Missouri Physical Therapists Continue Efforts to Establish New Rules Governing Health Insurance Providers’ Reimbursement and Co-Pays for Physical Therapy Services
(EUREKA, Mo.) – The Sports and Physical Therapy Center in Eureka, together with other private-practice physical therapy clinics in Missouri, is continuing in its efforts to raise public awareness and support for proposed legislation that would level the playing field for insurance reimbursements and co-pays for physical therapy services. The St. Louis County clinic heralds the recent actions of the Missouri House of Representatives and State Senate in relation to that cause.
Bills introduced in the Missouri House and Senate aim to eliminate insurance providers’ current practice of negotiating more favorable contracts with hospital-run physical therapy clinics than with owner-operated clinics. According to EqualPay4EqualServices.com, the bargaining power of large hospital systems gives them greater leverage with insurance providers and results in a lack of consideration for the needs of small, private-practice clinics.
Health insurance companies reimburse large, hospital-run clinics more than private-practice clinics for the same services – while charging patients who choose private-practice physical therapy clinics higher co-pays. Because private-practice physical therapy clinics do not have the same bargaining power as hospital systems, many are increasingly struggling to maintain operations, resulting in business closures and fewer choices for patients.(1)
Private-practice physical therapy clinic owners assert that these practices are discriminatory to small businesses, and that reimbursement and co-pays should be equal, regardless of where patients receive physical therapy treatment. They are working to gain support for their cause through patient education and online resources such as the EqualPay4EqualServices.com website and petition.
In the Missouri House of Representatives, two proposed bills demonstrate support for independent physical therapy clinics. Representative Donna Lichtenegger sponsored Missouri House Bill (HB) 1355, the Equal Pay for Equal Services Bill. The bill will require health insurance providers to provide equal reimbursement and co-pays to physical therapists providing the same services, regardless of the setting or venue in which services are provided. Representative Dwight Scharnhorst sponsored HB 1134, the Fair Co-Pay Bill, which prohibits health insurance providers from imposing a greater co-payment, co-insurance or deductible for physical therapy services provided by a licensed physical therapist than for services provided by a physician or osteopath.
Identical legislation has been proposed in the Missouri State Senate, where Senator Kurt Schaefer sponsored Missouri Senate Bill (SB) 644, and Senator Eric Schmitt sponsored SB 687.
The House and Senate took action on the bills during the current legislative session. On April 18, HB 1355 was voted “do pass” in an Executive Session of the Professional Registration and Licensing Committee, while HB 1134 was passed on April 12 by a majority vote of the full House.(2) Both SB 644 and SB 687 had recent committee hearings by the Small Business, Insurance and Industry Committee.(3)
“Private-practice physical therapy clinics will continue to advocate for change until fair pay legislation becomes law. The current disparity affects not only our reimbursement rates, but also our patients’ co-pays,” said Sean Quinn, owner of The Sports and Physical Therapy Center in Eureka, Missouri. “We are urging our representatives to recognize that the quality of treatment provided by private clinics and hospital-run clinics is exactly the same. Therefore, there should be no difference in reimbursement, which is currently dictated by the bargaining power of large hospital systems.”
According to Quinn, the present system’s disparity prevents private clinics from receiving sufficient reimbursement from health insurance companies, while encouraging patients to choose large, hospital-run clinics. Many private clinics have been forced to close, resulting in fewer treatment choices for patients – which Quinn feels could affect their quality of care. “Patients should have a choice in their treatment. Whether a private-practice clinic is closer to their home or work, has the expertise the patient needs for his or her condition, or is a better environment for the patient – these options matter, and should remain open to all patients, without the burden of higher co-pays,” he asserted.
Quinn is grateful that patients recognize the value of his team’s physical therapy services and continue to choose the Sports and Physical Therapy Center for their treatment, but notes that many other clinics were unable to continue on minimal reimbursements and are no longer in business. He says the result is less competition, and fewer incentives to provide quality physical therapy services. “It’s in our patients’ best interest for private-practice physical therapy clinics to not only survive, but to be sustainable as financially sound, high-quality businesses. In order to manage our operations, recruit quality physical therapists, and help our patients reach their goals, we need equal reimbursement and fair co-pays.”
About the Sports and Physical Therapy Center
Located in Eureka, Missouri, the Sports and Physical Therapy Center was founded in 2004 and serves patients in the greater St. Louis area. Owner Sean Quinn is a licensed Physical Therapist in Missouri as well as a Certified Strength and Conditioning Specialist. He holds a master’s degree in Physical Therapy from St. Louis University, and specializes in manual therapy techniques, orthopedics and sports medicine. Quinn worked in outpatient physical therapy clinics for several years before establishing his own practice. Today, the center employs a team of highly skilled physical therapists and personal trainers, as well as dedicated finance, customer care and administrative staff. For more information, visit http://www.ptstl.com or call 636-938-4065 .
(1) EqualPay4EqualServices.com website; “What Are We Fighting For?” page.
(3) Missouri Senate website; “SB 644” and “SB 687” overview pages.
SB 644: Link no longer available
SB 687: Link no longer available