Well Established Physical Therapist is Seeking Acqusitions of PT Practices Along the East Coast

As a well established physical therapist in private practice, I am interested in talking with colleaugues who are contemplating their succession plan  and exit strategy. I currently own a  three office practice in Delaware focusing on providing quality physical therapy services to adults with orthopedic and neurological challlenges.  I am interested in acquring like minded practices in states along the East Coast, and am 100% committed to offering a fair valuation, an amicable and fair transition, superior conitnuity of care and a smooth collaborative transition.

If you are potentially interested in being acquired, please feel free to reach out to me . I will sign a confidentiality/ non disclosure agreement  and look forward to opening a meaningful dialogue.
Email in confidence to srapposelli@pptandfitness.com.

Stephen Rapposelli, PT, OCS

AVAILABLE IMMEDIATELY in Westchester County Pediatric Private OT Practice! Sublet Opportunities for Pediatric Physical and Speech Therapists or other Pediatric Providers Per Diem Opportunities for Pediatric OTs

Vanessa Pastore MA, OTR/L, a well known and highly regarded pediatric Occupational Therapist has recently opened her private practice, Create Abilities of N.Y.  in Bronxville NY and has the following opportunities available immediately

Per diem Opportunities suitable for Pediatric OTs  who are looking for a part time case load of children predominantly birth to 10 years old. Opportunities for mentorship available. Fee for service commensurate with experience.

Sublet/ Rental opportunities for  pediatric physical therapists or speech pathologists, but can also be suitable for  Counseling, Special Education, Play Therapy, Social Work, Tutoring, Nutritionist, Psychologist, etc.  The space is available Monday through Sunday 7 AM until 8:00  PM.
Hourly rentals considered but prefer monthly rental with annual lease in the fully built out 650+ square foot office.  There is a fully equipped sensory gym and well as partitioned areas for private one on one sessions, waiting area  and a private bathroom.  This  practice is in a great family friendly community and has  ample parking.  Rent is inclusive of all maintenance costs, including weekly professional cleaning and basic utilities and free high speed internet.

It is anticipated that there will be tremendous opportuntiies for cross referrals and collaboration.

For further information please contact Vanessa directly. 
Vanessa Pastore, MA, OTR/L
Owner, Create Abilities of N.Y. OT
81 Pondfield Road Suites 3 & 5
Bronxville NY 10708
Tel. 914 337-0034
Cell: 212 960-8705

What its Like to Be on Medicare Now

Reprinted from the NYTimes July 31 2019. By Abbey Goodnough

Medicare for All? For More? Here’s How Medicare Works

As Democrats embrace the idea of expanding the federal health insurance program, we looked at what it covers and costs. It’s far from “free.” Medicare, the federal health insurance program for people who are 65 or older, has become something of a panacea in the Democratic presidential race.

Some candidates, including Senators Bernie Sanders and Elizabeth Warren, want to give it to everyone and even expand its benefits. Others, like former Representative Beto O’Rourke, want to give it automatically to people who don’t have other health insurance. Many, including former Vice President Joseph R. Biden, want to give people the right to buy into a Medicare-like public health insurance program. Whatever their positions, Medicare is what most of the candidates are holding up as a model for universal coverage, a goal they all embrace.

Medicare is popular among its 60 million beneficiaries, but the program also has limitations, and it is certainly not “free.” Co-payments can be high for some people, especially for long-term hospitalization and some medications. Some Democratic proposals, including those from Mr. Sanders and Ms. Warren, would changethat by eliminating premiums and deductibles, and pay for the program instead with higher taxes.As expansion of Medicare becomes a campaign season rallying cry, we took a look at what it’s like to be on Medicare now.

Here are some answers to basic questions.

What exactly does Medicare cover? Are the benefits good?

The benefits are comprehensive, though not exhaustive. Medicare divides benefits into categories. One, Part A, covers inpatient care at hospitals and — with some limits — skilled nursing facilities, where people often go to recover from an injury or illness. It also covers hospice care and, in some circumstances, home health care. Another category, Part B, covers doctor appointments, outpatient procedures and tests, some mental health services, as well as wheelchairs, walkers and other equipment. Prescription drugs are covered under Part D. Part C is a privately run managed care option called Medicare Advantage.

What doesn’t Medicare cover?

Medicare does not cover glasses, basic eye exams, hearing aids and most dental care — frustrating omissions for many beneficiaries, who are at an age when they are more likely to need these services. It also won’t pay for care received outside the United States.

But by far the most expensive thing Medicare doesn’t pay for is long-term care in nursing homes, assisted living facilities or at home. Some people buy long-term care insurance, or spend down their assets to qualify for Medicaid, which does cover nursing home care. A private room in a nursing home cost an average of $100,375 last year, according to Genworth, a financial company.

Part A typically has no monthly premiums (like Social Security, it’s financed by payroll taxes all workers pay), but it has a deductible of $1,364 per “episode of illness,” plus a fixed amount — as high as $682 a day — if you spend more than 60 days in the hospital.

For Part B — doctor’s visits and outpatient care — premiums are based on income. The standard premium this year is $135.50 a month, but financial help is available for people with low incomes who don’t qualify for Medicaid, the government health program for the poor, which covers just about everything.

Richer Medicare beneficiaries — individuals with annual incomes over $500,000 — pay $460.50 a month. Premiums are typically deducted from people’s Social Security checks. Part B also has a deductible of $185 a year, and co-payments of 20 percent after you reach your deductible.

Many people buy supplemental “Medigap” insurance to cover Medicare’s out-of-pocket costs.

Unlike Affordable Care Act plans, Medicare has no cap on out-of-pocket spending, so the cost can climb quite high for sick people. An analysis by the nonpartisan Kaiser Family Foundation found that Medicare enrollees in fair or poor health spent an average of $6,128 in 2013, or 47 percent of average Social Security income.

Prescription drug costs can also be high in Medicare, and they represent one of the most complex, confusing parts of the program. Medicare Part D plans are run by private insurers, and the premiums cost $40 a month on average this year, according to Kaiser. There are also annual deductibles before coverage kicks in — they are capped at $415 this year — plus co-payments and coinsurance. But if your income is low enough, you may qualify for extra help paying for drugs, and in some cases, owe no premiums or out-of-pocket costs.

Then, there is the dreaded “doughnut hole” — a gap in which the Medicare drug plans don’t pay for patients’ medications after they have spent a certain amount — this year, $3,820. At that point, enrollees have to pay 25 percent of the cost of brand-name drugs, and 37 percent of the cost of generic drugs, until their total out-of-pocket spending has reached $5,100. Once they hit that, they qualify for “catastrophic coverage,” and only pay a small co-payment for covered drugs for the rest of the year.

Kaiser recently found that one million Medicare beneficiaries had out-of-pocket spending above the catastrophic threshold in 2017, averaging $3,214.

Medicare Advantage is an increasingly popular alternative to traditional Medicare. Advantage plans are offered by private insurers that have contracts with Medicare. These plans have all the same benefits as traditional Medicare, and often more, such as dental care or health club memberships. Co-pays and deductibles vary depending on the plan. Unlike traditional Medicare, all Medicare Advantage plans have limits — $6,700 this year in most cases — on out-of-pocket spending.

Medicare pays Advantage plans a fixed monthly sum for each beneficiary, while in traditional Medicare, providers are paid for each service based on an annual fee schedule. As a result, Advantage plans tend to use tools like pre-authorization requirements and strict provider networks to control costs.

Those restrictions can be a turnoff to people with a lot of medical needs. Some data suggests people with Medicare Advantage tend to be healthier but less wealthy than those with traditional Medicare. One thing is certain: the private plans are growing in popularity. About one-third of Medicare recipients, or 22 million people, now have them, up from six million in 2005.

This depends largely on whether they have traditional Medicare or a Medicare Advantage plan. Traditional Medicare allows beneficiaries to seek care from any doctor or hospital in the United States that accepts it, and does not require referrals to specialists or prior authorization for services.

But Medicare Advantage plans typically have strict networks of medical providers that beneficiaries have to use unless they are willing to pay more. Some Advantage plans may cover care outside the network, according to the Center for Medicare Advocacy, but the out-of-pocket costs are generally higher than for in-network care. Advantage plans do cover emergency care outside their network — if you are traveling domestically, for example — but nothing else.

No, but most do. According to the federal Centers for Medicare and Medicaid, 2,752 doctors and other providers opted out of Medicare in 2018 — a minute number considering there are more than one million practicing doctors alone. Psychiatrists are the biggest category of doctors who opt out, according to Kaiser.

A small share of doctors who accept Medicare are called “nonparticipating providers,” meaning they can choose to charge Medicare patients higher fees, up to a certain limit. The patients are responsible for paying the full amount beyond what Medicare pays — a practice called balance billing.

It is even more rare for a hospital not to accept Medicare, although some private psychiatric or other specialty hospitals that cater to the wealthy may not.

Yes, although few people take this step, at least according to a report last year by the inspector general at the Department of Health and Human Services. The report found that beneficiaries and providers appealed more than 863,000 denials from 2014 through 2016 — only about 1 percent of the total number of denials during that period. But their success rate was high: About 70 percent of the appeals were fully successful at the first level (there are five possible levels to keep appealing to), according to the report. Most were from providers regarding payments that had been denied, not patients regarding services that had been denied.

Reed Abelson contributed reporting.

Georgia PT Practice – Well established, highly regarded Physical Therapy practice outside of Atlanta is for sale due to the upcoming retirement of its owner.

This well established and  highly regarded  PT owned outpatient physical therapy practice is coming up for sale due to the owner’s pending retirement.

This practice sees a combination of orthopedic and neurological patients, and  has very well established local referral sources. The practice is a Medicare Part B, works with many WC patients  It is in  network with a large number of insurance contracts including Humana (all plans), BCBS (anthem) except HMO, Cigna (open access Plus, PPO and HMO, Medicaid plans (Wellcare, Amerigroup, PeachState and CareSource. UHC, One Call and Medrisk.

The practice averages about 65 sessions per week  and the  staff consists of Physical Therapist/Owner, a full time physical therapist assistant and support staff of 1. At the present time, the practice  consistently grossing over $300,000.  The owner is willing to stay on for a reasonable transition period and other staff is eager to stay on with new owner.  The existing lease is very favorable, renewable and transferable.

The practice is in a great family friendly community conveniently located with ample parking. The 1600 square foot facility is ADA compliant, fully built out and equipped, with a main gym, 2 closed door private treatment rooms,  nd reception area.  It is fully equipped and all equipment is in very good shape including a recumbent bike, rowing machine, biodex balance machine, tread mill , parallel bars, elliptical, US/E -stim  etc.  The practice is in a great family friendly community conveniently located with ample parking.   The existing lease is very favorable, renewable and transferable.

Full financial information and practice statistics are available upon request. Ask price is $100,000 and owner is willing to consider to stay on for a reasonable transition period.

Serious inquiries only:  Please contact the practice owner directly at ptclinicforsale96@gmail.com.

7 of Your Most Burning Questions on Social Security (With Answers)

 Reprinted from the NY Times. Mark Miller 8/2/2019.

People have lots of questions about Social Security: Will it still be around when I retire? How much will I get? How does the spousal benefit work?

That’s not surprising.

No government program is more important to so many Americans. This year, Social Security is expected to pay $1.1 trillion to 69 million recipients of retirement and disability benefits and Supplemental Security Income. Nearly all Americans pay into the program and can expect to receive a benefit at some point in their lives. And it is the largest retirement income source for a majority of older households.

The New York Times recently invited readers to submit their questions about Social Security. Today, we’re responding to some of the most frequent ones.

Is Social Security financially secure? Should people in their 60s who can afford to wait to claim benefits wait until they can get the highest monthly benefit, or should they consider signing up now because the program may not be there in 20 years?

In the years ahead, Social Security does face a financial shortfallthat requires action by Congress. The combined trust funds for Social Security’s retirement and disability programs are on course to be depleted in 2035; without changes, funding from payroll tax receipts will be sufficient to pay only 80 percent of currently scheduled benefits.

That would mean immediate, across-the-board benefit cuts, but the pain would be felt most acutely by today’s younger workers and low-income retirees.

“If policymakers don’t address Social Security’s finance gap by 2035, all Gen Xers and millennials would experience the cuts throughout retirement,” notes Richard W. Johnson, director of the program on retirement policy at the Urban Institute. “An additional one-third of retirees could end up in poverty.”

The shortfall stems primarily from the retirement of baby boomers combined with the slow growth of the labor force, which reduces the ratio of workers paying into the system and beneficiaries. Rising life expectancy also plays a role; so does rising inequality in worker earnings.

When Congress last adjusted the cap on wages subject to the payroll tax in 1977, the intent of lawmakers was to cover 90 percent of all wages. But wages above the cap have grown more quickly than the average wage, so the cap (set this year at $132,900) now covers only 83 percent of wages, reducing taxes flowing into the system.

“Given the strong public support for the program, it is inconceivable that Congress won’t step in sometime before 2035 and put things on an even keel,” he says. “It’s a source of concern, but not something to lose sleep over.”

Congress could put Social Security back into financial balance with new tax revenues, benefit cuts or a combination of both. The Democratic-controlled House is advancing a plan that would putSocial Security back into balance over the next 75 years by increasing payroll tax rates by 0.1 percentage point annually through 2043, reaching 14.8 percent for that year and later. The bill also would apply payroll taxes to earnings over $400,000, starting in 2020. The bill would expand benefits modestly.

The legislation, sponsored by Representative John B. Larson, Democrat of Connecticut and chairman of the Ways and Means Social Security Subcommittee, has 211 co-sponsors in the House.

Could you provide a full explanation of “spousal benefits” for living spouses, and for widows, widowers and divorced people?

The spousal benefit is available to couples who have been married at least one year. It allows one partner to claim a benefit as high as 50 percent of the benefit at full retirement age of his or her spouse — so long as that spouse has already claimed benefits. That requirement often trips up people hoping to generate some income while the higher-earning spouse puts off claiming benefits to earn delayed retirement credits.

“It’s one of the most misunderstood things that we see,” says Elaine Floyd, director of retirement and life planning for Horsesmouth, a firm that trains financial advisers.

If you are entitled to a spousal benefit when you file, in most cases you must file for both your own and your spousal benefit simultaneously. You’ll be paid your own benefit first; a spousal benefit amount will be added if your own benefit is less than half of your spouse’s total. Filing means that you will no longer accrue delayed retirement credits.

People born before Jan. 2, 1954, can still file for a “restricted claim” of only their spousal benefit. They were grandfathered into rules in place before passage of the Budget Act of 2015. This provision allows them to receive a spousal benefit while building delayed retirement credits on their own account, until age 70.

In all cases, widows or widowers can receive a survivor benefit when a spouse dies, providing they were married at least nine months at the time of death. In most cases, the survivor benefit is equal to 100 percent of the deceased spouse’s benefit.

Many divorced people are surprised to learn that they can file for a spousal benefit on the record of an ex-spouse. To qualify, you must be single and have been previously married to your ex at least 10 years. You also cannot be receiving a benefit greater than your divorced spouse’s benefit. If the ex is 62 or older and the divorce occurred over two years earlier, the ex does not need to have filed for his or her benefit.

Eligibility for an ex’s benefit is lost if you remarry, and you can’t file for benefits on your new spouse’s earnings record until you’ve been married to that person at least one year.

If your ex-spouse is deceased, you may be able to claim a divorced-spouse survivor benefit. The rules are basically the same except that you can be remarried as long as you remarried after age 60.

Spousal benefits were made available to same-sex married couples after the landmark 2013 Supreme Court decision striking down key provisions of the Defense of Marriage Act.

Do Social Security benefits last your lifetime?

Yes — benefits are paid as a monthly annuity, and they are adjusted for inflation each year.

“Not only is it the cheapest annuity that you can buy, but it is very difficult to find an annuity of any kind that is adjusted for inflation,” says Dirk Cotton, a retirement researcher. “That makes Social Security extremely valuable.”

Why do most articles about Social Security push the idea of waiting until you’re 70 to claim and don’t mention the “break even” calculation that would help you decide whether to claim earlier?

The break-even age is a very common method for deciding when to claim. This is the age in the future when, if you started claims at different ages, your accumulated benefits would be equal. Starting benefits early works to your advantage if you don’t live to the break-even age; you also come out ahead by delaying benefits and then living beyond the break-even point. The losing outcome is delaying benefits and dying before reaching the break-even age.

Here’s how claiming ages affect benefit amounts. Social Security starts by taking into account your 35 years of highest wages, and translates this into something called the primary insurance amount (P.I.A.). If you wait until the current full retirement age of 66, you will receive 100 percent of P.I.A. If you start at 62 (the earliest opportunity), you will receive a reduced benefit for the rest of your life — 25 percent lower. By waiting past full retirement age, you would get the delayed retirement credit, which is 8 percent for each 12-month period that you delay. The credits are available until age 70.

Andy Landis, a Social Security expert and the author of “Social Security: The Inside Story,” refers to break-even as the “money ahead” date.

For a claimant with a full retirement age of 66 who files at 62, Mr. Landis calculates that her money-ahead age is 78 — that is, she will be ahead in lifetime benefits until age 78; at that point, a person with the same P.I.A. who waits until full retirement age will catch up with her. After that, the later filer is ahead for the rest of her life.

If the same woman files at 66, her money-ahead age is 82.5 — after that age, someone who waits until 70 to file is ahead permanently. (Mr. Landis’s examples assume inflation-adjusted dollars and exclude any taxation of benefits.)

But many experts argue that break-even is not the best way to decide when to claim, because of Social Security’s value as an inflation-adjusted guaranteed source of lifetime income.

“None of us who are healthy have any idea when we’ll die,” Mr. Cotton says. “So it’s not a good way to make the decision, unless you have a really good reason to think you won’t live at least 18 years.”

You can run your own numbers using the tables and calculator on the Social Security website.

I am 68, and my Social Security benefit amount is lower than my husband’s because I stayed out of the work force for five years to raise my children — even though he worked fewer years and earned less over all than I did. Has there been any progress in raising benefit amounts for people in my situation?

The responsibility of caring for children, elderly parents or other relatives remains a key reason that women tend to work fewer years than men. That reduces their income from Social Security, pensions and savings.

Caregiver credits are applied by the retirement programs of many industrialized nations, including Britain, Sweden and Germany. In the United States, lawmakers and policy experts have proposed a variety of remedies. One would allow caregivers to exclude more years from the P.I.A. formula; allowing caregivers to exclude five years would increase their benefits. Other plans would provide wage credits to caregivers.

“It would be an imputed income amount for the years when you were providing caregiving,” says Nancy Altman, president of Social Security Works, an advocacy group, and a member of the Social Security Advisory Board, an independent bipartisan government agency. “This definitely is an issue that has come to the attention of policymakers, and doing something about it has broad support. The question is when we will see some action on it.”

How much of my Social Security income will be taxed?

For lower-income retirees, Social Security usually is tax free, while higher-income seniors pay taxes on a sliding scale. No more than 85 percent of your benefit is taxable.

To determine if your benefit is taxable, add up your gross income, nontaxable interest income and half of your Social Security benefit. If that number exceeds $25,000 (for individuals) or $32,000 (joint filers), some portion of your benefit is taxable. For details, see the instructions for completing lines 5(a) and 5(b) of Form 1040 in the Internal Revenue Service’s guide.

I own my own business. Is it possible for me to “pay into” Social Security?

Assuming you are paying self-employment taxes, you already are contributing. The self-employment tax, paid in lieu of the payroll tax that employers split with employees, is 15.3 percent, with 12.4 percent going to Social Security and 2.9 percent to Medicare.

Self-employed people pay double the rate that they would as employees, but can deduct half the cost from income taxes when they calculate their adjusted gross income.

Business owners who are incorporated pay Social Security taxes as employees. More information is available from the I.R.S.


An earlier version of this article referred imprecisely to the way a spousal Social Security benefit is calculated. The benefit can be as high as 50 percent of a spouse’s benefit at full retirement age, not 50 percent of the spouse’s benefit.


Immediate openings for Pediatric OT PT and SLPs in Midtown Manhattan


A longstanding name in the NYC special ed landscape is excited for its September 2019 relaunch.  Happy Hour 4 Kids, under original co-founder Joel Maute along with new and engaged partners, is bringing fresh energy and ideas to our 30thStreet location.  We are seeking enthusiastic, dedicated, and motivated therapists, including occupational therapists, physical therapists, and speech therapists who can provide high-quality services in our alternative education program.  You’ll experience an unparalleled work environment, a top-of-the-industry benefit package, supportive management and collaborative supervision.

If you are looking for a company culture that is disrupting industry norms while changing children’s lives, we encourage you to apply.  Please email resumes to manhattanOT@gmail.com


Located in Lake County, California, this well established and PT owned outpatient physical therapy practice is coming up for sale due to owner relocation. THIS IS A GREAT OWNERSHIP OPPORTUNITY at a very good price.

This well established  highly regarded  PT owned outpatient physical therapy practice is coming up for sale due to the owner’s relocation.

The practice is in a great family friendly community conveniently located with ample parking. The 1900 square foot facility is fully built out and equipped, with a main gym, 2 closed door private treatment rooms, laundry room and breakroom, and reception area. There is also a bathroom that is ADA complaint. Therapy equipment and office equipment included in the sale are recumbent bike, elliptical, treadmill, stationary bicycle, smith machine, stair stepper, trampoline, 1 hydrocollator machine, 1 low mat table, 3 treatment tables, 1 high low table, office furniture, 1 desktop computer, 2 printer/scanner copier machines, scanner, refrigerator, washer and dryer and so much more.

This busy practice sees a great variety of  orthopedic and neurological patients, and  has very well established local referral sources. It is in  network with a large number of insurance contracts. The practice averages about 120 sessions per week, and up to 60 new patients monthly.  The staff consists of Physical Therapist/Owner, a full time physical therapist assistant and support staff of 2. At the present time, the practice is full-time consistently grossing over $450,000.  The owner is willing to stay on for a reasonable transition period and other staff is eager to stay on with new owner.  The existing lease is very favorable, renewable and transferable.

Ask price is $100,000 and owner is willing to consider partial  financing for the right buyer.  Full financial information and practice statistics are available upon request.

Serious inquiries only:  Please contact the practice owner directly at 707-245-8065 or physicaltherapyaroundthelake@gmail.com

Help them win a grant, help your patients stay safe!

Fellow occupational therapists! Barbara Hellman, MOT, OTR/L and her daughter* invented a product that makes car seat buckles easy (for grandparents, parents with hand weakness etc.)  They are now a TOP 8 finalist for a $5K Grant and need your vote to help them win.
The contest ends on this Tuesday July 16th, so please take a moment to support a fellow therapist and vote for UnbuckleMe.

Vote here: https://themamaladder.com/grant
Barbara’s daughter and business partner Rebecca Davison* is the Mom Entrepreneur listed (scroll down to find her name & UnbuckleMe).

Thank you so much!  The support from the therapy community is greatly appreciated, and it is perfectly okay to vote from more than one device until July 16th.

UnbuckleMe is the award-winning solution for parents or grandparents who struggle to unbuckle kids’ car seat buckles (commonly due to arthritis, carpal tunnel syndrome, de Quervain’s or other hand/wrist conditions).
Barbara Hellman, MOT, OTR/L and her daughter Becca are eager to share UnbuckleMe with people who need it. Use promo code OTLOVE to save 15% off purchases on the website.

They also work with private clinics and practitioners across the country and sell wholesale with a minimum 6 piece order.

Here’s a great video of the product in action: https://youtu.be/5yXB76HvVmoNeed some inspiration? Read this blog and get inspired on  how they brought this product to market!Feel free to reach out to Barbara directly at barb@unbuckleme.com to learn more.

Connect with us on FacebookTwitter and Instagram!


Pediatric Therapy Equipment for Sale in Manhattan ( NYC)

The sale includes some office equipment plus a climbing wall, special needs high backed swing, portable foldable play pen and balls, Little Tikes high backed 2 in 1 Baby toddler swing  and other  pediatric therapy equipment including this 10 x12 swing frame ( can help with disassembly) is for sale. All in great shape and reasonably priced.

For a full list  and description of equipment, plus prices and year bought  click here.  and download the spread sheet. Cash and checks are accepted. The practice owner will require an immediate deposit on all large items.  
Questions or to make arrangements??  Contact the practice owner at  917 544 0897
or email at  

Interested parties can receive pictures of the equipment. Pick up must be completed by July 12, 2019 – address:
227 West 29th St. #3R
Btw 7th-8th Ave
NYC 10001

Please feel free to share with colleagues.

UnitedHealthcare Announces New Pilot Program to Increase Access to Physical Therapist Services as Result of Collaboration With APTA

This week, UnitedHealthcare (UHC) announced a pilot program in 5 states that will waive the cost of copays and deductibles for 3 physical therapy sessions for patients with low back pain (LBP) living in Connecticut, Florida, Georgia, North Carolina, and New York. The pilot, which could affect as many as 1 million enrollees, goes into effect July 1, 2019. Other states will join the program in 2020 and 2021.

Specifically, the pilot will be available to UHC enrollees with new onset of LBP when receiving care from an outpatient in-network provider. This benefit change will not extend the enrollee’s physical therapy or chiropractic benefit maximum, and will apply only to services related to treating back pain. Enrollees must have physical therapy or chiropractic benefits remaining in order to use this benefit.

UHC will send emails about the benefit change on a quarterly basis to enrollees in the 5 states as they gain access to the benefit. Information also will be included on myuhc.com in the enrollee’s benefit information under Rehabilitation Services – Outpatient Therapy and Chiropractic (Manipulative) Treatment.

This pilot follows a multiyear collaboration between APTA, OptumLabs, and UHC that included publication of a study in the American Journal of Managed Care (subscription required). This study affirms that higher copays and payer restrictions on provider access may steer patients away from more conservative treatments for LBP, including physical therapy and chiropractic services. “Innovative modifications to insurance benefits,” authors write, “offer an opportunity for increased alignment with clinical practice guidelines and greater value.”

“This type of collaboration between a professional association and a private insurer is key to advancing the essential role of the physical therapy profession in improving outcomes for patients,” says Carmen Elliott, MS, APTA’s vice president of payment and practice management. “APTA continues to advocate for benefit design that is validated by data and meets the needs of patients, providers, and payers.”  For additional info 

Here’s my two cents... Having been in the industry for long enough to to remember the days when providers worried that insurers would not honor negotiated reimbursement rates, while insurers were concerned  that providers would find loopholes to augment the claims they submitted,  I am always happy when I read of  insurer-provider alliances. I do  think this program is a step in the right direction. On the other hand, while the APTA was talking with UHC, I wish they would have discussed how this insurance company has devalued the profession, and has adopted a LOW flat fee methodology for its in network providers that does not factor in the amount of time a therapist spends with a patient. UHC also has a history of audits using a “Recovery Services” team who aggressively try to classify therapy services either as medically unnecessary, or retroactively deny payment, and often demand  refunds because documentations submitted in audits ” did not support” payment or meet their standards. For certain practices, especially those OON, I have never seen a more aggressive attempt to classify services that were rendered in the good faith that they would be paid for as “overpayments” with refunds demanded or taken from future payments. These are not simply “first world problems’ of physical therapists; they strike at the core of why more and more practices opt out rather than in with carriers like United Health Care. Addressing these core issues could help all patients, not just those with LBP and really help increase a patient’s access to physical therapy.