Physiotherapy and Treatment times

[physiobob]

Hi all

I have be steadily having more and more trouble arguing with various private medical insurance companies about the length of treatment time they permit per client.

I spend most of my time doing rehabilitation and as such my sessions are likely to be on average 60mins. With a basic exercise recommendation of 30mins, some manual work for 15 mins, possibly some EPA, checking and practice of home program etc etc, 60 mins seems appropriate. In fact the UK's OCPPP recently published National Averages that have finally broken the 30 minute mark.

I would like to hear from others on a number of fronts:-

1. Many may book people in for a half hour session but the client might spend up to 2 hours rehabilitating in the clinic. Should we not therefore note that the treatment time was actually 2hrs, not 30mins. By charging for 30mins we are telling the insurance companies that this is all the time needed for a treatment session.

2. One company in the UK, PPP will permit a client to have 3-5 - 30 minute sessions in a week, but will not pay for one 60 minute session. Does this not seem wrong if the rehabilitation session needs 60mins to have a positive and lasting effect?

3. It is true that actue injuries might on average require 30 min sessions. However we lump all together. The stroke rehabilitation centres wouldn't achieve much in 30mins so why are we not identifying the type of treatment program that fits with the length of treatment.

I feel these issues need immediate attention from the National associations and a statement should be made and figures collected to separate out the type of treatment from the standard treatment times. What say you all? 8o

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[MrPhysio+]

Hi
I am Australian, you are British, and the problem is world wide! Insurers are only interested in saving money, and demonstrate this consistently, by illogical policy, new directives, and inability to see reason. The Insurers do not want to grant 60 miniute consultations, as they expect to see a rise in extended time consultations, without an overall drop in consultation frequency per week or month. Constant hamstringing of our efforts to provide quality care actually creates a situation where treatment outcomes are less than optimal, and guess what, we get the blame for the Insurers interference and decreased cost effectiveness.

The problems are due to the bean counters having no understanding of the human physiology or rehabilitation considerations, and their need to demonstrate that they can dream up new policy in order to receive achievement bonuses. It does not seem to matter that their ideas are unworkable, or that they have been trialled elsewhere and failed. Change is seen to be good. Poor outcomes can be blamed upon others.
Cynical? What, me? Never!
The only way that you may win is to argue the point based upon potential savings to THEIR systems - and demonstrate the possibilities. This is easier written than achieved, as the Insurers tend not to listen regardless.Try contacting political representatives, as Insurer costs to the community may be seen as a political issue.
Goodluck.

[HygeiaUK]

I have only got round this a couple of times, and most often when the client has been Orthopaedic Surgeon referred, and lived a distance away. I argued that my one hour appointments where cheaper than two half hour appointments and they got paid by the health insurance company. However, I did have to have support from the surgeon. In general I usually do longer rehab appointments, but overlap these appoitments with other clients, so the client is working away in the background, with me popping in and out on rehab while I'm one to one with someone else. I then see them one to one for 20 mins so that the whole counts as a single consultation.
I find my normal consultation time is 40 mins and my rehab appoints last 1 hour. However I always charge for 30 mins.
Have you read my post on the refer and do not refer guidelines ? I would appreciate your comments

[Physiobase]

This is all true. However we need not fight the insurance companies as a first step. What we should do is report accurately on our associations annual gathering of statistics. Once an association starts to segmentalise treatments types it will become clear that 60mins is in fact a common treatment time. Insurers might only wish to pay for 30 but as long as they know we are seeing them for 60. At the moment we are the ones blocking the progress.

Please everyone consider this when a statistics form comes you way in the next year. Lets all ask for a breakdown of acute vs chronic vs rehabilitation treatments type and the average treatment time that relates to each. 8o

[chp4211]

I agree with most of what's been said. I think part of the problem exists because there seems to be conflict in defining what constitutes "treatment time". One school of thought seems to be that whilever the patient is present and "doing something" they are undergoing treatment. Another seems to claim that treatment only exists where the physio is directly interacting with the patient. In the public system it can cause some conflict with statistical reporting and privately it can cause problems with treatment times either being seen as too long (eg: the rehab style of treatment) or too short (ie: having 10 min Rx and electrotherapy the rest).

It seems there's no easy answer, but I would agree a united front is what's needed in order to move to resolve it.

Ray