OPINION -- This is a sinister plot by Regence to take advantage and bully therapists and Regence members. It is unequivocally corporate warfare against physical therapy and those we treat. This continues to be my experience as a therapist and clinic owner since the roll out the Regence Care Core program (RCC) in November 2013.
RCC arbitrarily began requiring that all Regence members be preauthorized for physical therapy treatment through a third party program called Care Core. RCC was launched without any regard for members, providers or the astronomical administrative costs to clinics which are more than double of any other health insurer in Oregon and Washington.
RCC is a ruse to restrict access to care without regard to outcomes and value. Quality care with excellent outcomes are not part of the TRCC equation. The less visits per patient diagnosis the higher the clinic is rated. My sources estimate that less than 5% of PT clinics are rated as Tier A, the top RCC pseudo standard. This is astounding since many of us have earned such a comparable Tier A rating from even United Healthcare. If Regence actually had the vision that outcomes as a measurement of value were important this entire fiasco could easily have been avoided. Such statistical analyses are readily available from a number of companies at considerably less costs to ALL involved. Care Connections and Foto are two of the many firms that now measure outcomes.
I do not know any therapist or clinic owner where value and quality are not a top priority. Regence needs to admit that this is a complete fiasco and cease this program immediately. There continues to be valuable dialogue between TRCC and the OPTA and APTA leadership. They have been some improvements but nothing substantial. We must support and communicate with the PT negotiators while keeping the pressure on Regents from the consumer perspective. This can be done by:
1. Discussing RCC with Regence members.
2. Make available the phone numbers for Care Core 1-855-252-1115, Regents 800-676-2583 and the Oregon Insurance commission 503-947-7984 when care is restricted.
3. Advise elected officials.
4. Advise health insurance brokers about the restriction in PT care.
Let’s be proactive to protect the rights of patients and the PT profession.
Keith Glasser MSPT, Cert MDT is the owner of Optimal Results Physical Therapy. [email protected]. The full article is available by contacting [email protected].
Regence is a for-profit organization that exists to serve its administration (first) and its shareholders (second). Why would they behave any differently than what is described above?
I hope that people can eventually put enough pressure on their legislators to make these companies illegal. There is no other remedy. They do not exist to serve the public, but at the moment they are perfectly legal -- and so will continue to take advantage of public largess so long as we allow it.