High Co-pays Lead to Increased Health Care Costs

Physical Therapists have seen first-hand the impact high co-pays have on patient's access to medically necessary care.

ALBANY , NY (05/19/2010)(readMedia)-- Editor's note: This release is in direct response to The Employer Alliance for Affordable Health Care's release criticizing physical therapy advocacy efforts to reign in run away co-payments.

While the Employer Alliance for Affordable Health Care bills itself as a "coalition of more than 3,000 employers and individuals from across New York, representing more than 200,000 working New Yorkers, committed to preserving quality affordable health care", the organization has the same address as the Health Plan Association of New York and lists in its 2008 federal tax return that the keeper of records for the organization is Leslie Moran, the Senior Vice President of the Health Plan Association.

Empirical evidence has demonstrated that high co-pays ultimately lead to increased health care costs. And physical therapists have seen first-hand the impact high co-pays have on patient's access to medically necessary care.

In January 2010, the New England Journal of Medicine published a study demonstrating that high co-pays resulted in patients foregoing ambulatory care and increased health care costs as those same patients utilized more acute care down the road such as hospital admissions. (1) The authors of that study concluded that "raising cost sharing [co-pays] for ambulatory care among elderly patients may have adverse health consequences and may increase total spending on health care."

"When you have patients who are in pain and recovering from major surgeries forego medically necessary care because they can't afford the high co-pays that can add up to $600 per month or more, you know there is a problem with our health care system," said Matthew R. Hyland, PT, PhD, MPA, CSCS, President of the New York Physical Therapy Association.

The New York Physical Therapy Association has advocated for passage of legislation - (S.4321-A. (Breslin)/A.8171-A. (Cahill) - which would limit co-pays to a reasonable amount and provide individuals in need of physical therapy appropriate access to that care. The legislation would limit co-pays for physical therapy sevices to no more than 20% of the reimbursement to the provider of care.

This approach strikes an appropriate balance between allowing health plans to continue to impose co-pays to deter non-medically necessary care but affords individuals in need of physical therapy appropriate access to that care. It is also consistent with co-pays required under the Medicare health insurance program. Additionally, the legislation does not limit the ability of health plans to impose utilization review of physical therapy claims to deny coverage for non-medically necessary care.

"For critics of the legislation to claim that it is intended to 'increase the bottom line of one or two providers' is absolutely galling. The legislation in no way impacts the reimbursement provided by health plans to providers of physical therapy care," said Hyland.

"Runaway co-pays in New York have gotten so bad that we have seen numerous instances of the co-pays exceeding the negotiated reimbursement provided by health plans for physical therapy care, meaning these health plans are covering absolutely nothing for the costs of physical therapy care. The notion that health plans are providing coverage for physical therapy is increasingly becoming a myth," continued Mr. Hyland.

"I am proud that over 300 physical therapy professionals joined me today in advocating for passage of legislation that would benefit our patients by providing appropriate access to necessary health care. It is the right thing to do for our patients, the health care system and ultimately health plans will recognize that it is in their best interest as well," concluded Mr. Hyland.

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(1) See Trivedi, A, Moloo H. Mor V Increased Ambulatory Care Copayments and Hospitalizations Among the Elderly Vol. 362:320-328 (January 28, 2010).

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Physical therapists are highly-educated, licensed health care professionals who can help patients reduce pain and improve or restore mobility -- without expensive surgery or the side effects of medications. The New York Physical Therapy Association (NYPTA) is a non-profit professional organization composed of approximately 5,000 licensed physical therapists (PTs), physical therapist assistants (PTAs) and PT/PTA students. The NYPTA is dedicated to serving the public's health interests, improving the standard of health for people of all ages, and advancing the interests of physical therapists in the State of New York. Learn more about conditions physical therapists can treat at www.apta.org/consumer, and find a physical therapist in your area at www.findapt.us.