Anthem Blue Cross of CA Leaving Members In The Lurch

Beginning Monday, February 1, 2010, many Anthem Blue Cross members may have more difficulty finding physical therapists willing to treat them. A situation resulting from a "cost restructuring" move by the insurance company.

In November 2009, a letter was sent out by Anthem to all the physical therapists, occupational therapists, and speech therapists in its network, telling them that they would be switching to a flat fee rate of reimbursement of $75 per visit in February 2010. Depending on the services provided, this represented a 25-200% reduction in the reimbursement rate.

These rates are an absolute insult to these 3 allied health professions. I know personal trainers at gyms, with less education, that get paid more for 1-hour sessions. Why should medical professionals with advanced degrees be reimbursed less? In my opinion, these drops in reimbursement set a dangerous precedent because there will likely be 2 outcomes:

1) Good therapists wanting to devote time and quality care to their patients, will have to opt out of the network. This means that patients that want to see them, will have to bear more of the burden of the expenses.

2) Therapists that remain in the network will likely shorten time patients get with licensed PT's and use more aides/assistants to administer care. They may also begin to double book patients to try and increase productivity of their staff members. This will result in a significant drop in the quality of care and less than optimal outcomes for patients.

The bottom line is this "restructuring" will result in significant ramifications to both Blue Cross providers and patients. Throughout this process the last few months, Anthem Blue Cross has held steadfastly to the claim that this new fee structure will actually save their patients money. They have tried to justify their position by stating that decreased reimbursement to therapists will result in decreased out-of-pocket expenses for their patients. At our facility, we have already seen other insurances forcing patients to pay a co-pay/co-insurance ($40) higher than the reimbursement amount the insurances are paying ($35). Why should you the patient be paying more than the insurance company? What is your insurance premium going towards? Why should you have to pay higher premiums and higher visit costs?

The most disturbing aspect of this decision? Wellpoint, Inc., Anthem Blue Cross' parent company, posted 4th quarter net income for 2009 at $2.7 billion. A meteoric rise from $331.4 million from a year ago. Wellpoint says they are expecting continued growth and CEO Wayne DeVeydt is quoted as saying, "Our insurance subsidiaries remain well-capitalized and we continue to generate substantial operating cash flow." So why the need for higher patient premiums and cuts to provider reimbursement? You can read more about it here.

Though they are the most recent, Blue Cross is not the only insurance provider to change it's reimbursement methodologies and shows us why third-party payers fear a national health care reform that would challenge them for members.

While we wait for our leaders in Washington to come to an agreement on new policy, there are some things that you can do to preserve the quality and affordability of your health care.

• Write a letter to Blue Cross representatives and voice your concerns. A sample letter and contact list can be found on the More Physical Therapy website here.
• Write, call, or email California insurance officials and express your concerns. A list can be found again on the More Physical Therapy website above.
• Contact members of Congress with your concerns using the email forms provided by PTPN's Political Action Center.
• Contact your HR department and express your dissatisfaction with Blue Cross and the fact that you may be paying higher premiums for more limited access to providers.

At Elite Sports Physical Therapy, we know that we will not be able to continue to provide the standard of care that we would like at Blue Cross' new reimbursement rate. We are still evaluating our current situation and will keep all of our patients (current and future) apprised of our contract decisions.

If you have any questions feel free to contact us at 510.656.3777 or continue checking our website at www.espt-ca.com for updates.

Thank you for your understanding and support.

Win a 32 gig iPod Touch!!

The greatest compliment that we have received at ESPT is the recommendation of our services from past patients and the endorsement of our facility from referring providers.

To show our gratitude, Elite Sports Physical Therapy, will be having a raffle on Mar. 1, 2010 for a 32 gb iPod touch.

To qualify for the drawing, all you need to do is refer a patient to us sometime before Feb. 28. For each patient that you refer to us, you will be given a drawing entry. So the more people you send, the more chances you have to WIN!!!

For complete details about the drawing or to print up the entry form, you can check out our website at: www.espt-ca.com and click on the link.

Thanks again for your support and good luck everyone!!

Seeing With Our Hands, Not Just Our Eyes

When I was in physical therapy school, a lot of my professors would tell us that as physical therapists we "see not only with our eyes, but also with our hands."

For a good manual therapist that is absolutely true. We use our palpation skills to look for soft-tissue tension, check for alignment issues, and assess proper motion/movement. We do more than simply ultrasound and exercise you as a patient. There are in fact a plethora of tools at our disposal. Below I'll describe a few of them for you.

Soft Tissue Mobilization
Often times muscle tension needs to be addressed or joint dysfunction may persist/return. For example, after an injury or surgery, adhesions and scar-tissue may form in the area, limiting normal range of motion (ROM). With soft-tissue mobilization, those adhesions can be broken down. In addition tissue fluids can me moved so swelling is dissipated and circulation can improve.

At ESPT, we are one of the few clinics in the area that offer Sound-Assisted Soft-Tissue Mobilization. By using special tools to help break down the soft-tissue and fascial restrictions, we can better treat ongoing muscle and tendon issues (tendinosus) in ways our competitors can't.

Joint Mobilization
Muscle spasms can also respond to a restricted joint, so simply heating and stretching an area may not produce lasting results. By mobilizing a stiff joint, we can restore proper movement and range of motion, thus taking stress off of the surrounding muscles. These mobilizations should be painless, but on occasion can be a little painful if the joint is very stiff. In any case, there should be no lasting symptoms after the mobilizations.

At ESPT, we are the only clinic in the area with the ATM2 by Back Project. You can read more about it in our blog here. With the ATM2, we can "reset" your neurological system so that you do not perceive pain. Muscles often respond with guarding/spasm, when we are in pain. By supporting your body with the ATM2 apparatus and eliminating your pain, your muscles will have a chance to relax and return to their normal function, instead of tightening up to protect you.

Muscle Energy Techniques
This is a special technique using voluntary contractions by the patient to mobilize restricted joints and lengthen shortened muscles. This procedure is a little more active as compared to joint mobilizations, since it requires patient interaction to contract certain muscles against a counterforce provided by the therapist. These are tolerated very well and do not usually stress the joint.


High Velocity, Low Amplitude Mobilizations
This is a more aggressive technique that takes a joint to its restrictive barrier and thrusting with a low amplitude to restore proper joint motion. If it is used properly, increased motion and decreased muscle spasm should be noticed immediately. Therapists have to go through special coursework/training in order to perform these mobilizations.

At ESPT, we are fortunate to have the only Certified Orthopedic Manual Therapist in the area. You can read about it in our blog here. And Joey is qualified to perform these high velocity, low amplitude mobilizations. Come see him if you have back pain/neck pain that has not improved with physical therapy elsewhere.

In today's health care environment, physical therapy clinics can no longer just be "gyms." Patients cannot come in and simply run through exercises. Therapists have to show what they are capable of and how they can provide a unique, professional service that others cannot. We need to prove our worth, so that patients know they are getting quality service and care with their insurance dollar.

If you haven't experienced any of the above techniques in your physical therapy treatment or would like to find out more about them, feel free to contact us at Elite Sports Physical Therapy @ 510.656.3777.

What Can A Manual Physical Therapist Do For Me?

10-15 minutes
Ten-fifteen minutes. That is typically the amount of time most patients spend with their physical therapist. They are usually greeted by an aide when they arrive, then given some combination of hot packs, ultrasound, or exercise to warm-up. They may start with some exercises after that, then the therapist comes for a brief period to stretch them, do a little hands on work, or instruct them in some new exercises. After that, the patient continues with more of their program with the aide, then they end their session on ice and electrical stimulation. They might be in the clinic for 60-75 minutes, but they don't spend more than a fraction of that with the PT. Sound familiar?

If that sounds like your physical therapy experience, then you need to look for a new physical therapist. You need to make sure that your insurance dollar is getting the most for you. You need to seek out a new breed of physical therapist. You need a manual physical therapist.

New Era
In this era of rising health care costs, we know people value their money and their time. We don't want them to waste an hour at our facility thinking: "I could have received that same treatment from my personal trainer" or "I could have found that out from the web and saved myself $50."

Manual physical therapy is a specialized form of physical therapy focused on the hands-on approaches used to treat dysfunction, rather than relying on a device or machine. In addition to be healing experience of human touch, manual PT's are able to affect muscle tissue and mobilize joints in an attempt to decrease muscle spasm/tension and improve joint motion.

Why Doesn't My PT Do It?
Manual therapy is only a small part of the education a therapist receives in school. Once in practice, many therapists may not spend the time, resources, or energy necessary to become efficient and proficient in this area of practice. And physicians may not have a thorough understanding of the benefits of manual physical therapy.

Manual therapy has been shown to provide relief for those suffering chronic neck and back pain, as well as conditions such as sacroiliac joint dysfunction and frozen shoulder. Whether relief comes once again from the touch of another human, manual technique have been shown effective in improving joint mobility, which can help decrease discomfort and alterations in motion/posture/function.
45 Minutes!!!
At ESPT, we have set ourselves apart by providing you the most 1-on-1 physical therapist time of any clinic in Fremont. By getting 45 minutes with the physical therapist, you can rest assured that we will be able to spend time working with you and assessing your treatment and progress in ways that other clinics cannot.

At ESPT, you will receive hands-on care at each and every physical therapy treatment. With manual therapy (and 3x as much PT time as some clinics are offering), you will have the experience of a licensed PT working to normalize your flexibility and mobility. Through soft-tissue work and joint mobilization, you will see firsthand why it's important to have that "hands-on" approach in rehabilitation.

At ESPT, we have the city's only Certified Orthopedic Manual Physical Therapist. You can meet him here. And he will provide you with treatment that you cannot receive anywhere else.

If you want the best physical therapy care in 2010, contact us at Elite Sports Physical Therapy (510.656.3777).

Next Blog: Types of Manual Therapy

Happy New Year!!

Today is probably the day most of you are returning to work after the holidays. It's a day that's usually approached with dread or anticipation. You either want the vacation to keep going or your excited to start the year off right.

At Elite Sports Physcial Therapy (ESPT), we want to wish you a prosperous and Happy 2010!!! Whatever resolutions you make for yourself this upcoming year, aim high. If you don't every shoot for the stars, you'll never have the opportunity to reach them, right?

For 2010, we have some pretty exciting things in store for the Fremont community. Keep checking our website (www.espt-ca.com) or blog (www.espt-ca.blogspot.com) for updates.

"Do more than is required.
What is the distance between someone
who achieves their goals consistently
and those who spend their lives and careers merely following?
The extra mile."

Gary Ryan Blair