Episode 96 - Les Shute, part 1: A Fairness Advocate

Les Shute

Les Shute is the founder and President of 2PointOnline.  It is currently on hold for Les but it’s an online technology and consulting business whose primary focus is to introduce a platform that will allow transparency for claims professionals related to pricing and service of physical therapy services specifically serving the workers compensation market. He's also serving as the Director of Business Development for Focus On Therapeutic Outcomes.  In 1997 he cofounded Network Synergy, a specialty network company.  Over the past 15-years, Mr. Shute has built upon his extensive education and public speaking experiences regarding the evolution of managed care business models.  He is a graduate of North Central College where he holds a BBA in Marketing.  His commitment to establishing win-win business relationships and his passion for doing the ‘right things’ at the ‘right time’ will be the catalysts that propel his work to a sustainable position of commercial success and market leadership.

 

Show Notes

 

Personal Background

Les enjoys living in sunny Florida.  He and his wife have two daughters. 

 

Professional Background

Les explains that he’s a worker’s compensation industry specialist.  He outlines the progression of his career from an adjuster where he called providers and managed cases to his work in specialty networks to now his advocacy for providers. 

He’s developed the observation that PT’s tend to be much more likely to receive the “hammering” or being targeted by the payers.

Les also mentions the worry that therapists who compete can’t talk to each other for fear of collusion.  Les strongly encourages therapy providers to get together and talk to learn from each other.  

 

Quote

“When you’re a hammer, everything looks like a nail.”

He also describes the behavior of insurance companies like the ‘wack-a-mole’ game which you may have to listen to understand.  Les has an idea as to why physical therapists seem to have an affinity to be sitting targets to get “wacked.”

 

Les mentions a Physical Therapy Business Alliance (PTBA) and would recommend PT’s to talk to each other.

 

The Timing of Transformative Change

Alternative Payment Models are on the horizon based on what Les understands.  He predicts a timeframe of when this change from payment for procedure or fee-for-service to value-based purchasing and payment.  He shares that the Medicare goals are to pay a percentage of the claims based on outcomes.  He believes patient-reported outcomes will be very important to measure and that data collected on patients will position a clinician much better.  

 

Why is it Important to Have Awareness of Reimbursement

Les explains the interaction between specialty networks and payers and conversely their interaction with providers.  They play both sides in attempting to secure the need for their service and set each of the other parties against each other.

 

What Makes Effective Outcomes

Prior, there has been little to no focus on outcomes.  In the near future though, measuring effectiveness and efficiency, that is, how much improvement have you achieved and how efficiently have you done it are most important.