Physical therapy centers wrestling reimbursement issues

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Published: December 17,2007

Physical therapy centers around the state are treating a wide range of patients for a variety of reasons. They’re also battling insurance issues along with Medicare and Medicaid reimbursement.

“It’s a constant fight to be reimbursed by Medicare. That’s our biggest issue,” said James Griffin II, a physical therapist assistant and clinic director at the Human Performance Center in Monticello. “We’ve struggled to keep our piece of the pie, but our portion of the cuts they make are big.”

Lobbying for change

The Monticello center is part of the national Human Performance Center group that has nearly 1,000 clinics in the U.S. and is the second-largest provider of rehabilitation services. With that strength, Griffin said it is part of a grassroots effort to continue lobbying Washington for Medicare reform through the American Physical Therapy Association.

Reimbursements are also a problem at Pearl River Rehab in Picayune, a center owned by Richard and Meg Ramberg. He is the business manager and she is the physical therapist.

“We’ve just found out reimbursements have been reduced again,” he said. “Insurance companies don’t want to pay either, and that makes it difficult for patients. Physicians in the area tell me the same thing. I’m trying to be nice, but I haven’t had anyone answer why with anything I believe.”

Stating that insurance is a problem for anyone in the healthcare field, Ramberg said some companies require so much paperwork that he and some of the physicians in Picayune no longer take patients with those policies.

“Some of these insurance companies throw out roadblocks, and we just don’t have time to do all the paperwork,” he added.

The Rambergs are also trying to recover from the loss of patients due to Hurricane Katrina. “They were patients that my wife has treated for years, and now she’s starting all over and gaining the trust of new patients,” he said. “We can’t rebuild over night.”

As medical director for the five Genesis Therapy clinics in the Jackson area, Gregg Trussell finds that access and utilization are difficult with insurance as coverage becomes more restricted.

“That challenges us to provide better care, faster and with more results,” he said. “We try to work as fast as we possibly can to produce the results the person wants, and to provide them with education to prevent more injuries.”

Forget about a slow season

Trussell said the state’s year-round warm climate means more activity for residents and thus no slow season for physical therapy.

“We’re active more months of the year, and we get into trouble with the increased opportunities we have,” he said. “Also, sports are very important in this state. It’s part of our value system, and there’s a lot of participation by males and females. We have more opportunities to get out there and do things.”

Genesis Therapy sees a lot of orthopedic patients and works with knees, backs, shoulders, feet and ankles. They also see a lot of patients with multiple sclerosis and cerebral palsy.

“We see a wide range of patients on referral from physicians,” Trussell said. “For our spine program, we require all therapists to go through the McKenzie Spine Institute and are pleased with what they teach.”

Griffin said the Human Performance Center also sees a variety of conditions, ranging from car accidents to broken arms and legs. “We do everything from the top of the head to the feet, and see a lot of all of it,” he said. “We have patients ranging in age from infants to 104 years old.”

Investing in technology

It constantly upgrades equipment, and purchased five Biodex units a few years ago at a cost of $25,000 per unit. “It’s a swanky piece of equipment that is used to test actions and the amount of force along torque curves, range of motion and the continuity of that force,” Griffin said.

In Picayune, the Rambergs see that some patients tend to take off from physical therapy during the holiday season. They see children with developmental problems to adults who’ve had strokes and everything in between.

“The problems we see the most are probably knee injuries and hip replacements,” he said. “Patients can come without physician referrals, but we think it’s a bad idea. We don’t have the capacity to take x-rays and we don’t want to play doctors.”

Contact MBJ contributing writer Lynn Lofton at llofton656@aol.com.

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