Myles Morneault

I work for a small critical access hospital in the northern part of the state. Our outpatient therapy clinics see over about 2,000 new patients a year, totaling over 15,000 visits per year. In 87% of our cases, the patients will have completed therapy in 12 visits or less. I'm sure you've heard many people say there is an ever-growing administrative burden related to healthcare and prior authorizations. What we are asking for is to lessen this burden for 87% of our cases. With a change like this, there is also going to be a significant reduction in administrative burden on behalf of the insurance companies. Every time we submit paperwork for prior authorization someone has to review it and make a decision. Each time they request a peer-to-peer review, at least three individuals are involved in this process. The root of the issue here is that patients are getting the brunt of this issue. Just this week, we had three patients who required authorization after their initial evaluation, and we had to cancel their first follow up appointment because we had not heard back from the insurance company regarding their authorization status. Patient care is affected. For most commercial payers, we have to submit for authorization after the initial evaluation. Here is a typical scenario we see every day: A therapist evaluates a patient referred to them from the emergency room with an acute exacerbation of low back pain from repetitive lifting and based on their assessment feels like the patient will be appropriate for discharge in about 12 visits. The therapist asks for 12 visits and the clinic receives notification from the insurance that they are approving 4 visits. So, after two weeks and 4 visits, we then have to submit authorization for more visits. The therapist requests 8 additional visits and we receive notification that they are approving 4 visits. So then two more weeks go by, a total of 8 visits has been used, the patient is making progress and now we have to submit for yet another authorization. The therapist asks for 4 visits. The insurance company comes back and says, before they approve the visits, there needs to be a peer-to-peer review completed. They give the therapist a number to call to schedule a peer-to-peer. The therapist has a full day of patients and therefore the only time to make a call in order to not impact patient care, is during their lunch hour. They call the reviewer who asks a few questions that they could have answered if they had reviewed the therapist's documentation and says okay, the 4 visits are approved. We've now submitted 2 prior authorizations and had a peer-to-peer review in order to get the 12 visits that the therapist had initially requested at the start of care. Our own federal government already uses a system like this. The VA currently approves 15 visits before needing to submit for authorization. Medicare does not require authorization for therapy services. Because the research shows that about 90% of all therapy cases are completed in 12 visits or less. The United States Military utilizes Physical Therapists as primary care providers. In September 2023 there was a landmark review of the economic value of physical therapy, and I invite you to review the findings of this report that support our profession's impact on reducing financial burden on the healthcare system. https://www.valueofpt.com/globalassets/value-of-pt/economic_value_pt_u.s._report_from_apta-report.pdf Thank you for your time and consideration on this matter that will have a direct impact on your constituents who are navigating care in our medical system and reduce the administrative burden on hospitals, clinics, and insurance companies alike.