburgh-area independent physical therapy practices.

Network access for local physical therapists has been a mixed bag.

While Highmark has been open to nearly all licensed physical therapists, access to UPMC's network has been more limited. …

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