FW: [OANDP-L] National P&O Contracting
Tony Barr
Description
Collection
Title:
FW: [OANDP-L] National P&O Contracting
Creator:
Tony Barr
Date:
9/9/2006
Text:
It's becoming evident since the consultant, Ms. Smithson, not only has
ignored our requests for her credentials and telephone # , minimizes
legitimate responses opposing Linkia's monopoly efforts of controlling
O&P(see below comments), and is not posting her replies to the O&P
Listserve, she maybe working for LINKIA.
Ms. Smithson joins the ranks of secret identities that plaque this field and
is most likely a consultant hired by Linkia to field objections, of what may
turn out to be, if they are successful, one provider of choice for all major
insurance companies in the USA to deliver O&P services.
Although I had previously posted by comments directly to Ms. Smithson's ,I
have again posted both her reply to me and my comments for all to read.
It seems relevant to Ms Smithson's quote since the industry has no way to
monitor or measure quality of care, and the industry simply has no
standards of care or outcomes what so ever, is one of the biggest
attractions for working with one provider.
NONSENSE!
It is encouraging to see the growing number of subscribers reply to her
requests on the Listserve .
Perhaps she may honor us in the same way by posting her comments to it as
well ?
Below is her reply to my comments .
Anthony T. Barr
_____
From: sue smithson [mailto:<Email Address Redacted>]
Thank you for your detailed insight. But with all due respect, the challenge
I continue to have is other people, like yourself, have provided responses
that are heartfelt but are all based upon personal experiences and cannot be
measured or quantified. As in your own words you clearly qualify that your
comments are in myopinion, although I do not dismiss the value of your
opinion, respectfully it cannot however be measured or qualified and thus
cannot be given greater weight than the opinions of others.
You state that not all providers are equal, we agree, however this industry
has no way to monitor or measure quality of care, so anyone can make
claims about what patient care or customer service is better or worse. That
is one of the biggest attractions for working with one provider; this
industry simply has no standards of care or outcomes what so ever. It is
our belief that by using one provider quality of care will actually increase
significantly across the board as there will now be one established standard
that can be managed and enforced by one controlling entity. Call it Linkia
or Hanger, it really does not matter, they can control and be accountable
for each and every member in the network.
As for your comments regarding the patient eval programs, I am very aware of
this program and to be very frank, that is a major attraction for national
insurance companies. Finally a systematic method for monitoring patient
outcomes. Plus, no prosthetic provider can deliver care without a written
Rx from a physician, so the limb provided was at the request of a licensed
physician, and in the majority of instances it is a physician that is also
within the same network. In addition, the device requires prior approval
through a prior authorizaton process. What you have identified as a concern
is from my perspective a major attraction and clearly demonstrates a
consistent procedure for quality and controlled care for better outcomes and
better patient management and better cost controls.
I hope this is not coming across as argumentative, that is not my intent.
And I am neither pro Hanger/Linkia or against them.I just want to share with
you my observations from my perspective. I have having difficulty
understanding how this industry works and thinks. I have been overwhelmed
by people stating they do bad care and we treat patients better so the
contract is bad because it prevents patients from being treated by me, but
when it gets right down to it, it really is nothing more than antidotal
stories and personal opinions and complaints from people that just lost a
contract; there is nothing scientific to qualify or quantify the various
companies and no way to measure if the quality of care goes up, down or
stays the same.
It appears that a national contract with one company that can monitor and
manage a national network of providers under one umbrella is a formula for
quality and consistent care and managing costs. Plus, we will for once be
able to establish a benchmark for standards of care, something this industry
has apparently been unable or unwilling to do over the past 50 years or so.
I have having difficulty is seeing any downside to the the patient, the
referral or the insurance provider.
Thank you for your time, I will continue to sift through these responses to
see if I can learn some better insight into this matter so I can better
support the insurance companies that contract for my services.
Sue
Do you have a web site address of your company that I could review for a
little more information and perhaps a telephone number I could call?
Linkia is setting up a national contracting process, for the insurance
companies this appears to be a good thing, sign one contract as opposed to
negotiating and signing hundreds of contracts. Saves administrative costs
and thus keeps premiums down. And yes, Linkia is affiliated with one
national provider, we know that, but why would this be an issue? Coverage,
service and costs are the issues to be considered, as long as that can be
delivered, everything else is secondary.
Linkia HAS set up a national contracting process. Linkia is not only
affiliated with only ONE national provider but is a wholly owned subsidiary
of that national provider. In my opinion eliminating or reducing the
patient's choices of providers by positioning Linkia to contract with major
national insurers is not secondary.
The O&P industry is unregulated, few if any states have licensure, and the
industry as a whole does not appear to have any compliance or internal audit
standards of any consequence. By contracting with one network/company, a
uniform and consistent patient care standard can be applied because it is
being controlled by one group that can actually monitor and enforce minimum
standards, something the O&P industry and association has apparently not
been able to implement with the independent practices.
Eleven states currently have active licensure laws and the 40 others do not
require ANY qualifications, criminal back ground checks, or certification to
evaluate bill Medicare./Medicaid or third party insurers for their service.
Unlike every other legitimate health care profession , there is not
regulated health care providers for the most part nor price controls on
the cost goods (components).This is what insurers should be focused on not
exclusively the lowest cost of services they must provide.
The cost of components is out of line causing a trickle down effect of
multiplying the total cost of rehabilitation and reductions is benefits in
a unregulated health care field..
The AOPA's board and ABC board is heavily saturated and influenced by
Linkia/ Hanger members.
A two year old New York investigation which revolved into multiple state
class action law suit against a Hanger and Hanger facility involving
fraudulent prescriptions is still in play and I believe other billing
issues are currently under investigation nationally by the OIG office.
ABC Professional Disciplinary Committee has taken no action to my formal
complaint so I will assume the case is still open.Hanger president, Tom Kirk
is a director of the PDC committee.
Review AOPA's publication, the O&P Almanac issue, May 2004 pp10-13, Carrie
Parsons wrote Hanger forms MCO to Link Facilities and Payers for discussion
that Linkia is good for the industry!
Is that not an endorsement for Linkia by AOPA who also have independent
provider members?
The result is that the deck maybe stacked against not only independent
providers , but also the patient's future choice of providers .
What is wrong with this picture ?
Linkia securing lucrative contracts with most major Insurers with a 630
plus provider network (Hanger), with the support of the national O&P
trade industry (AOPA), and the nations largest distributors of O&P
components (SPS), AND the nations largest amputee patient non profit
organization (ACA) effectively supporting Hanger/Linkia thru their parity
initiatives efforts, funded with Hanger and industry $$$, to legislate state
parity laws .
It is not only Mr. Kidd that prophesizes the down fall of traditional O&P
care but several others.
Interview Susie Ebersbach, Director of Business Development, POINT Health
Centers of America, Inc.
1) What is the impact of the Linkia model on independent providers,
Linkia,
patients and eventually the payers?
In my opinion, should Hanger be successful in attaining full managerial
contracts to control payer's provider networks, independents will lose
tremendous market share, patients will have severely limited provider choice
and quality of care will erode over time. The number of providers will be
decreased, thereby allowing the major providers remaining to begin to demand
better pricing for at least a portion of their services. said Ebersbach.
When Hanger predicts that $50M in additional revenues is possible thru its
Linkia division, and yet reimbursements are dropping, then these revenues
represent a shift in market share (away from the independent) and NOT growth
in the total market.
Are not the insurers accountable and ethically responsible to who and how
their policy holders are sent and treated ?
In Florida, Blue Cross Blue Shield paid millions of dollars to unlicensed
providers in a regulated state, for non-delivered services.
Ms Smithson, if you are truly a independent consultant to insurance
companies, as you represent yourself, and have accurately stated that the
industry has no standards of care or outcomes what so ever and no way to
monitor or measure the quality of care, may I suggest you advise to your
clients to comply to state licensure laws and encourage the insurance
industry to mandate quality of care by contracting exclusively with licensed
health care providers ? ?
Anthony T. Barr
ignored our requests for her credentials and telephone # , minimizes
legitimate responses opposing Linkia's monopoly efforts of controlling
O&P(see below comments), and is not posting her replies to the O&P
Listserve, she maybe working for LINKIA.
Ms. Smithson joins the ranks of secret identities that plaque this field and
is most likely a consultant hired by Linkia to field objections, of what may
turn out to be, if they are successful, one provider of choice for all major
insurance companies in the USA to deliver O&P services.
Although I had previously posted by comments directly to Ms. Smithson's ,I
have again posted both her reply to me and my comments for all to read.
It seems relevant to Ms Smithson's quote since the industry has no way to
monitor or measure quality of care, and the industry simply has no
standards of care or outcomes what so ever, is one of the biggest
attractions for working with one provider.
NONSENSE!
It is encouraging to see the growing number of subscribers reply to her
requests on the Listserve .
Perhaps she may honor us in the same way by posting her comments to it as
well ?
Below is her reply to my comments .
Anthony T. Barr
_____
From: sue smithson [mailto:<Email Address Redacted>]
Thank you for your detailed insight. But with all due respect, the challenge
I continue to have is other people, like yourself, have provided responses
that are heartfelt but are all based upon personal experiences and cannot be
measured or quantified. As in your own words you clearly qualify that your
comments are in myopinion, although I do not dismiss the value of your
opinion, respectfully it cannot however be measured or qualified and thus
cannot be given greater weight than the opinions of others.
You state that not all providers are equal, we agree, however this industry
has no way to monitor or measure quality of care, so anyone can make
claims about what patient care or customer service is better or worse. That
is one of the biggest attractions for working with one provider; this
industry simply has no standards of care or outcomes what so ever. It is
our belief that by using one provider quality of care will actually increase
significantly across the board as there will now be one established standard
that can be managed and enforced by one controlling entity. Call it Linkia
or Hanger, it really does not matter, they can control and be accountable
for each and every member in the network.
As for your comments regarding the patient eval programs, I am very aware of
this program and to be very frank, that is a major attraction for national
insurance companies. Finally a systematic method for monitoring patient
outcomes. Plus, no prosthetic provider can deliver care without a written
Rx from a physician, so the limb provided was at the request of a licensed
physician, and in the majority of instances it is a physician that is also
within the same network. In addition, the device requires prior approval
through a prior authorizaton process. What you have identified as a concern
is from my perspective a major attraction and clearly demonstrates a
consistent procedure for quality and controlled care for better outcomes and
better patient management and better cost controls.
I hope this is not coming across as argumentative, that is not my intent.
And I am neither pro Hanger/Linkia or against them.I just want to share with
you my observations from my perspective. I have having difficulty
understanding how this industry works and thinks. I have been overwhelmed
by people stating they do bad care and we treat patients better so the
contract is bad because it prevents patients from being treated by me, but
when it gets right down to it, it really is nothing more than antidotal
stories and personal opinions and complaints from people that just lost a
contract; there is nothing scientific to qualify or quantify the various
companies and no way to measure if the quality of care goes up, down or
stays the same.
It appears that a national contract with one company that can monitor and
manage a national network of providers under one umbrella is a formula for
quality and consistent care and managing costs. Plus, we will for once be
able to establish a benchmark for standards of care, something this industry
has apparently been unable or unwilling to do over the past 50 years or so.
I have having difficulty is seeing any downside to the the patient, the
referral or the insurance provider.
Thank you for your time, I will continue to sift through these responses to
see if I can learn some better insight into this matter so I can better
support the insurance companies that contract for my services.
Sue
Do you have a web site address of your company that I could review for a
little more information and perhaps a telephone number I could call?
Linkia is setting up a national contracting process, for the insurance
companies this appears to be a good thing, sign one contract as opposed to
negotiating and signing hundreds of contracts. Saves administrative costs
and thus keeps premiums down. And yes, Linkia is affiliated with one
national provider, we know that, but why would this be an issue? Coverage,
service and costs are the issues to be considered, as long as that can be
delivered, everything else is secondary.
Linkia HAS set up a national contracting process. Linkia is not only
affiliated with only ONE national provider but is a wholly owned subsidiary
of that national provider. In my opinion eliminating or reducing the
patient's choices of providers by positioning Linkia to contract with major
national insurers is not secondary.
The O&P industry is unregulated, few if any states have licensure, and the
industry as a whole does not appear to have any compliance or internal audit
standards of any consequence. By contracting with one network/company, a
uniform and consistent patient care standard can be applied because it is
being controlled by one group that can actually monitor and enforce minimum
standards, something the O&P industry and association has apparently not
been able to implement with the independent practices.
Eleven states currently have active licensure laws and the 40 others do not
require ANY qualifications, criminal back ground checks, or certification to
evaluate bill Medicare./Medicaid or third party insurers for their service.
Unlike every other legitimate health care profession , there is not
regulated health care providers for the most part nor price controls on
the cost goods (components).This is what insurers should be focused on not
exclusively the lowest cost of services they must provide.
The cost of components is out of line causing a trickle down effect of
multiplying the total cost of rehabilitation and reductions is benefits in
a unregulated health care field..
The AOPA's board and ABC board is heavily saturated and influenced by
Linkia/ Hanger members.
A two year old New York investigation which revolved into multiple state
class action law suit against a Hanger and Hanger facility involving
fraudulent prescriptions is still in play and I believe other billing
issues are currently under investigation nationally by the OIG office.
ABC Professional Disciplinary Committee has taken no action to my formal
complaint so I will assume the case is still open.Hanger president, Tom Kirk
is a director of the PDC committee.
Review AOPA's publication, the O&P Almanac issue, May 2004 pp10-13, Carrie
Parsons wrote Hanger forms MCO to Link Facilities and Payers for discussion
that Linkia is good for the industry!
Is that not an endorsement for Linkia by AOPA who also have independent
provider members?
The result is that the deck maybe stacked against not only independent
providers , but also the patient's future choice of providers .
What is wrong with this picture ?
Linkia securing lucrative contracts with most major Insurers with a 630
plus provider network (Hanger), with the support of the national O&P
trade industry (AOPA), and the nations largest distributors of O&P
components (SPS), AND the nations largest amputee patient non profit
organization (ACA) effectively supporting Hanger/Linkia thru their parity
initiatives efforts, funded with Hanger and industry $$$, to legislate state
parity laws .
It is not only Mr. Kidd that prophesizes the down fall of traditional O&P
care but several others.
Interview Susie Ebersbach, Director of Business Development, POINT Health
Centers of America, Inc.
1) What is the impact of the Linkia model on independent providers,
Linkia,
patients and eventually the payers?
In my opinion, should Hanger be successful in attaining full managerial
contracts to control payer's provider networks, independents will lose
tremendous market share, patients will have severely limited provider choice
and quality of care will erode over time. The number of providers will be
decreased, thereby allowing the major providers remaining to begin to demand
better pricing for at least a portion of their services. said Ebersbach.
When Hanger predicts that $50M in additional revenues is possible thru its
Linkia division, and yet reimbursements are dropping, then these revenues
represent a shift in market share (away from the independent) and NOT growth
in the total market.
Are not the insurers accountable and ethically responsible to who and how
their policy holders are sent and treated ?
In Florida, Blue Cross Blue Shield paid millions of dollars to unlicensed
providers in a regulated state, for non-delivered services.
Ms Smithson, if you are truly a independent consultant to insurance
companies, as you represent yourself, and have accurately stated that the
industry has no standards of care or outcomes what so ever and no way to
monitor or measure the quality of care, may I suggest you advise to your
clients to comply to state licensure laws and encourage the insurance
industry to mandate quality of care by contracting exclusively with licensed
health care providers ? ?
Anthony T. Barr
Citation
Tony Barr, “FW: [OANDP-L] National P&O Contracting,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 24, 2024, https://library.drfop.org/items/show/227247.
