AAFP went to bat for patients in rural America recently when it asked an insurance company to rethink a proposed policy that would effectively limit some patients' access to outpatient therapy services.
"Physicians, not health plan employees, should decide what care and treatment are in the best interests of their patients, and who should provide it," wrote the Academy in an Oct. 25 letter. (PDF file: 3 pages / 16 KB. More about PDFs.) to Wellmark Blue Cross and Blue Shield.
The letter was in response to Wellmark's plan to refuse reimbursement for outpatient therapy services provided "incident to" a physician's services unless those services are provided by a physical therapist or an occupational therapist. Read more about the plan in Wellmark's December 2005 Blue Ink newsletter. (PDF file: 16 pages / 12.1 MB. More about PDFs.)
Under Wellmark's proposal, a physical or occupational therapy assistant also could provide such services if he or she were supervised by a physical therapist or occupational therapist.
However, "Outpatient physical therapy is the most common outpatient therapy provided incident to a family physician's services, and family physicians do not typically employ physical therapists or physical therapy assistants in their practices," wrote AAFP Board Chair Mary Frank, M.D., of Mill Valley, Calif.
Frank said Wellmark's proposal "will negatively impact access to such services in family physicians' offices," especially in rural and frontier areas that comprise a large part of Wellmark's service area in Iowa and South Dakota.
Because there are severe shortages of these therapists in many Iowa and South Dakota communities, "restricting the ability of physicians to utilize allied health professionals would severely limit access to quality therapy services in those communities where a physical therapist and an occupational therapist are not available," said Frank.
The letter also pointed out that Wellmark modeled its proposed policy after a similar Medicare rule that currently is in litigation. "Any implementation by Wellmark of this therapy-incident to policy prior to the final determination of the lawsuit would seem ill-advised," said Frank.
Frank said the Academy would like to work with Wellmark to help develop a proposal that meets its needs "without adversely affecting access to such services in rural settings and other areas."
