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The American Physical Therapy Association (APTA) has released it’s statement regarding the transition from Cigna to American Specialty Health physical therapy contracts:
APTA sent a comment letter to CIGNA summarize concerns regarding the Cigna National Physical Medicine Clinical program’s use of American Specialty Health (ASH). Here are some of the points APTA shared with Cigna:
- ASH has limited physical therapy experience and it does not have the requisite expertise to render appropriate clinical decisions regarding medically necessary physical therapy services.
- The ASH Provider Agreement (Agreement) is overly complex, difficult to follow, and will not be readily understood by most therapy providers.
- The Agreement’s payment methodology imposes a burdensome and one-sided appeals process.
- The ASH provider tiering mechanism as described in the Clinical Performance System is unduly complex and arbitrary, and it is not keyed to clinical outcomes.
- The Agreement’s administrative features are burdensome, including the MNR process and the obligation to check the Medicare exclusion list monthly.
- Utilization management under the Agreement calls for non-PTs to review appeals of adverse decisions, and it is not truly evidence-based, since it relies on Clinical Practice Guidelines (CPGs) selected by ASH via a process that does not meet APTA standards.