Physical therapists speak out to Himes

As legislators pore through a health care reform bill that runs nearly 2,000 pages, U.S. Rep. Jim Himes, D-4, took another stop on his listening tour to hear the concerns of physical therapists and see how -- and if -- the bill could help them.

A dozen therapists told Himes their stories -- many of which involved insurance companies constantly lowering reimbursement rates -- that put them in a hard place.

"We're not too far from being break-even. There are no corporate jets around here," said Richard Preneta, director of Preneta Physical Therapy in Fairfield, which is where the meeting was held. "You know, I'm [working] 50-60 hours ... and we're getting by. We're doing well. We take good care of our employees and we try to do a great job for our clients coming in, but the reimbursement fee schedules have gotten so low."

He said that private insurance companies are paying 30 percent less than Medicare, which was already low to begin with. Due to the low reimbursement rate, Prenata heard that a colleague was laid off because he was the highest-paid (yet most experienced) at a practice. He's seen more recent graduates filling those positions.

"I'm not knocking it -- we all started someplace -- but if you have a clinic full of new graduates you're not going to have the same level of care," said Preneta.

David Scopino, managing partner at C.O.R.E. Physical Therapy and Sports Medicine, based in Bridgeport, told the story of an 87-year-old patient, a retired teacher, with a herniated disc and arthritis in the knees so bad that she can barely walk. Her doctor ordered 12 sessions of physical therapy. She was only able to obtain six.

"Basically, the insurance industry dictates the care," said Scopino.

Shaleighne Preneta, practice administrator at Preneta Physical Therapy, said it is difficult to fight back against the lower reimbursement. She said the companies have the power to say "Well, OK, if you don't want to join up that's fine. We have plenty of providers."

"We feel like we're by ourselves," she said. "They don't care about us. Nobody cares about us, that we're trying our hardest to serve our patients, but yet we can't afford to give the service for what they want to pay."

Himes listened to the physical therapists and asked questions or for clarification with some of the subjects that were brought up. He also mentioned how he suffers from lower back pain. His doctor told him that he could go through surgery, spend "a lot of time and a lot of money" but the results would probably be less fruitful than performing stretching exercises and seeing a physical therapist.

The issue of promoting education rather than spending money on tests and surgery is something that Michael Emery, president of the Connecticut chapter of the American Physical Therapy Association, said is vital to the reform of health care.

"Instead, they should come to a physical therapist. We educate them. We indentify the faulty mechanics because of the injury... it eliminates the extra physician ordering extra tests and more paperwork and more confusion," he said.

Toward the end of the hour-long session, the physical therapists were left with what they arrived with: uncertainty.

"I don't know quite how to get around this problem we started with here, which is, the insurance companies tell you you're going down 30 percent. We don't have a lot of jurisdiction over that," said Himes.

He explained that in the public option portion of the bill, reimbursement rates would be negotiated with the health care providers.

"That could be good or bad, depending on the nature of the negotiations," said Himes. "I'm having a little trouble getting it around my head where we've got the leverage to deal with the problem that we opened our meeting with."

Scopino replied, "It's our primary problem."

Himes concluded the meeting and asked if he could be sent some studies that were previously discussed that show the value of physical therapy in treating injuries in a cost-effective manner.

"I got to tell you, this was a blind spot," he said, referring to the issues that physical therapists are dealing with.