Network's Steps Irk Private Physical Therapists

By Twedt, Steve | Pittsburgh Post-Gazette (Pittsburgh, PA), December 15, 2013 | Go to article overview

Network's Steps Irk Private Physical Therapists


Twedt, Steve, Pittsburgh Post-Gazette (Pittsburgh, PA)


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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