PPACA world: Rehab therapyNews added by National Underwriter on February 13, 2013
National Underwriter

National Underwriter

Joined: April 22, 2011

By Allison Bell

Policy watchers at PTPN -- a network that represents about 3,500 providers of physical, occupational and speech therapy -- say they are optimistic about how the coming "essential health benefits" (EHB) package will affect PTPN therapists.

Most states still have not yet defined their EHB packages, but "PTPN is encouraged by the general acceptance of the crucial role of rehabilitation and therapy in the commercial insurance marketplace, including by the small group market," said Jerry Connolly, PTPN's lobbyist.

PTPN is trying to deliver the message that spend money on rehab services and up front can help hold down the total cost of care and improve overall outcomes, group representatives said.

PTPN is citing a study on primary care referrals of patients with low back pain that showed that referring patients quickly saved about $2,700 per case.

Dr. Michael Weinper, PTPN's president, said the study shows that offering good rehab services is a way to reduce overall health care expenditures.

“There’s a lot of return on investment to be had with a robust rehab benefit,” Weinper said.

The EHB cometh

The therapists that PTPN represents are just some of many types of health care providers who are trying to keep new cost management and benefits standardization programs from crowding them out.

One provision in the Patient Protection and Affordable Care Act of 2010 (PPACA) could affect demand for therapy services is a requirement that all individual and small group health plans offer an "essential health benefits"(EHB) package that includes both "habilitative" and rehabilitative services.

Some PTPN therapists provide "habilitative care" to children with disabilities who never had typical abilities to start with.

In other cases, the therapists are providing rehabilitation services for adults who have come out of the hospital after suffering heart attacks, strokes, severely broken bones, or other health problems that could, in many cases, force those patients out of the workforce, or even into a nursing home.

Overall costs

Critics argue that the evidence supporting the cost-effectiveness of some types of rehab therapy is weak.

The rehab therapists contend that their services can help lower acute care, disability and long-term care (LTC) costs by helping patients get the most out of what they have.

In addition to the EHB package provision, PPACA includes, for example, a provision that is supposed to punish hospitals when too high a percentage of patients return to the hospital soon after leaving.

Therapists argue that that they can help prevent the preventable readmissions, and also prevent the need for patients to enter the hospital in the first place.

"Therapists can provide preventive and wellness care often more cost effectively than other types of providers, and our training in body mechanics, musculoskeletal issues and other areas make us well-suited to helping the aging population in particular stay active and healthy," Weinper said.

Originally published on LifeHealthPro.com
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