Guy Terry PT, OCS

Guy Terry PT, OCS

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APTA Comments on Cigna/ASH

The American Physical Therapy Association (APTA) has released it’s statement regarding the transition from Cigna to American Specialty Health physical therapy contracts:

APTA sent a comment letter to CIGNA summarize concerns regarding the Cigna National Physical Medicine Clinical program’s use of American Specialty Health (ASH). Here are some of the points APTA shared with Cigna:

  • ASH has limited physical therapy experience and it does not have the requisite expertise to render appropriate clinical decisions regarding medically necessary physical therapy services.
  • The ASH Provider Agreement (Agreement) is overly complex, difficult to follow, and will not be readily understood by most therapy providers.
  • The Agreement’s payment methodology imposes a burdensome and one-sided appeals process.
  • The ASH provider tiering mechanism as described in the Clinical Performance System is unduly complex and arbitrary, and it is not keyed to clinical outcomes.
  • The Agreement’s administrative features are burdensome, including the MNR process and the obligation to check the Medicare exclusion list monthly.
  • Utilization management under the Agreement calls for non-PTs to review appeals of adverse decisions, and it is not truly evidence-based, since it relies on Clinical Practice Guidelines (CPGs) selected by ASH via a process that does not meet APTA standards.

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It Must Be More Complicated Than THAT

This is something that goes unsaid in my office, but I can read it on the faces of patients. Today’s patient had suffered 6 months of nagging headaches and neck pain. After a few visits to the doctor for NSAIDs and muscle relaxants, he was referred to a neurosurgeon and pain management physician, an MRI was ordered, and his neurosurgeon referred him to see me. [Read more…] about It Must Be More Complicated Than THAT

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Chasing “The Latest Thing”

I recently received a voicemail message from a former patient (whose son I had also treated) asking if I practice a specific proprietary, trademarked, and well-publicized technique. I responded via email, and then realized that this response could have been written a dozen or so times over my previous 17 years as a therapist, so I ought to just make a generic letter regarding all such techniques: [Read more…] about Chasing “The Latest Thing”

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A Therapist’s Sales Pitch

As you may or may not know, we’re looking to hire a physical therapist and/or licensed physical therapy assistant. If you’ve read over our website, checked our Facebook page, or been a patient, you’ll understand that our focus is high-quality work: getting patients back to their lives as quickly as possible, or finding them the correct solution for their problem. [Read more…] about A Therapist’s Sales Pitch