Providing Active Care
for Active People

TPR Pilot Study

Updated September 2017 from Joe Greene:

I wanted to take a moment to provide a status update on the Wisconsin Pilot, as well as provide some general direction as to where the project is heading next. As you know, the pilot officially ends at the end of this month in the three states.

It is simply impossible to appropriately thank everyone in Wisconsin and beyond for your support, work, data collection, advocacy, ideas, and future commitment to what happens next. Thank you so much for all you have done to help the NATA, our profession, and our state make progress in the area of insurance recognition and employer advocacy. We are breaking new ground and we hope to accelerate progress nationally based upon what we have learned in the pilot states!

I do want to especially thank those on our team with OrthoVise. They include Kyle Scharer (Operations) , Steve Allison (Implementation), and Ryan Wilkinson (Education). They focused on the areas in parentheses, but were my sounding board with everything and helped in many other areas along the way. In addition to Kyle, Steve, and Ryan, Lincoln Likness (Hudson Physicians) provided physician advocacy for the project early on. We also could not do what we have done without all of our pilot site coordinators. Thank you so much for all of your efforts in implementation and data collection! I also want to thank Rick Shaw (IN), Mary Kay Rohrkemper (OH) and Michelle Kahler-Campbell (OH) who functioned in the roles of State Business Development Coordinators in Indiana and Ohio. We certainly learned a great deal from each other and about what will work moving forward. I also need to thank all of those in WATA State Leadership. This especially includes Kenny Wilka, our past President who believed and advocated for Wisconsin to be a pilot state, and Brent Amble, our current President. In addition to Brent and Kenny, I want to express thanks to the entire WATA board and to Mark Husen, our WATA Reimbursement Committee Chair. The alignment of our association in prioritizing this initiative has made all of the successes we have attained possible, and have allowed us to work on something that we believe to be incredibly important and are passionate about. It has been fun to tell the story of athletic training to payors, employers, athletic trainers, and students in support of the project, and change many minds and perceptions along the way.

Finally, I need to thank Clark Simpson. Without Clark’s vision for this project, his design of this effort, and his advocacy with the NATA Board of Directors, we would simply not be on the tipping point of substantial progress in the area of insurance recognition. He gave me (us) the opportunity in the pilot states to take this effort on. We designed our own roadmaps along the way and learned for the entire profession. Thank you Clark!

You should know that I have submitted a draft of the final report at this time to Amy Callender, who is the NATA Director of Governmental Affairs and has oversight over this project. Amy and I are reviewing/editing/amending in advance of a report to the NATA Board of Directors in November. The report includes the learnings and recommendations that need to be considered by the Board and National Office. It is my hope that we continue to move this initiative forward with a very minimal gap in effort. I look forward to sharing more with all of you when I can about the direction and specific details. I think you will be pleased with the direction it will be headed in.

Just a few important new updates specific to Wisconsin at this time.

  1. We have secured another meeting with the Director of Medicaid in Wisconsin. His name is Mike Heifitz and we meet with him on 10/11. We will be putting forward our formal request for recognition.
  2. We just learned yesterday that WPS, Arise, and Arise Aspirus have removed athletic training from their list of exclusions when their 2018 Coverage policy goes into effect with respective institutions. This will be January 1 at the latest. We have had success with WPS inconsistently with prior authorization. After January 1, WPS prior authorization providers (ie Magellan et al) will take this into consideration and should approve automatically. If this is not the case, let Joe know asap.
  3. We will be applying for recognition by Security Health Plan again. If accepted, this likely would not go into place until Calendar Year 2019.
  4. Humana, Network, Aetna and United remain priority targets with other smaller market share payors on the horizon. The precedents with other payors should increasingly help our cause with payors who still exclude athletic training or have not added athletic trainers as providers who can deliver physical medicine and rehabilitation services.
  5. Just a reminder that Anthem Blue Cross and Blue Shield of Wisconsin will begin recognition when their 2018 coverage policies go into effect. This will be January 1, 2018 at the latest.
  6. Multiple new sites are coming on board and Steve Allison continues to work with many of them who are at various stages, We have had contact with three new sites in the last month that are interested in using athletic trainers in roles that are reimbursable.
  7. For your background and utilization, I have included the most updated payor summary below. As you know, the more payors that come on board shifts the business case positively for employers.

Payor Recognition Summary

Commercial Recognition: Not on Plan Exclusions: 11

Anthem Blue Cross and Blue Shield of Wisconsin
Arise
Arise Aspirus
Dean Health Plan                          
Quartz Health Plan
Unity (Gundersen and Physicians)
 PlusAurora BayCare: Self Insured
FortCare Cerner: Self Insured
Sysco: Self Insured
WPS
Commercial: Prior Authorization Required: 8

Cigna
Group Health Cooperative
Health Partners
Aetna
Humana
Medica
United
WEA Trust
Workers Compensation:  36

Acuity
Aegis
AIG
America WC
Amtrust North America
Argent
Berkley Agri-Business
Broadspire
Chubb
CBCS
CCI, Columbia County
Cincinnati Insurance
CNA Claims Plus
Corvel
Frankenmuth Mutual
Gallager Bassett
Heartland
Horizon Management Group
Liberty Mutual
Pekin Insurance
Preferred
Secura
Sedgwick
Sentry
Society Insurance
State of Wisconsin
Travelers Indemnity
Travelers Property
Tyson
United Heartland
United WI
Wausau
West Bend Mutual
Western National WC
WI State Historical Society
Zurich American



NATA Board of Director Meeting Presentation

I will have a standard update in June, but I have been focusing most of my efforts on my presentation to the NATA Board of Directors that will occur on Sunday, January 25th. It will be a very positive, honest, and constructive presentation that highlights the progress we have made in the pilot, but will focus upon what we have learned and our recommendations for extending the pilot after it formally ends in September. I will discuss the present gaps and the questions that we have to answer as a profession in order to make significant consistent progress nationally with recognition by payors, and with shifting the culture of athletic training service delivery and how employers seek to utilize athletic trainers.

In addition to highlighting some of the key data and summarizing the pilot project and results from the pilot sites, I can tell you that I will focus the discussion in my time with the Board  upon the following 7 Strategic Themes that are based upon what we have learned in the pilot, and from other experiences.

  1. Alignment of National, District, and State Resources and Initiatives
  2. Governmental Affairs and the Impact of State Practice Act Language
  3. The Importance of Payor and Employer Advocacy
  4. Regulatory and Compliance Review : White Paper or Position Statement Development
  5. Billing and EHR Vendor Communication and Standardization
  6. Utilization of Legal and Regulatory Resources
  7. Pre and Post Professional Education Reform

NATA News Articles

I have attached multiple articles that we have contributed to in the NATA News that highlight the efforts and the results of our pilot. There will be another article specific to EMR adoption and inclusion of athletic training in July, but I hope that you find these interesting if you have not already seen them! Please use them in any way that you feel appropriate. Big thanks to Jordan Grantham in the NATA Office for doing a fantastic job with these!

Links to these articles:
October 2016
January 2017
May 2017
June 2017

Dean Health Plan!

We have some very positive news to report from Dean Health Plan. As you know, we have requested that they review their Guidelines for Athletic Training in order to consider changes that were made in our practice act in 2010. The revision looks to be very representative of what we have hoped for and allows athletic trainers to treat those who participate in vigorous physical activity as defined in the Definitions portion of our WI Athletic Training State Practice Act. They have also just confirmed that athletic trainers can see post-operative patients as long as the patients fall under the athletic training scope of practice. More to come specific to this as I have a formal meeting with their Senior Clinical Provider Network Consult on Wednesday to confirm and review their new guidelines and answer any additional questions. If you are already billing DHP, you have likely heard from them.

Other Payors

Our team will continue to work with other payors in the state that have not formally recognized Athletic Training yet. We will be circling back to them with a priority upon WPS, WEA, Humana, Security, and Network. We anticipate formally recognition from WPS shortly. We will also make an overture to United again when the timing is better.

The WATA Third Party Reimbursement Initiative
Owner and CEO of Orthovise: Joe Greene

In conjunction with state and national leadership, we have developed a well designed strategic plan to advance third party reimbursement initiatives in the State of Wisconsin that will implement diverse pilot programs at key locations around the state. This will allow us to learn best practices, but also allow us to identify the educational needs of employers and members. Please be patient with this process as we want to create a well designed and coordinated roadmap for those athletic trainers and employers that wish to pursue third party reimbursement for athletic trainers under the athletic training scope of practice in the State of Wisconsin. This plan will also include advocacy efforts with payors and employers.

Important educational materials and updates will be posted here regularly as we work on your behalf to advocate for the profession of  athletic training in the State of Wisconsin. We will be adding FAQ’s to this page and we will also have the functionality to distribute communication via multiple social media outlets. This will allow us to optimize communication with you, the membership. This is very important to WATA leadership, and we couldn’t agree more. We want to keep you updated as effectively as possible.

We have assembled an exceptional and dedicated team to this cause that is excited to work on your behalf.  These individuals will be working as part of our company to move our mutually agreed upon initiatives forward. We are building the content for these individuals now and will post it below within the next week.

All this said, we cannot accomplish what we need to without the support of the membership and volunteers. With your support, we will work extremely hard to enable opportunities now and in the future for you.

WATA Third Party Reimbursement Pilot Sites

Thank you to our confirmed Pilot Site Institutions! Our pilot site program launched on 7/1/2015.

Portage Divine Savior Hospital
Columbus Community Hospital
Community Health Network
Fort Healthcare
Grant Regional Health Center
Baldwin Area Medical Center
Aurora BayCare Medical Center

The WATA has identified and secured approval from seven healthcare entities that have both practice type and geographic diversity to serve as pilot sites. In order to be a pilot site, each organization has committed to supporting the processes associated with billing third parties for autonomous rehabilitation services delivered by an athletic trainer in an outpatient rehabilitation clinic or through a physician office. The 97005 and 97006 and/or other 97000 series codes will be utilized and supported at pilot sites. Pilots will last 12 months in duration and implementation began on 7/1/2015.

For more detailed information specific to what is required of pilot sites, please see the following document:

Wisconsin Pilot Program Requirements and Description

If you have questions and believe that your institution would explore being a pilot site or consider utilizing athletic trainers in a reimbursable capacity, please contact Joe Greene @ joegreene@orthovise.com or at (608) 220-6196.

 See more at: http://www.orthovise.com/watasbd/

Follow social media for updates: 

OrthoVise Web Presence: http://www.orthovise.com/watasbd
Twitter: Follow us via @joegreeneov
Facebook: Search for OrthoVise or follow the link below and Like us. https://www.facebook.com/pages/OrthoVise/335420689882742
Linked in: Search company pages for OrthoVise, or follow the link  https://www.linkedin.com/company/orthovise?trk=biz-companies-cym

Wisconsin Payor Recognition

 

Full Recognition

Payors that formally recognize rehabilitation services delivered by athletic trainers.

  1. Anthem Blue Cross and Blue Shield of Wisconsin
  2. Dean Health Plan                                                   
  3. Unity Health Plan                                                  
  4. Physicians Plus Health Insurance
  5. Aurora BayCare (Self Insured Plan)
  6. FortCare Cerner (Self Insured Plan)
  7. Sysco (Self Insured Plan)

 

Reimbursement with Prior Authorization

These payors have recognized athletic training services when prior authorization has been secured.

Payment approval is inconsistent and denials are likely or common if you have not obtained prior authorization.

  1. Cigna
  2. Group Health Cooperative
  3. Health Partners
  4. Humana
  5. Medica
  6. United
  7. WEA
  8. WPS

 

Workers Compensation Payors

These payors are workers compensation payors that recognize and reimburse for outpatient rehabilitation services delivered by athletic trainers.

  1. Acuity
  2. America WC
  3. Amtrust North America
  4. Broadspire
  5. Chubb
  6. CBCS
  7. Hartland
  8. Horizon Management Group
  9. Liberty Mutual
  10. Preferred
  11. Secura
  12. Sedgwick
  13. Sentry
  14. State of Wisconsin
  15. Travelers Indemnity
  16. Travelers Property
  17. Tyson
  18. United Heartland
  19. United WI
  20. Wausau
  21. West Bend Mutual
  22. Western National WC
  23. WI State Historical Society
  24. Zurich American