Episode 97 - Les Shute, Part 2: The Payer's Perspective

Les Shute

Les Shute is the founder and President of 2PointOnline.  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. 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

Greatest Challenge

For the physical therapist, Les believes the challenge is that we’re viewed as a cost and not as an invaluable member of the team to best manage patients.  The strength of other disciplines, specifically, the orthopedic surgeons can present particular trouble for our profession and PT becomes one of the services or interventions that are “trimmed” out to reduce cost.

 

Memorable Professional Story

Les shared an instance where, when he was presenting he was encouraged, “you really are looking at things with a glass half empty perspective.” Since that discussion and constructive criticism he received he learned that we may best approach this issue in a constructive way.  He elaborates that everyone knows the challenging aspects of this battle so it’s best to maintain the “half full” attitude.

 

Best Professional Advice

Les was once told, “You tried too hard to change the world, you have to operate in the world as it exists rather than the world you want to exist.”  Les sees himself as an idealist and that can influence his ability to resolve the problems that he most wants to change.  

 

Resources 

ww.joepaduda.com is a website that discusses what’s happening in healthcare costs, policy, research, and other news for insurers, employers and providers.

 www.workcompcentral.com provides more legal and regulatory changes and/or egregious issues as it pertains to managing injured workers.

Bob Wilson and Mark Walls both are individuals that have blogs that discuss worker’s compensation issues

 

Payer Organization Negotiations

Les suggests when looking into negotiating rates with payers to first review explanation of benefits and contact their provider relations department.  He explains what to say and what to emphasize.  He also offers what he wouldn’t do and why.  Les clarifies that he used to be on the other end of that phone call of negotiating rates and, if it’s explained well a provider can be successful.

 

Studies

The California workers compensation paper offers a statement of their position on the issue of payment. - although value-based reimbursement programs haven’t been as successful as was hoped, the efforts toward that end will continue as they believe it will eventually help with reducing cost.

CWCI Annual Report on worker’s compensation expenditures is significant because they breakdown the spending to providers and those that go to the management fees.  

Les believes that as we transition to alternative payment methods telemedicine or tele rehabilitation can provide additional value to patient care and control cost in a responsible and effective way.

 

For those who are interested in collecting outcomes in preparation for the alternative payment age upcoming, whether it’s in a formal way through Focus On Therapeutic Outcomes (FOTO) or in a less formal way, he would strongly encourage us all to be actively collecting outcomes.  He also encourages us to get out there and discuss with colleagues about successes and ideas to build the strength of the profession and our practices.

 

If you want to get in touch with Les you can reach him via email or phone at:

lesshute@fotoinc.com

(863) 608-1138

We hope to deliver this content to the committed professional who wants to improve his/her care and we hope to do it in a way that is easily accessible, the world over, in today's technological age.

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