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By Mike Pettinella Daily News Correspondent | 0 comments

LE ROY — Privately-owned physical therapy practices are receiving inadequate treatment when it comes to issues such as health insurance co-pays, physical therapy as an alternative to surgery, workers compensation laws and freedom of choice, according to a local physical therapist and leader of a Western New York PT coalition.

“It all comes down to being treated equitably and fairly,” said Patrick Privatera, president of Le Roy Physical Therapy & Village Fitness and president of the Physical Therapy Alliance of Upstate New York.

“Insurers categorize physical therapists as ‘specialists’ just like orthopedists, neurologists, cardiologists, and other physician specialists but they fail to appreciate that our practice patterns are very different. A patient might see a physician specialist two to three times per year to treat a given condition, but patients might see a physical therapist two to three times per week during an episode of care. When specialist co-pays are set at $40 per visit, you’re seeing very unequal coverage.”

In recent years, insurance companies have raised premiums charged to employers and subscribers. Despite this trend, Privatera said, costs of care are being shifted back onto the consumers.

“Co-pays for physical therapy are a great example,” he said. “There has been very little change over the past 10 years in the fees insurers pay or allow for a physical therapy visit, but insurance premiums seem to increase by 10 percent every year, and co-pays for PT have risen from $5 to 10 per visit to up to $50 to $60 per visit.”

Privatera said that patients may think that physical therapists are making more money due to the higher co-pays, but that’s not the case.

“Ten years ago, a patient might have had a $10 co-pay on a visit with a $42 allowance, meaning the insurance company paid us $32. Now, the patient might have a $40 co-pay on a visit that pays us $42. The insurance company pays us only $2. In more and more cases, the insurance company pays zero as the co-pay is more than we are allowed by contract, but tells the patient they have a physical therapy benefit.”

He also said that Kentucky recently passed legislation that caps the patient’s responsibility of physical therapy costs to 20 percent. “That’s what we’re hoping to achieve,” Privatera said. “It should be co-pay; right now it’s ‘me-pay’.”

Privatera said he also is concerned about the perception that physical therapists aren’t qualified to diagnose injuries.

“Today’s PTs graduate with a six-year clinical doctorate degree, and several studies have established that a physical therapist’s clinical diagnostic ability parallels or exceeds that of a primary care physician,” he said.

Furthermore, Privatera said physical therapy treatments often are more cost effective.

“There is a lot of data to support the efficacy of PT over many traditional and more costly treatment options,” he offered. “Billions are spent each year on unnecessary surgery, diagnostic imaging, injections, and pharmaceuticals … and physical therapists are in a position to curb these costs.”

He cited osteoarthritis as an example of this.

“With a large increase in total hip and knee joint replacements forecasted as the baby boomers age over the next five years, and with costs in excess of $25,000 per surgery, PT should be much more engaged in disease management algorithms,” he said. “Our alliance has tried to meet with insurers to discuss this, and they seem to pay us lip service in support, but have been unwilling to collaborate on our innovative ideas or to make any significant changes to policies or procedures.”

Privatera said that physical therapy has historically been viewed as a commodity — “a thing instead of the experts that we are. We’re working hard to change that misconception of the profession.”

The patient’s freedom to choose his or her physical therapist is essential to the future of privately-owned practices, Privatera contends.

“Some physicians will tell patients that they need to go to a specific PT office to receive treatment, and sometimes it is because the physician has a financial interest in the physical therapy practice to which he is referring,” Privatera said. “We want people to know that they are free to choose. Just like physicians, physical therapists have different levels or areas of expertise and people need to know they can choose.”

Physicians who own physical therapy practices have justified this on the grounds that it eliminates delays in getting treatment, and that patients will receive better care from therapists that they supervise, Privatera said. However, a June 2010 report by the Medicare Payment Advisory Commission (MedPac) found these justifications largely unfounded and cited potential “conflicts of interest” in physician self-referral.

“Fortunately for us in the Batavia and Rochester areas, there are not a lot of physician-owned practices, but there are at least a dozen in the Buffalo area. It’s a huge problem there,” he said.

Additionally, New York State Workers Compensation regulations have placed burdens upon the physical therapy profession, Privatera indicated.

“The current medical treatment guidelines were intended to eliminate both delays in care for injured workers and costly, unnecessary procedures, but they have had the opposite effect,” he said. “There is additional administrative paperwork and a ‘variance process’ that delays care and keeps people out of work longer than necessary. To make matters worse, NYS has not allowed a fee increase for physical therapists since 1994, although physicians received an increase of 30 percent which coincided with the guidelines implementation.”

As a result, many physicians and physical therapists are opting not to accept workers compensation insurance, leaving injured workers with fewer alternatives to receive health care, Privatera said.

“Our alliance has been active in trying to rectify these issues,” Privatera said, adding that he has met with state legislators, including Steve Hawley, who is a member of the NYS Assembly insurance committee.

Looking ahead, Privatera hopes that increased dialogue will lead to a greater understanding of his profession.

“As the debate surrounding health care reform continues, physical therapists are in a unique position to deliver better, more cost-effective outcomes for musculoskeletal conditions,” he said. “At the end of the day, we’re just hoping to eliminate the barriers which prevent us from doing this.”

NEW YORK—The exclusive remedy provision in workers compensation law does not bar an employee from collecting uninsured motorist benefits from a self-insured employer, New York state’s high court has ruled.

In the case of Elrac Inc. vs. Birtis Exum, Mr. Exum was in an automobile accident with another car while working for Elrac, a self-insured subsidiary of Enterprise Rent-a-Car Co.The other car’s driver had not purchased liability insurance, according to Tuesday’s New York Court of Appeals ruling. So Mr. Exum notified Elrac that he intended to seek uninsured motorist benefits from the employer through arbitration.

Elrac sought to stay the arbitration, and a trial court granted the petition. But in 2010, an appellate court reversed and allowed arbitration to proceed.

Elrac appealed to New York’s highest court, arguing that because Mr. Exum is entitled to workers comp benefits in this injury case, he is barred from recovering uninsured motorist benefits.

Exception to the rule

While New York state law says an employer’s liability for workers comp benefits “shall be exclusive and in place of any other liability whatsoever,” the high court found that wording “cannot be taken literally” in all cases.

“Specifically, the statute cannot be read to bar all suits to enforce contractual liabilities,” the court ruled. “If an employer agrees, as part of a contract with an employee, to provide life insurance or medical insurance, and breaches that contract, an action to recover damages for the breach would not be barred.”

Likewise, “There is no policy reason why Exum’s uninsured motorist protection should decrease because he happened to be driving the car of a self-insurer,” the court ruled in affirming the appellate court’s decision to allow arbitration to proceed.

POUND RIDGE, N.Y. – The Pound Ridge Town Board dodged a fiscal bullet this past week when it averted a 147 percent increase in the town’s workers’ compensation costs.

The board held a special meeting Saturday to deal with the issue after it was brought to its attention by the town’s insurance agency. If nothing had been done by Jan. 1, the old policy would have continued and the 147 percent rate hike would have kicked in.

“We were able to get in a state fund called the New York State Public Entities Group,” said Town Clerk Joanne Pace. “We had to make sure it was apples to apples – that the coverage was just the same.”

Pace said when the town’s insurance agent saw what was about to happen, he came to the board with the proposal.

“We needed to have a resolution ,” Pace said. “We had to do it by Jan. 1 – that’s why we had the special meeting.”

In other news from the meeting, the town approved a request for a commercial filming permit from Urban Productions to film a milk commercial at 76 Cross River Rd. However, since the approval was given, the production company decided to film elsewhere.

“They found this house in Pound Ridge that they thought was perfect, but they found another house and changed their minds,” Pace said. “It’s too bad.”

Also at the meeting, the board accepted the resignation of Pound Ridge Police Officer Peter Olsen. Olsen is leaving to take a full-time position as an investigator with the New York State Attorney General’s Office. As his replacement, the board appointed Tom Ritchie to the part-time post. Ritchie is also a member of the Lewisboro Police Department and the Vista Fire Department.

“He is also an EMT and we liked that,” Pace said.

Celebrity Chef Bobby Flay stretches for his training run on the West Side waterfront in Manhattan last year. Flay was training for the New York Marathon.  Stretching exercises can help runners avoid hamstring injuries.

Read more: http://www.nydailynews.com/sports/more-sports/running-doc-tips-avoid-treat-hamstring-injuries-include-ice-compression-stretching-article-1.993883#ixzz1hCafr9qn

The Obama administration said on Thursday that it would propose regulations to give the nation’s nearly two million home care workers minimum wage and overtime protection. Those workers have long been exempted from coverage.

Labor unions and advocates for low-wage workers have pushed for the changes, asserting that the 37-year-old exemption improperly swept these workers, who care for many elderly and disabled Americans, into the same “companion” category as baby sitters. The administration’s move calls for home care aides to be protected under the Fair Labor Standards Act, the nation’s main wage and hour law, as most other workers are.

“The nearly two million in-home care workers across the country should not have to wait a moment longer for a fair wage,” President Obama said in a statement. “They work hard and play by the rules and they should see that work and responsibility rewarded.”

These workers, according to industry figures, generally earn $8.50 to $10 an hour — around $17,000 to $20,000 a year — compared with the federal minimum wage of $7.25 an hour. In its announcement, the White House said 92 percent of these workers were women, nearly 30 percent were African-American and 12 percent Hispanic. Nearly 40 percent of them rely on public benefits like Medicaid and food stamps.

While industry experts say the overwhelming majority of today’s home care aides are paid at least the minimum wage, they also say that many do not receive a time-and-a-half premium when they work more than 40 hours a week.

“The job they do is a real job and they deserve the same basic rights as any other workers,” said Steven Edelstein, national policy director of PHI PolicyWorks, a nonprofit group that seeks to improve conditions for home care workers. “This industry has one of the nation’s fastest-growing work forces, and the challenge is to make these better jobs if we’re trying to attract good people to come and provide the services.”

Labor Secretary Hilda L. Solis has made clear for several months that she was considering updating decades-old regulations in several areas, including the home care industry, where workers often provide services like tube feeding, wound care or assistance with physical therapy. The changes the administration is proposing will be subject to 60 days of public comment.

In recent weeks, numerous Republican lawmakers have criticized the anticipated proposals, saying they would increase costs for federal and state programs as well as individuals.

At a hearing last month, Representative Tim Walberg, a Michigan Republican who is chairman of the House subcommittee on work force protections, said, “Medicare and Medicaid expenses will likely increase as a result” of narrowing the companionship exemption. He added that the move was going to make senior citizens and their families “less able to afford home care, which is typically paid not by insurance, but by families themselves.”

In 1974, the Labor Department exempted “companionship” workers from coverage under the Fair Labor Standards Act, a move that focused on baby sitters at a time when the home care industry was in many ways in its infancy.

Under the changes, industry experts said, for the first time many home care agencies would be required to pay their aides for the hours spent each day traveling between patients’ homes.

According to the federal government, the nation’s over-65 population will climb to 72 million in 2030, from 40 million today, and an estimated 27 million of them will need some form of home care.

In 2007, the Supreme Court issued a decision involving a New York home care aide, Evelyn Coke, who often worked 70 hours week, ruling that she was not entitled to overtime pay under existing regulations. The court said it was up to Congress or the Labor Department to change the rules.

The White House said that nearly 90 percent of home care workers were employed by agencies. Officials with the National Association of Home Care and Hospice said Thursday’s announcement would cause many agencies to hire more workers rather than pay a overtime to employees who worked more than 40 hours a week.

“The vast majority of these workers are women, many of whom serve as the primary breadwinner for their families,” Secretary Solis said. “This proposed regulation would ensure that their work is properly classified so they receive appropriate compensation and that employers who have been treating these workers fairly are no longer at a competitive disadvantage.”