The Blue Cross Blue Shield Physical Therapy Advisory Committee (PTAC) held its regularly scheduled meeting yesterday. We have not been able to meet since November 2019 due to the COVID-19 pandemic.
The meeting was substantial and the committee had robust discussion with BCBS of AL about several issues, including one issue the PTAC had brought up last year. BCBS made a major announcement. A brief synopsis is described here:
· BCBS announced in our meeting that they will be changing their supervisory visit requirement from every 6 visits to every 10 visits.
· This has been a repeated request from licensees around the state, in order to decrease the burden of having to track two timelines. At our meeting last year, PTAC submitted supportive documentation, including Medicare regulations, to BCBS for consideration.
· The change will be effective March 1, 2021. BCBS said they will be sending out additional information to its participants the first part of February formally announcing the change.
· They agreed that notifying licensees would be appropriate now so you can make appropriate changes to your systems.
· BCBS informed us of their new High Performance Network.
· The network was designed by the larger BCBS organization, and AL is only one state taking part in it.
· For now the program is only in the Birmingham Metropolitan Statistical Area (MSA).
· If you are a participating PT, OT or ST in the Birmingham MSA, you are included.
· We asked about measures they are using, and currently for therapy, there are only cost savings measures. Since the program was designed by the larger BCBS organization, BCBS of AL does not know for certain what their plans are to develop these, but will seek additional information and share it with us. We advised that the PTAC would like to be proactive in suggesting quality of care/outcome metrics for this program.
· You can find additional information HERE.
· At this time, there are no plans to expand the program outside of the Birmingham MSA.
· BCBS of AL shared with us some numbers on the impact COVID-19 has had on their beneficiaries:
· Over 7,000 inpatient admissions for ~60,000 inpatient days
· 40% of those days have been ICU days
· They did see a reduction in services outside of the hospital, and were able to give back $83 million in premium relief to its members.
· They successfully implemented telehealth, waived cost-sharing for many of their members, increased access to prescription drugs and gave rural hospitals and rural providers interest free cash advances. Additionally, they gave to communities through meals for seniors, small business loans and PPE for healthcare workers.
· Overall, they believe the telehealth allowed for physical therapists has been successful. They reassured us they will keep allowing it as long as the public health emergency (PHE) goes on. They asked PTAC about their experiences and experiences of other PT providers and we shared the various ways it has been utilized. PTAC believes it is a beneficial mode of therapy delivery even after the PHE, and will work with BCBS to gather relevant data to try to make that happen.
· There are no upcoming medical policy reviews for services PTs provide.
· In 2019, PTAC had presented information and research about the other commercial insurers who have begun waiving copays for a defined set of PT visits for persons with low back pain (LBP). This was because the research is supportive that early intervention by a PT can reduce the overall cost of care for LBP patients, and by waiving copays for the first 4-6 visits, it would incentivize patients to stick with it.
· Due to the onset of the PHE, this project had to be put on hold, but they reassured us they are still interested in further discussions.
If you have additional questions about any of these issues, please reach out to one of your PTAC members:
· Doug Cole @ DCole@therapysouth.net
· Ellen Strunk @ Ellen@RehabResourcesAndConsulting.com
· Jonathan Zecher @ JonathanZ@Focus-physio.com
· Sidney Scarborough @ SidScarborough@gmail.com
· Tiffany Higginbotham @ higginbothamt@therapysouth.net
