Re: National P&O Contracting/Patient Most play A Role
Tony Barr
Description
Collection
Title:
Re: National P&O Contracting/Patient Most play A Role
Creator:
Tony Barr
Date:
9/13/2006
Text:
Susie Ebersbach of POINT Health Centers of America, Inc. has accurately
provided excellent input to the short longevity a independent provider
could face if this national O&P contracting assault by Linkia is
successful.
However, the patient of these services is also negatively effected with the
impact of such a consequence and to their future choice of providers.
All patients of comprehensive O&P care should be active participants in
their medical care and should contact their health care providers opposing
exclusive contracting resourcing.
Every provider should encourage their patients to have open discussions with
their health-care providers about the proposal and the severe limitations
incurred of national contracting to Linkia and ONE managed healthcare
provider network.
Most of you, as independent providers, have formed special
alliances,friendships and professional relationships with your patients for
years. Inform them of what is occurring here and that if they don't react
you may no longer be able to be their provider.Ask them to call their
insurer.
Once they are properly informed,that under this scenario, if successful,
they may have no longer have access to your professional care and the thrust
of this consequence is not only felt by you, but also by them.
Inform them of what is being proposed here. Pressure ACA (who is partially
funded with tax payer dollars to represent the needs, to educate,empower on
behalf, and to advocate, for all amputees), Multiple Scoliosis, Spina
Bifida, and other national associations representing the handicap, what is
at risk and to oppose national O&P contracting with ONE primary management
network of O&P providers.
Patients also most play a role in their health care future.
Anthony T. Barr
President
Barr Foundation
www.oandp.com/barr
www.ErtlReconstruction.com
-----Original Message-----
From: Orthotics and Prosthetics List [mailto:<Email Address Redacted>] On
Behalf Of Susi Ebersbach
Sent: Wednesday, September 13, 2006 12:39 PM
To: <Email Address Redacted>
Subject: Re: [OANDP-L] National P&O Contracting
I have read all the responses to the Smithson National P&O Contracting
post and noted there is a very basic concept no response has specified,
though several have come close, and I fear it is so basic we may believe it
to be common knowledge. You won't often see my opinions on the list-serve,
though I read it faithfully and am regularly influenced by all of yours. If,
in fact, there is an advisor to major insurers in the U.S. out there with
a lack of understanding of this key capitalistic concept, then I would hope
this response will help clarify and educate.
In my opinion, here is the fundamental concept lacking from the National
P&O Contracting According to Smithson post....
Yes, it is true that managed care insurers desire to lower their costs of
administration, just as providers do, by streamlining contracting,
credentialing and service location management functions. (What is still ripe
for debate is whether these costs are lowered, or simply deferred to the
provider). At any rate, insurers may be in the market for network services.
Yes, it is true that both Linkia and POINT (not OPGA-which does not contract
to service managed care organizations) strive to provide these same benefits
to managed care insurers.
The key difference between the POINT network (owned by VGM) and the Linkia
network (owned by Hanger) is that VGM does not own, or intend to own any
service provider locations. Therefore, it does not intend to move
market-share, via POINT, to VGM. The fees to operate the network are
similar, but POINT does not take the service provider portion of payment
home to its bottom line. The same cannot be said of Hanger, who clearly
operates Linkia to gain market-share through Linkia, and intends to move as
much service as possible to its Hanger service centers. This makes the
liaison between CIGNA and Linkia/Hanger monopolistic/monopsonistic in the
view of independent providers and of mindful patients. It poses an inherent
threat to the independents survival and only an independent company that is
willing to turn its business over to its competitor would logically
cooperate. If this model is expanded, patients will ultimately suffer.
It's not purely a matter of the number of providers in each network, the
core issue centers around the ownership of the service locations the
contracted entity will naturally prefer to send insureds to for service, and
the long-run impact the gradual shift to a single provider will have on the
industry.
This may not matter to the insurer, but it is of critical importance to the
survival of the independent provider.
Regards,
Susi Ebersbach
Director of Business Development
POINT Health Centers of America, Inc.
7061 Corporate Way
Dayton, OH 45459
Tel (937) 439-7869
Fax (937) 439-7858
Cell (866) 764-6860
<Email Address Redacted>
www.pointhca.com
provided excellent input to the short longevity a independent provider
could face if this national O&P contracting assault by Linkia is
successful.
However, the patient of these services is also negatively effected with the
impact of such a consequence and to their future choice of providers.
All patients of comprehensive O&P care should be active participants in
their medical care and should contact their health care providers opposing
exclusive contracting resourcing.
Every provider should encourage their patients to have open discussions with
their health-care providers about the proposal and the severe limitations
incurred of national contracting to Linkia and ONE managed healthcare
provider network.
Most of you, as independent providers, have formed special
alliances,friendships and professional relationships with your patients for
years. Inform them of what is occurring here and that if they don't react
you may no longer be able to be their provider.Ask them to call their
insurer.
Once they are properly informed,that under this scenario, if successful,
they may have no longer have access to your professional care and the thrust
of this consequence is not only felt by you, but also by them.
Inform them of what is being proposed here. Pressure ACA (who is partially
funded with tax payer dollars to represent the needs, to educate,empower on
behalf, and to advocate, for all amputees), Multiple Scoliosis, Spina
Bifida, and other national associations representing the handicap, what is
at risk and to oppose national O&P contracting with ONE primary management
network of O&P providers.
Patients also most play a role in their health care future.
Anthony T. Barr
President
Barr Foundation
www.oandp.com/barr
www.ErtlReconstruction.com
-----Original Message-----
From: Orthotics and Prosthetics List [mailto:<Email Address Redacted>] On
Behalf Of Susi Ebersbach
Sent: Wednesday, September 13, 2006 12:39 PM
To: <Email Address Redacted>
Subject: Re: [OANDP-L] National P&O Contracting
I have read all the responses to the Smithson National P&O Contracting
post and noted there is a very basic concept no response has specified,
though several have come close, and I fear it is so basic we may believe it
to be common knowledge. You won't often see my opinions on the list-serve,
though I read it faithfully and am regularly influenced by all of yours. If,
in fact, there is an advisor to major insurers in the U.S. out there with
a lack of understanding of this key capitalistic concept, then I would hope
this response will help clarify and educate.
In my opinion, here is the fundamental concept lacking from the National
P&O Contracting According to Smithson post....
Yes, it is true that managed care insurers desire to lower their costs of
administration, just as providers do, by streamlining contracting,
credentialing and service location management functions. (What is still ripe
for debate is whether these costs are lowered, or simply deferred to the
provider). At any rate, insurers may be in the market for network services.
Yes, it is true that both Linkia and POINT (not OPGA-which does not contract
to service managed care organizations) strive to provide these same benefits
to managed care insurers.
The key difference between the POINT network (owned by VGM) and the Linkia
network (owned by Hanger) is that VGM does not own, or intend to own any
service provider locations. Therefore, it does not intend to move
market-share, via POINT, to VGM. The fees to operate the network are
similar, but POINT does not take the service provider portion of payment
home to its bottom line. The same cannot be said of Hanger, who clearly
operates Linkia to gain market-share through Linkia, and intends to move as
much service as possible to its Hanger service centers. This makes the
liaison between CIGNA and Linkia/Hanger monopolistic/monopsonistic in the
view of independent providers and of mindful patients. It poses an inherent
threat to the independents survival and only an independent company that is
willing to turn its business over to its competitor would logically
cooperate. If this model is expanded, patients will ultimately suffer.
It's not purely a matter of the number of providers in each network, the
core issue centers around the ownership of the service locations the
contracted entity will naturally prefer to send insureds to for service, and
the long-run impact the gradual shift to a single provider will have on the
industry.
This may not matter to the insurer, but it is of critical importance to the
survival of the independent provider.
Regards,
Susi Ebersbach
Director of Business Development
POINT Health Centers of America, Inc.
7061 Corporate Way
Dayton, OH 45459
Tel (937) 439-7869
Fax (937) 439-7858
Cell (866) 764-6860
<Email Address Redacted>
www.pointhca.com
Citation
Tony Barr, “Re: National P&O Contracting/Patient Most play A Role,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/227291.
