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On-site PT pays off for two practices
Looking for a new source of revenue to make up for the recent reimbursement squeezes by Medicare and private-pay insurers? You may want to consider a technique that is working for some physical therapists: direct contracting with employers.
Providing on-site physical therapy to several key large employers has boosted the patient base for two practitioners interviewed by Rehab Continuum Report: Joseph Mancuso, PT, owner of Twinboro Physical Therapy in Central, NJ, and Marilyn Roofner, PT, director of outpatient rehabilitation at Orlando (FL) Regional Health Care System.
"It’s an obvious connection," Roofner says. "Employers are paying the bill for their employees to have health services. This is a way to not so much cut out the insurance company but go directly to the employer by providing on-site services as well as services in your rehab setting."
In an average year, Orlando Regional Health Care has 21,000 patient visits from direct contracts with employers, Roofner says. Clients include The Walt Disney Co., Frito-Lay, The Orlando Sentinel (a local newspaper), Sea World, and Lockheed-Martin.
Services are based on the company’s needs, both Roofner and Mancuso say. In several cases — including Roofner’s work with Disney and Mancuso’s work with Bristol-Myers Squibb, General Motors, and Rutgers University — therapists have set hours each week that they see patients at an on-site facility at the workplace. Visits are billed directly to the employer as if a patient had visited the practice independently. In other cases, Roofner says she contracts at a one-time fee for educational sessions — for example, a "healthy back" session for new pressroom employees at The Orlando Sentinel, or a stretching workshop for dancers at Walt Disney World.
Both practitioners note the on-site therapy is very beneficial to the companies involved. At Bristol-Meyers Squibb, for example, where the physical therapy facility is open two days a week from 7:30 to 9:30 a.m., the company has recognized significant savings, says Joseph Ferro, MD, senior medical director of Bristol-Meyers Squibb. "Our most impressive was in carpal tunnel [injuries]," he says. "According to the Department of Labor, each injury costs $3,000 — $30,000 if surgery is required. Three years prior to instituting our program, we had 12 cases, all of which required surgery. Since 1992 [when the on-site PT program started], we have had a total of three surgical cases [of 22 patients with carpal tunnel injuries]."
A client of Roofner’s completed a two-year study after instituting on-site PT services and a certified personal trainer. "They had a 50% decrease in the reported number of sprains and strains and a 66% decrease in workers’ comp costs," she says.
While these success stories make great testimonials when pitching to potential new clients, how can an outpatient rehab department or hospital start from scratch? The key lies in your own accounts receivable and patient records, Mancuso and Roofner say (for other tips on working with direct contract clients, see story on p. 66).
Review your records to see which employers you are frequently drawing patients from. The larger the size of the employer, the better the chance they would be amenable to on-site services or a direct contract relationship in which employees come to your facility.
Do your research before approaching the company, Mancuso says. Find out who its insurance carrier is, or whether the company is self-insured. If it is self-insured, the money is coming out of its own pocket anyway. Include information on the number of specific types of treatment your practice is providing for its employee population, and ways those costs can be lowered by seeing employees on-site soon after an injury has occurred, not to mention preventing future injuries. Prepare a presentation that shows how a direct contracting relationship can reduce its health care costs.
Build on relationships you may already have in place. Mancuso was able to parlay a strong referral base from one local physician into a direct employer contract when the physician — Ferro — went to work for Bristol-Meyers Squibb.
Roofner got support from one patient who was a corporate vice president at a target client. "She kept working it from the inside and saying we need to have this.’ Even though it took about five years, we got the business because I was knowledgeable about the company and their needs, based on good relationships and rapport with some of their employees who had been patients."