Advocacy

Dr. Rockar’s Response to Open Request

I would like to begin this post by thanking APTA President, Dr. Paul Rockar for replying to my last post in a timely manner.  He has agreed that his formal reply be shared to the readers of this site and it has been inserted below.   If anyone has any concerns or  discussion points that you would like me to share with him during our follow-up discussion, please leave in the comments section below or email me directly @ joebrence9@hotmail.com

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12 replies »

  1. It’s happening all across the country. It has nothing to do with competition, John. If the payment model changes to one lump sum paid for services, paid to one entity, the hospital systems and insurer systems are linking up. The other aspect: big data… merging patients, providers and payers into one entity does have a positive with regard to analyzing data and focusing on lean production (like Virginia Mason Medical has done). Control is much tighter within a narrow network vs every provider accepted into a payer’s system.

    The flip side… access to care is reduced and as you say choice of provider is reduced.

    A happy medium… remember the big data? Well… go ahead and allow providers outside of the system to be within the network. Use big data analysis to determine the cost & quality of those outside providers also. Set up patient payment/responsibility schemes that assist patients in making a decision based on quality of care. If a provider’s quality is not within an acceptable range, the patient would have a higher copay responsibility.

  2. My concerns are this:
    1. The network which Dr. Rockar and I are discussing is large, but narrow. Very narrow. The company in which he is CEO is one of the very few accepted providers of rehabilitation services in Pittsburgh.
    2. From my interpretation of his response, it appears that opening up the network would lead to non-standardization resulting in lower-quality, less-coordinated care, which may or may not result optimal patient-focused outcomes. Should the APTA support such networks?
    3. How does one assess effectiveness of a system without comparing providers? ie. How do we know his company provides higher quality care and achieves better outcomes, if we are not comparing? I am with Selena on analyzing big data and increasing co-insurance responsibility based on a measure of quality.

  3. Joe, the biggest goal for any of those big systems is to get paid. It all comes down to money. The big systems DO have access to care language within the contracts. IF access becomes an issue (not sure how that is determined), the door will open for providers not within the system to be allowed into the network.

    Doubtful the APTA has any control over these emerging models. The models are emerging due to the upcoming changes in payment. In a way, the models have kind of been in existence for a long time. Historically, the hospital systems have always tried to keep their patients within their system and generally didn’t share options for care outside of their system. The emerging model is quite a bit tighter because the payer is merged with the hospital system.

    In other countries with a single payer system, if a person wants non-hospital care, they pay out of pocket. With what is happening, it’s looking more and more as if a person will probably just pay out of pocket for the freedom of choice when the choice isn’t within the integrated system.

    The systems will only be assessing the effectiveness of care provided within their system. Since there is no standardization in assessing effectiveness, we’re all screwed. And, if the system doesn’t have a third party involved in determining the effectiveness, how believable is the reported effectiveness?

  4. Hi Paul,
    I am a member of the APTA but I am not a member of the private practice section. I appreciate the resources which exist and am appreciative of Dr. Rockar in putting me in contact with Justin Moore. That stated, I still suspect Dr. Rockar can be a great advocate for those practicing in his home region.

  5. Certainly a “hot topic” among clinicians in the Pittsburgh and southwestern PA area. While I greatly appreciate the research and guidance that has come out of UPMC, and the employment / funding they steer to our area, I also hear of multiple applications form well qualified clinicians who have been denied access to the UPMC network.
    The heart of the affordable care act, whether you supported or opposed it, (or remained neutral like the APTA) appears to be patients and businesses ability to “shop” for the best plan and providers for their individual needs on the insurance exchange web site. It seems this same opportunity should be given to PT patients.
    Evidence tells us that positive outcomes can be obtained through a variety of methods. Certainly case studies show success with methodology that has yet to be studied through large, multicenter RCT’s. The literature also supports the need for patients to have control of their rehabilitation and select the provider they feel will work best for their given condition.
    I do not think that any large network should exclude any provider. The competition it fosters will only promote better clinicians, customer service, affordability, and ultimately improved outcomes for our patients. And isn’t that what our profession is about?

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