"They're being squeezed so that care may suffer," said Fourth District Congressman Jim Himes to a Minuteman reporter, speaking about the physical therapists who had gathered at Preneta Physical Therapy, 2119 Post Road, in Fairfield on Monday afternoon. He noted, "I've actually heard the same thing from a lot of (health care) providers."
It was the latest stop on Himes' health care listening tour. In the last few months, the freshman Congressman has heard from groups of doctors, nurses, emergency care workers, home health aides, and pharmaceutical executives, who have given him their take on the state of health care.
Many at Preneta owned their own physical therapy businesses. They told the Congressman that insurance companies were putting arbitrary caps on the number of physical therapy visits a patient could have, that insurers were restricting how patients could get to them, and that insurers were also cutting fees arbitrarily without any justification or explanation.
In fact, they all said that they are paid less today than they were 10 years ago.
Vic Vaughan, Clinical Manager of Sacred Heart Sports Rehabilitation, and Federal Affairs Liaison for Connecticut Physical Therapy Association, said that the therapist's reimbursement from the insurance company may only be $67 total.
Co-pays are often as high as $35 and as a result, the insurance company is paying less per visit, than the patient - or $32. "And yet, the patient pays $9,000 to $12,000 yearly for a policy for his family," said Vaughan.
"If a patient has to pay $45 per visit, he may think long and hard about coming to physical therapy," he added.
"Second, the insurance company makes the decision about your need. This really hurts patient care and makes it hard for the patient to get the care they deserve," Vaughan said.
He pointed out that stroke and joint replacement patients generally get 9 to 12 visits. "Literature shows that (such) patients need far more care - a minimum of 20 visits to get to maximum function - so you're going to be leaving patients hanging," he said.
Stroke victims could easily take 6 months or longer, he added.
Another therapist pointed out that a child may have a sprained ankle at a young age and if they don't get the proper amount of physical therapy when young, they will return as an adult with knee and hip problems. "Longevity-wise, physical therapists should get in there early," she said.
The pharmaceutical industry has made it very prevalent for people to just "pop a pill" which treats the symptoms, not the cause, said the therapist, adding that patients then need other therapy to get off the painkillers, such as oxycontin.
A large stumbling block to providing physical therapy are the two companies paid by the major insurance companies in Connecticut to manage physical therapy care, according to the therapists present.
Orthonet and Optum are hired by large companies such as Aetna, United Healthcare, and soon, Blue Cross Blue Shield, to oversee physical therapy of patients, Vaughan said, adding that the only large insurance company, in this area, that does not use them is Connecticare.
"Sometimes they (Orthonet and Optum) decide not only how many visits, but how much you're paid, and sometimes they even pay you," he said, adding, "They manage costs by denying care for the most part."
"Ostensibly, they manage coverage," said Vaughan, "but actually, the whole point is to save money, so it's all about managing costs."
"We do more and more paperwork and reimbursements are steadily reduced," said Vaughan.
Congressman Himes offered his own observation on insurance companies. He said one doctor told him, "You know how I know that they collude? Because (large insurance company A) gives me $118.20, and (large insurance company B) also gives me $118.20."
One physical therapist and business owner said, "I have many sleepless nights, knowing that I'm responsible for 25 families and that people are paying insurance companies for care they're not getting."
At one point, Himes was recapping what he had heard from the group, and said, "I'm hearing that you are often an alternative to more costly care." He got fervent 'Yes's' from those present.
Later Himes told a Minuteman reporter he wanted to make sure that physical therapists aren't left behind in healthcare reform, "because they're very cost-effective in dealing with certain problems."
Vaughan said, "It's just becoming extremely difficult for us physical therapy providers, in wanting to do good work and be fairly compensated for it."