The list of providers who are trying to make the case that their services are essential — and cost-effective, and cost-preventing — includes psychologists, dentists, optometrists, social workers, urgent care clinic managers, acupuncturists, chiropractors, and more.
Insurers and the providers have been fighting the battles with each other and in state legislatures for decades.
Now the national effort to develop the new “essential health benefits” (EHB) package is forcing the country to engage in a new, intense, wonky round of debate about what health care matters, and why.
One group in the EHB battle includes rehab therapists — the providers of physical, occupational and speech therapy who help patients overcome everything from broken legs to strokes, and who, in some cases, may provide similar, “habilitative” services to children with autism, mental retardation and other disorders who are not on track to develop typical life abilities in a typical way.
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PTPN — a network that represents about 3,500 rehab and habilitative therapists — has been trying to help the therapists deliver the message that spending money on the therapists’ services up front can help hold down the total cost of care and improve overall outcomes.
“There’s a lot of return on investment to be had with a robust rehab benefit,” said Dr. Michael Weinper, PTPN’s president.
The EHB cometh
Congress sparked the current wave of provider group outreach campaigns by making the EHB package provision part of the Patient Protection and Affordable Care Act of 2010 (PPACA).