2005-03-25 / Columnists

Eye On Physical Therapy

By Dr. Tim Rohrs

I recently received a certified letter from Managed Physical Network Inc. (MPN) that let me know that as of May 10, 2005 I would be kicked out of their provider network. MPN handles the rehabilitation authorizations for New York State employees through their Empire Plan. One might think that I would have to do something very bad or unethical to get kicked out of the network. Surely, I must have been substandard in my treatments or in the care I provided to their members. If in fact those were the circumstances, I would deserve to be kicked out of the network.

Sadly, the truth is far different. In January of 2005 I received a certified letter from MPN stating that my “performance” in the network was inferior. My performance was not judged on anything you or I might care about such as patient satisfaction, or were patients getting better and have less pain. Nor was it based on physician feedback; had the referring physician been happy with the outcome for the patients.

MPN’s plan was to have me sign a “Performance Improvement Agreement”. This document outlined the goals I would have to meet so that I would remain as a network provider. One of the goals was to limit patient visits to below 10. If a patient that had MPN as their insurance came in after a knee replacement or rotator cuff repair, I would have to limit their number of sessions to 9 or less. Of course it does not matter that there is no limitation of visits outlined in the patient’s enrollment book. It would matter even less that the patient’s surgeon ordered therapy for three times a week for 8 weeks. Another part of the “Performance Improvement Agreement” required me to provide less than 4 services per visit. So, if the MD ordered electric stimulation, ultrasound, massage, joint mobilization, therapeutic exercise and ice packs, I would have to pick which 3 to do and ignore the others.

Many insurance companies try to reduce costs by not authorizing visits past a certain number. Some pay a flat fee for an office visit. MPN is slick in that they will never deny an authorization request for more visits. What MPN will do is kick the provider out of the network if they request too many visits. If a patient was denied visits by the insurance company and they were injured, the insurance company would be held liable and accountable for discontinuing the treatment. MPN coerces the therapist to restrict treatments with the threat of being kicked out of network, while positioning themselves as not accountable. This places the burden on the therapist.

I refused to sign the agreement, and was ultimately kicked out of the network for not signing. I refused to let the insurance company dictate what my patients need to get better. I believe that when you visit a health care practitioner, you should receive the care appropriate for your condition, and that your treatment is not designed by a therapist that is guided by fear of being kicked out a network.

As a side note, I have written complaining of this situation to the State Insurance Department; Assemblyman Alexander B. Pete Grannis: Chair, Committee on Insurance, Member, Committee on Health ; Assemblywoman Audrey Pheffer: Chair, Committee on Consumer Affairs and Protection Member, Committee on Governmental Employees; Senator Malcolm Smith; and NYS Attorney General Eliot Spitzer. After 2 months I have only received letters back from Assemblywoman Audrey Pheffer and Assemblyman Alexander B. Pete Grannis.

Each has expressed their concern for the situation. They may become even more concerned when they need physical therapy; they are also state employees covered by this “mangled care” plan.

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