June 19--Highmark Inc. is clamping down on chiropractors and physical therapists in an effort to reduce use of those services and cut costs, the Downtown-based health insurer said on Tuesday.
As the state's largest health insurer, with 4.9 million members, the move is likely to spur similar action by other carriers across the state, experts said.
"Utilization of physical therapists and chiropractors has been and continues to be a problem for all insurers," said Jonathan Greer, vice president of the Insurance Federation of Pennsylvania Inc., a Philadelphia-based trade group. "Highmark, because of its market dominance, dictates market practices."
Starting Sept. 1, Highmark will require chiropractors and physical and occupational therapists to receive authorization from the company to continue treating patients after eight visits in a year. Highmark's health insurance plans that offer chiropractic treatments can vary widely, but typically cover at least 20 visits a year, the company said.
"Inappropriate utilization associated with physical medicine services represents a significant cost to Highmark group customers and members," the company said. About 2,750 chiropractors, 3,450 physical therapists and 800 occupational therapists will be affected by the new policy.
Dr. William Aukerman, a chiropractor who's practiced in Greensburg for 30 years, called it "absurd" and said Highmark is unfairly targeting his profession.
"I think the eight-visit limit is definitely arbitrary," Aukerman said. "There's no peer-reviewed journal that says it needs to go up for review at eight visits."
For example, it typically takes 16 to 28 visits to treat a disk herniation, he said.
Highmark will require providers to submit a treatment plan justifying additional visits. The company said its claims data show nearly two-thirds of its members have their issues resolved in eight visits or less.
Highmark is contracting with Healthways Inc., a Nashville, Tenn.-based company, to review the treatment plans.
Highmark spent more than $200 million paying chiropractors and physical and occupational therapists in 2010, and those costs are growing, said Dr. Virginia Calega, Highmark's vice president of medical management and policy. The company declined to provide specific rates of increase for those costs.
The new policy applies to Highmark insured groups in Pennsylvania and West Virginia, and to Highmark individual members and Medicare Advantage members in those states. Groups that are self-insured may also participate, Highmark said.
The Pennsylvania Chiropractic Association is opposed to the authorizations, said York County chiropractor Dr. Eric Osterberg, a vice president on the Harrisburg association's board.
"There's a very small number of practitioners in every health care field that use services too much," Osterberg said. "They're shooting bazookas instead of using fly swatters" to deal with over-utilization of chiropractic treatment.
There are about 4,300 chiropractors in the state, Osterberg said.
Tom Tomczyk, principal in the health care practice at Buck Consultants, Downtown, said this isn't the first time a health insurer has tried to cut down on chiropractic treatments. There can be abuses of over-treatment, he said. As long as Highmark follows best medical practices in determining whether additional treatments are necessary, he said, "It's a good step in the right direction."
Alex Nixon is a staff writer for Trib Total Media. He can be reached at 412-320-7928 or email@example.com.
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