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Network Adequacy

22 May 2022 8:12 AM | WSMTA (Administrator)


by Elizabeth Jane Brooks, LMT, BCTMB

Last month, WSMTA asked our members if they were turning away insurance patients. In response, 20% said no (with some saying they would like more) while 73% said yes. Of those who said yes, 33% said they terminated some or all of their insurance contracts. These results lead to a recent board discussion on network adequacy and how some therapists have unfounded concerns over not taking new patients.

To begin, what exactly is network adequacy?

In order for an insurer to deliver their members medical benefits, they are required by law to supply a geographic area with an adequate number of in-network providers capable of providing those services in a timely manner. To do this, they create provider panels: listed as directories of contracted providers. If an insurer can show that it has an adequate supply of providers, it will close their provider panel and no longer issue new provider contracts. Because of this, it is important to let the insurer know when you are not accepting new patients. If medical providers inaccurately report that they are accepting new patients, the insurer cannot accurately determine if there is a need for additional providers.

When there is network inadequacy, it’s common to hear patients complain about how long it takes to get an appointment with their healthcare providers—and we’re hearing this more and more. With the proliferation of narrowing health insurance networks, it is vitally important for us to be part of the solution.

Some participating providers are concerned that if they report being closed to new patients it will negatively affect them and their contracts. To be sure, this is not just an issue for massage therapists, but for all healthcare providers. However, this concern is unfounded. Reporting that you are not currently accepting new patients will not harm your contract or reflect poorly on you. Instead, it will have the opposite effect: it will show that you and your services are in demand.

Faulty information impairs the entire system. In order for insurers to provide their members with the required number of providers, it is imperative that they have accurate information so that they can properly determine their adequacy. Accurate reporting and frequent status verification, therefore, is a best practice that helps insurers both credential a sufficient number of providers for their members and allows newer practitioners to become contracted. It helps everyone.

With all the issues facing insurance in our industry, accurately reporting our status is one critical way we can both encourage and reward good insurance practice.

Upcoming Event: Register Today

WSMTA Annual Meeting. June 26 2022 -Empowering LMT's and Clinic Owners in an Insurance Dominated Environment.

EVENT DETAILS:

Please join us for the 2022 WSMTA Annual Meeting, including continuing education! 

This year we have chosen to meet once again via Zoom. We have realized that this format has allowed us to reach LMTs well beyond the greater Seattle/I-5 corridor areas, so we are continuing in an online format. 

This year's theme is:

Empowering LMT's and Clinic Owners in an Insurance Dominated Environment.  

We have a lineup of three very knowledgeable presenters.  Here are the logistics of the Annual Meeting:

Day:  Sunday, June 26, 2022

Time:  9:30 am - 2:30pm PDT

Where:  Zoom

CE Hours:  4 hours

John Conniff, Attorney:

John Conniff combines his broad background and practical knowledge to help clients find workable solutions to difficult problems. For over 25 years, he has counseled individuals, businesses, professionals, legislators, and government officials. In addition to running a law firm, John is a serial entrepreneur. He has owned or co-owned small businesses including Healthy Patients | Healthy Lives, providing business services to small health care practices and a multi-media company – JJP Media.

His wide range of experience provides him with insight into the complicated connections between business and law. He has worked extensively on employer issues, business contracting, insurance regulation, information privacy and security, health care regulatory

compliance, ERISA, and business transactions. John is a local attorney who has a decades long history with healthcare law and massage. He will be presenting on the topics of:

  • Competition law and healthcare networks

  • Antitrust and related business practices law

  • Supply and demand (with regards to massage)

  • Network adequacy and directory accuracy

B.J. Erkan, LMT:

While serving in the US military in 1990, B.J. hurt his back and experienced a musculoskeletal injury from the patient’s point of view. He was referred to a naturopath that had been previously trained in bodywork. Extremely skeptical at first, B.J. had a life changing, perspective shifting experience. Realizing he was meant for different things, he and his family moved to the Seattle area in 1991.

B.J. graduated from the Brian Utting School of Massage in 1994. Soon after being licensed, He had the opportunity to treat an MD with severe low back pain, and became known in the Kirkland area as a therapist who could effectively treat musculo-skeletal pain. In 1997 He began teaching massage anatomy and physiology at Bastyr University. In 1998 B.J. moved from Kirkland to Bothell and opened Bothell Integrated Health (BIH), LLC. Since then he and the BIH staff have given over 200,000 massages to people from Bothell and the surrounding areas. He also enjoys teaching CE classes to the BIH staff, and other therapists, and has taught, by request, at other medical massage clinics. BJ will be discussing:

  • History and economics of the massage business and how this relates to the formula of price setting and the importance of the collection of data of actual overhead costs in a variety of settings. 

  • The downside of signing contracts for low pay and how that affects the entire profession. 

  • The power of “collaboration and solidarity” amongst massage therapists, massage clinics, massage profession associations and other allied professional associations.

  • How to empower providers and our patients to create positive change in reimbursement rates.

Jane Brooks LMT:

Jane runs a private therapeutic massage practice dedicated to injury treatment and chronic pain relief. She is a board director with WSMTA, educator, writer, business consultant and the inventor of a patented seamless face cradle cover. As a seasoned therapist who has successfully navigated poor economic times, decreasing insurance rates, excessive demand for service, and Covid-19, she has a keen interest in helping others create their own sustainable and lucrative practice. Jane has been strategic in growing her practice to include multiple streams of income and moving from an insurance to a cash-based practice—all while charging premium prices, working fewer hours, and teaching others how to do the same. Jane will talk about:

  • How to increase revenue and stability with your insurance based practice.

  • How to transition from an insurance-based practice to a cash-based practice.

  • Ideas for potential additional financial streams and strategies.

ADDITIONAL INFORMATION:
Zoom attendance is 100 participants. We plan to record the meeting for later access and viewing.

 WSMTA Raffle Prizes for June 2022 Anual Meeting.pdf



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