National Physical Therapy News Month

The last several days there has been several news items impacting physical therapists:

-we had over a drop of 21% in Medicare with claims withheld and then another temporary fix thru Nov which resulted in a 2.2% increase

-Medpac  released a significant report telling us what we already know-physicians overutilize PT services when they are "in office ancillary".

-MD/PT partners in an email style that is a combination of Publisher's Clearinghouse, Ronco, and Shamwow released their response to Medpac data assuring their current and future clientele that regardless of any changes in law that their will be some type of  legal "work around" for private practices to "partner" (share in revenue) with referring physicians (but of course any legal agreements and potential liability, fraud and abuse  are between you and the doc group we only get a percent of what you get plus of course a "franchise" type of fee that protects your territory for this million dollar original idea that we gave you)

-APTA HOD passed the obvious: Physical Therapists shall have control over all clinical decisions relating to physical therapy.PT's in business relationships should be the exclusive decision makers.  While this would imply to me that this extends to the business relationship of "insurance contracts" and thus support the notion that physical therapy is provided by a physical therapist acting within their licensure, RC 15 which was written with this intent in mind was appropriately withdrawn (language inconsistent with intent).  Hopefully next year, we will have real "alignment"-with all APTA positions, etc. etc. supporting PT's as the exclusive provider which would should rid any trend at  promoting of medicare rules as "the way".

-CMS also released some interesting news on upcoming changes:

On June 25, 2010 the Centers for Medicare & Medicaid Services (CMS) issued the proposed physician fee schedule rule that would implement key provisions of the Patient Protection and Affordable Care Act of 2010 and update payment rates under the physician fee schedule for services furnished on or after January 1, 2011 (CY 2011). If this rule becomes effective, physicians, physical therapists and other health care professionals would receive a 6.1% cut to their Medicare payments starting January 1, 2011 in addition to the 21.3% reduction that has been delayed several times already this year due to the flawed Sustainable Growth Rate (SGR) formula. This reduction was replaced with a 2.2% update until November 30, 2010 when the President signed the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010” on Friday, June 25^th.

In addition to the projected reductions due to the SGR, CMS also proposes a multiple procedure payment reduction policy (MPPR) that would result in significant reductions in payment for outpatient therapy services. Specifically, CMS proposes to make full payment for the therapy service or unit with the highest practice expense value and payment of 50 percent of the practice expense component for the second and subsequent procedures or units of the service furnished during the same day for the same patient. The work and malpractice components of the therapy service payment would not be reduced. The proposed multiple procedure payment reduction policy would apply to both the services paid under the physician fee schedule (PFS) that are furnished in the office setting and those services paid at the PFS rates that are furnished by outpatient hospitals, home health agencies (Part B), skilled nursing facilities (Part B), comprehensive rehabilitation facilities, and other entities that are paid by Medicare for outpatient therapy services. It is estimated that if the multiple procedure payment reduction policy were implemented, payment for outpatient therapy services would be reduced by approximately 13% in addition to the projected SGR payment cut for CY 2011.



In other words, don't get to slap happy with a temporary 2.2% increase as we are coming down on you in more than one way beginning Jan 2011 including a "cascade" phenomenon-decreasing subsequent CPT codes after the first one which might cause a 13% reduction in addition to a 6.1% (can you say "health care reform") plus the 21.3% SGR.    (side note: another blog post for another time but history has a way of recurring here with the cascade ploy as many states in work comp have successfully fought and won in reversing this illogical attempt to cut fees).

Our history with CMS demonstrates why we need the physical therapist as the exclusive provider.  While on the surface, this would appear obvious-am quite sure physicians don't have a position that says "medicine should only be provided by a doctor, nurse, or midlevel practitioner'" our profession pushed CMS that only PT and PTA's can provide "physical therapy" which resulted in CMS being the only major payor that restricts PT from practicing within their scope of practice.  Ironically, many physical therapy state boards thru unfounded and puritanical nearsightedness have attempted and in some cases succeeded in opening up state practice acts and aligning CMS's explicit list.  LET THIS BE THE CASE STUDY OF WHY YOU SHOULD NEVER DO THIS.

This blog has been saying for years that it is a myth that "medicare is one of our best payors".  You cannot consider payment policy outside of their contractual language and regulations.  CMS has the most nitpick restrictions, enhanced compliance liability, documentation requirements, etc. etc. etc.  Most practices that I know spend significant resources and dollars on yearly training, auditing, and testing on medicare rules and such.  When you add the cost of this plus the cost of not allowing a PT to delegate or direct within their practice act, CMS actually ranks amongst the worst sources in payment.  When you now factor in the imminent reimbursement drop coupled with undoubtedly even more regulatory constraint, I can't imagine an environment where it will be viable to see medicare patients down the road without significant drop in PT salaries (PTA salaries will essentially be the same as PT's under this scenario since they are looked at by CMS as the same).    For those of you who still buy into medicare's rules, how would you like your salary tied to their policy and reimbursement? Unfortunately, the saddest impact will be to the growing roster of medicare patients-longer waiting times, possible "undertreatment", and a growing list of PT's who simply will opt out of seeing them altogether.

While there is debate and divisiveness on aligning APTA's governance in its positions this is something that needs to be done sooner rather than later and we should greatly support such efforts as long as they simplify the message-physical therapy is indeed exclusively provided by a physical therapist within their scope of practice.

 

Larry@physicaltherapist.com

This blog post is a product of my own conclusions-my opinion and does not reflect any associates, friends, or acquaintances of mine!