Even prior to the COVID crisis, private practice health care providers faced business headwinds that challenged their sustainability. For the past three decades the insurance industry has leveraged its influence over medical services. Increasing authorization and documentation requirements and reducing reimbursements have made it progressively more difficult for providers to meet patients’ needs. Recent changes in the Blue Cross contract and the continuous reduction in Medicare reimbursements have brought these business challenges to a critical juncture. At this point in our careers, we are choosing to reduce the stresses associated with providing the quality of care that we know is possible and that brings us such professional satisfaction.
Physicians have sought sustainability by either joining large medical groups or by transitioning to concierge practices. While fully understanding the rationale behind these business decisions, we seek to maintain our autonomy and to avoid creating preemptive costs to access our services. Therefore, we have transitioned the non-Medicare aspect of our practice to a supplemented self-pay model. In this model, recipients of care pay for services and receive reimbursement from their HSA or insurance company.
Despite the recurring reduction in reimbursement, we will continue to be providers for our Medicare patients and their experience at FPT will not be affected by these changes in our business model.
What this means for you:
Becoming out-of-network providers allows us to implement a clear and easy process for you to access our care. If you are a non-Medicare patient, you will pay for services on the day they are provided. We will provide you with a superbill to submit to your HSA plan or your insurance company for reimbursement, which will be emailed directly to you or printed out for you at the following appointment. Our front office can provide you with the information necessary to initiate the process. We expect HSA plans will reimburse you the full cost of treatment. We expect insurance companies will reimburse you exactly what they would have paid FPT for the services rendered, thus supplementing the cost of your care.
Development of future services:
Much of the U.S. medical model under emphasizes the role of non-pharmaceutical prevention and maintenance as key components of healthcare. Pain reduction, improved tolerance for activities and enhanced physical performance are reliant on good overall health and fitness. Restructuring our business model will allow us to explore less costly options of helping you achieve and retain these goals by incorporating bodywork, stress reduction, sleep and nutrition guidance programs to the services offered at FPT. These options, combined with our physical therapy services and training program, will allow us to fulfill your needs in the most cost effective manner. As we transition towards this more holistic care model, you will be capable of accessing these additional services either in conjunction with, or independent from, formal therapy through our Wellness program.
Necessary adjustment in our self-pay rates:
Folsom Physical Therapy has not adjusted its self-pay rate in over 20 years, an action we have postponed in order to spare our loyal community. To survive in practice, and to maintain the quality of our services, we must now do so.
We will be increasing our rates as follows:
- Physical therapy evaluation: $195 (1 hour plus extensive write-up)
- Evaluation with Michael Moore: $225 (1 hour plus extensive write-up)
- Standard follow-up appointment: $125 (30-35 minutes)
- Extended follow-up appointment: $190 (60 minutes)
Simplifying our practice model is a crucial step towards the sustainability of FPT. Doing so will allow us to keep our focus on providing you and your loved ones with the high quality and personal care you have come to expect from us. We appreciate your understanding, support and continued loyalty.
Tim McGonigle, P.T., Michael Moore, P.T.