White Paper on Fair Health Insurance Reimbursement (FHIR)
Current Problem with Reimbursement:
Insurance reimbursement to many physical therapists in Missouri is below the Medicarefee schedule, which is unsustainable. In some cases, reimbursement from insurancecompanies has not increased in well over 10 years. This lack of reimbursementincrease is despite the fact that insurance companies on average increase theirpremiums 20-25%/year. This lack of reimbursement is a tremendous road block toprivate practice survivability and ability to compete in the present healthcare market. Private insurance payers no longer negotiate reimbursement amounts with manyphysical therapy companies in Missouri, specifically small business private practices.
Attempts by private practice clinic owners to negotiate with insurance companies areoften dismissed by the insurers. The reimbursement issue has forced many privatepractices in Missouri to sell to larger corporations. Closure of private practice physicaltherapy clinics has negative economic effects for Missouri, including the loss of incomeand property tax payments not required for non-profit hospitals and health systems. Most importantly, simply ignoring this problem will reduce access to physical therapyservices for the residents of Missouri leading to the rising costs associated withdisability.
What we are proposing:
The Missouri Physical Therapy Association (MPTA) is proposing the Fair HealthInsurance Reimbursement (FHIR) bill. The bill will allow for a reimbursement increase in2018 and then biennial increases. The 2018 base year will be based upon 130% of the2017 Medicare physician fee schedule and a biennial increase shall be provided toproviders based on the percentage increase in the Medicare Economic Index (MEI). The MEI is the way of measuring the cost of delivering services, adjusted for inflation,and reflects practice cost.
The bill will not apply to self-funded insurance plans or Medicare Advantage plans. Thisbill will not apply to covered physical therapy services delivered in an inpatient oroutpatient hospital setting, or as part of skilled nursing facility or home health benefits.
What the change will do for citizens of Missouri:
This bill will ensure patients continue to have choice when it comes to their physicaltherapy provider. If small business physical therapy clinics close up, patient access tophysical therapy services in the state of Missouri will be significantly reduced. Mostimportantly, this bill will ensure patients have the necessary access to physical therapyin Missouri.
This bill will also allow for job expansion in Missouri by keeping smallbusiness physical therapy alive with realistic growth potential. Current and futureMissouri physical therapists will have the opportunity to own their own business. FHIRwill also benefit state physical therapy programs by providing more clinical trainingopportunities for their physical therapy students. Finally, this bill will allow a smallbusiness sector to survive, continuing to contribute to Missouri's tax base, which helpsthe state's school, roads, and overall development.