More Third Party Managed Care: Is PTWA Doing Anything About This?

I’m as disappointed as you are that on July 1 another large payer in Washington will start using eviCore to provide utilization management for outpatient rehabilitation. I’m fortunate to be a bit of an insider so I get cced on the email conversations between our volunteer leaders about these topics and I receive all of the committee reports throughout the year – so I can tell you that PTWA is doing something about this and has been for some time. If I were to reiterate every detail I know, you would need to spend several hours reading this post so I’ll provide some highlights and hope you will read between the lines and assume that it’s not realistic for us to say everything.

Highlight #1:
Our Reimbursement Chair, Pete Rigby, and Elise Latawiec from APTA have been meeting monthly with Regence and eviCore (formerly Care Core) for more than a year. As you can imagine, these conversations are not as simple as a conversation you might have with a friendly neighbor where you tell him that his dog has been digging up your flower beds. It’s more down the communication continuum toward President Barack Obama discussing an issue with President Raul Castro.

Highlight #2:
Pete, Elise, PTWA Payer Liaison Scott Spradling and others have been working on an eviCore/Regence survey, the results of which we think will inform these monthly conversations. We hope to have the survey link sent to you within two weeks. Please answer it.

Highlight #3:
You may also remember that we passed insurance reform legislation during the 2015 legislative session. We continue to advocate for insurance and third party administrator reform and regulation during every legislative session.

Highlight #4 – and perhaps the crown jewel:
And we’re part of the outcomes registry movement that APTA has embraced to package what physical therapists and physical therapist assistants do so that other practitioners with whom we partner, such as primary care physicians and surgeons, know what to expect when we’re part of their networks. This is a forward-thinking strategic initiative that will help shift the emphasis away from “them” doing things to “us” and put us in more of an offensive rather than defensive mode.

There is much that is being done that we cannot talk about for reasons of diplomacy as well as reasons of strategy.

Please take a few minutes to scan emails when we send them to you and to read newsletter articles. There will be at least two related articles with more details in our May newsletter.

I am always happy to hear your thoughts.

Erik Moen
PTWA President


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