Teton Therapy braces for Obamacare
By Mark Wilcox
October 25, 2012 –
RIVERTON — While state politicians waffle and delay over Obamacare, at least one Wyoming health-care provider has tried to get proactive about implementation of the law in a way that will help his business.
Jeff McMenamy, CEO of Teton Therapy, realized changes were coming and decided it wouldn’t do to wait for elections or lawsuits that may or may not implement changes to the law.
“With the Affordable Care Act they’re telling us how to do business and that’s a little disturbing to me,” McMenamy told the Business Report, adding he needs to keep quality up while the government tells him how to do it, walking a tightrope between compliance and quality.
For physical therapists and their clients, one of the most difficult changes to deal with under the Affordable Care Act has been the cap placed on physical therapy reimbursements through Medicare. He said though people may complain about Medicare, it hasn’t been bad in the past for his business to see Medicare patients, who often are more likely to need physical therapy than younger counterparts. Formerly, the cap was $1,500 through an outpatient provider like Teton Therapy, and then the outpatient provider had to refer patients back to hospitals, where no cap was enforced.
Now, McMenamy said hospitals providing physical therapy face the same $1,500 cap, removing a safety net for those in need of therapy. That said, McMenamy said he can file for exceptions and it isn’t a particularly difficult process.
“That’s been that grace,” he said. “We haven’t been denied payment.”
But formerly, he said any payment that was denied had to simply be eaten by physical therapists. They couldn’t “go after” the patient to collect. But under the Affordable Care Act, he said, the responsibility if payment is denied for going over the cap shifts to the patient instead of the provider.
“It’s kind of a betting game,” he said. “It’s putting a lot more on the patient.”
And putting the responsibility for denied payment on the patient, who is often on a fixed income, is something McMenamy said he doesn’t want to do. But in a way, he said the change has been good. It has forced therapists to see things from a patient perspective as situations arise for some where they need to gauge what therapy is doing for them personally in order to risk having those payments on their head in case of denied coverage.
“If they still say they can’t pick up their grandkids, we’re not meeting their goals,” he said, even though a therapist might judge success by being able raise an arm through a specific range of motion, for instance.
He said he expects the changes made in Medicare to filter throughout the insurance industry and become the norm.
“Regardless of if we like this or not, we’re gonna have to deal with it,” McMenamy said. “We had better be prepared to get these patients better. I don’t like to run my business on fear and what-ifs and feel the effects on my business. I’d rather be causative.”
McMenamy even went so far as to implement a survey on quality of care given many patients’ concerns that the clinic may be required to treat more people under the Affordable Care Act, something of which McMenamy said he has yet to see any effects.