Re: Linkia and Parity
Tony Barr
Description
Collection
Title:
Re: Linkia and Parity
Creator:
Tony Barr
Date:
9/1/2006
Text:
Since the O&P list serve is a valuable and open forum for everyone's
thoughts and ideas, here is my spin of the dilimma the profession and the
end users are facing, whether you label them patients or consumers..
I hope I don't alienate my good friends at Hanger,AOPA,ACA and SPS with
conveying these thoughts and suggestions.
The longevity of independent providers and the patient's FUTURE choice of
providers, are at stake.
Sadly, I believe ACA is advocating ,or at least opening the door, for
Hanger/Linkia, in what maybe their sincere efforts, to better ensure
prosthetic rehabilitation benefits, by supporting prosthetic parity laws in
over 12 states.
Mostly unregulated states I might add, so providers would require no
educational qualifications or credentials if those laws were passed..
ACA supporters and members believe this parity legislation is mainly
focused to mandate proper prosthetic benefits for amputees so they are all
for it. Under that veil, however is the Hanger organization and its wholly
owned subsidiaries Linkia/SPS ability to contract both prosthetic and
ORTHOTIC services with insurers whom must now be forced by law to provide
benefits. The O comes with the P from most underwriters and Hanger is
positioned to offer the lowest cost of services.
Enter Linkia and their ability to provide network management contracts
thru 630 + Hanger providers.
They can undercut any other provider in the system since Hanger also own
SPS and Hanger's cost of goods is deeply discounted.
In the recent past we have corresponded with ACA that the Barr Foundation
would like to consider supporting parity in Florida and any other REGULATED
state, but only with patients having the ability to choose a licensed
provider .
Parity is a ACA/AOPA /Hanger driven and funded effort, many independents in
Florida see supporting parity as the beginning of the end of third payer
provider contracts for them since Linkia/Hanger would be able to more
aggressively bid for the contracts if insurers are legislatively mandated to
provide appropriate O&P benefits.
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!
The result is that you may have the deck stacked against you with the
largest provider network (Hanger), the national O&P trade industry(AOPA),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.
Ivan Sabel, Chairman & CEO, Hanger Orthopedic Group. Reported, We also
recently announced a Linkia contract with Great-West which will go into
effect August 1st, and coupled with our Cigna Linkia contract, we now have
two full network management contracts in place.
There maybe only two options here.
1) Amend the parity bills with the Any Willing Provider Law.
Described below.Since it has taken effect in Arkansas, insurance companies
have been forced to deal with little guys. They may not send the check
directly to the provider, the patient instead, but providers will get paid.
I know that it's taken effect in Kentucky where it originated,.
Perhaps providers would have any interest in pursing that course to perhaps
minimize that concern ?
Thinking this bill might help independent providers to supporting parity
laws, I contacted and asked ACA'S Morgan Sheets, if ACA could support any
willing provider laws to their parity efforts.
They elected not to stating it would be sending mixed signals to legislators
in proposing two bills.
<URL Redacted>
2)File a complaint to the FTC re: possible violation of monopoly laws.
A monopoly is Exclusive control by one group of the means of producing or
selling a commodity or service: Monopoly frequently . arises from
government support or from collusive agreements among individuals (Milton
Friedman). <URL Redacted>
The adverse effects of monopolies can be much more noticeable on an
individual level than in the aggregate. These effects include the
destruction of businesses that would have survived had competition been
based solely on quality and price (with a consequent loss of assets of the
owners and jobs of the employees) and prices for products so high as to
cause hardship or be unaffordable for some people.
<URL Redacted>
Contact FTC for their perspective
http://www.ftc.gov/bc/compguide/index.htm
Interview Susie Ebersbach, Director of Business Development, POINT Health
Centers of America, Inc.
Ask
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.
Asked why Independents would cooperate by participating in a model that will
erode their market share, Ebersbach responded, I have never understood this
myself, so its probably more appropriate to ask the providers who choose to
do this. I will say it is an inconsistent business philosophy to offer your
dollars either via purchasing supplies or providing patient services through
a competitor entity, if you see the entity as a competitive threat.
Clearly, the growth of SPS purchases by independent facilities each quarter
demonstrates those independents are supporting Hanger, and infers they do
not perceive a threat. Over the years, reasons Independents have expressed
to me for engaging in these inconsistent practices revolve around the belief
that Hanger will never be able to provide services of the quality they are
providing at their independent facility, and the belief that this will
continue to translate into retained market share for the independent
practice. I see Linkia as a vehicle to thwart this logic by monopolizing
market share, if the MCO payers allow it.
Interview a displaced patient (contact Roger Lehneis 516-621-7277. He has
one who is concerned)
From all what appear cloudy issues maybe a silver lining. Perhaps this could
be a wake up call for patients AND independent providers not remain passive
and get involved with securing, proper O&P benefits, and what very well can
turn out to be the longevity of their profession and livelihood..
Have an nice weekend....
Anthony T. Barr
President
Barr Foundation
www.oandp.com/barr
www.ErtlReconstruction.com
thoughts and ideas, here is my spin of the dilimma the profession and the
end users are facing, whether you label them patients or consumers..
I hope I don't alienate my good friends at Hanger,AOPA,ACA and SPS with
conveying these thoughts and suggestions.
The longevity of independent providers and the patient's FUTURE choice of
providers, are at stake.
Sadly, I believe ACA is advocating ,or at least opening the door, for
Hanger/Linkia, in what maybe their sincere efforts, to better ensure
prosthetic rehabilitation benefits, by supporting prosthetic parity laws in
over 12 states.
Mostly unregulated states I might add, so providers would require no
educational qualifications or credentials if those laws were passed..
ACA supporters and members believe this parity legislation is mainly
focused to mandate proper prosthetic benefits for amputees so they are all
for it. Under that veil, however is the Hanger organization and its wholly
owned subsidiaries Linkia/SPS ability to contract both prosthetic and
ORTHOTIC services with insurers whom must now be forced by law to provide
benefits. The O comes with the P from most underwriters and Hanger is
positioned to offer the lowest cost of services.
Enter Linkia and their ability to provide network management contracts
thru 630 + Hanger providers.
They can undercut any other provider in the system since Hanger also own
SPS and Hanger's cost of goods is deeply discounted.
In the recent past we have corresponded with ACA that the Barr Foundation
would like to consider supporting parity in Florida and any other REGULATED
state, but only with patients having the ability to choose a licensed
provider .
Parity is a ACA/AOPA /Hanger driven and funded effort, many independents in
Florida see supporting parity as the beginning of the end of third payer
provider contracts for them since Linkia/Hanger would be able to more
aggressively bid for the contracts if insurers are legislatively mandated to
provide appropriate O&P benefits.
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!
The result is that you may have the deck stacked against you with the
largest provider network (Hanger), the national O&P trade industry(AOPA),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.
Ivan Sabel, Chairman & CEO, Hanger Orthopedic Group. Reported, We also
recently announced a Linkia contract with Great-West which will go into
effect August 1st, and coupled with our Cigna Linkia contract, we now have
two full network management contracts in place.
There maybe only two options here.
1) Amend the parity bills with the Any Willing Provider Law.
Described below.Since it has taken effect in Arkansas, insurance companies
have been forced to deal with little guys. They may not send the check
directly to the provider, the patient instead, but providers will get paid.
I know that it's taken effect in Kentucky where it originated,.
Perhaps providers would have any interest in pursing that course to perhaps
minimize that concern ?
Thinking this bill might help independent providers to supporting parity
laws, I contacted and asked ACA'S Morgan Sheets, if ACA could support any
willing provider laws to their parity efforts.
They elected not to stating it would be sending mixed signals to legislators
in proposing two bills.
<URL Redacted>
2)File a complaint to the FTC re: possible violation of monopoly laws.
A monopoly is Exclusive control by one group of the means of producing or
selling a commodity or service: Monopoly frequently . arises from
government support or from collusive agreements among individuals (Milton
Friedman). <URL Redacted>
The adverse effects of monopolies can be much more noticeable on an
individual level than in the aggregate. These effects include the
destruction of businesses that would have survived had competition been
based solely on quality and price (with a consequent loss of assets of the
owners and jobs of the employees) and prices for products so high as to
cause hardship or be unaffordable for some people.
<URL Redacted>
Contact FTC for their perspective
http://www.ftc.gov/bc/compguide/index.htm
Interview Susie Ebersbach, Director of Business Development, POINT Health
Centers of America, Inc.
Ask
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.
Asked why Independents would cooperate by participating in a model that will
erode their market share, Ebersbach responded, I have never understood this
myself, so its probably more appropriate to ask the providers who choose to
do this. I will say it is an inconsistent business philosophy to offer your
dollars either via purchasing supplies or providing patient services through
a competitor entity, if you see the entity as a competitive threat.
Clearly, the growth of SPS purchases by independent facilities each quarter
demonstrates those independents are supporting Hanger, and infers they do
not perceive a threat. Over the years, reasons Independents have expressed
to me for engaging in these inconsistent practices revolve around the belief
that Hanger will never be able to provide services of the quality they are
providing at their independent facility, and the belief that this will
continue to translate into retained market share for the independent
practice. I see Linkia as a vehicle to thwart this logic by monopolizing
market share, if the MCO payers allow it.
Interview a displaced patient (contact Roger Lehneis 516-621-7277. He has
one who is concerned)
From all what appear cloudy issues maybe a silver lining. Perhaps this could
be a wake up call for patients AND independent providers not remain passive
and get involved with securing, proper O&P benefits, and what very well can
turn out to be the longevity of their profession and livelihood..
Have an nice weekend....
Anthony T. Barr
President
Barr Foundation
www.oandp.com/barr
www.ErtlReconstruction.com
Citation
Tony Barr, “Re: Linkia and Parity,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 24, 2024, https://library.drfop.org/items/show/227274.
