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October 16, 2015
Since the passage of the Affordable Care Act in 2010, APTA has been engaged in positioning physical therapists in payment and delivery system reforms to better articulate and demonstrate our value to patients, payers, and policymakers. The association's efforts have included the 2013 Innovation Summit, investments in health systems research, advancement of quality initiatives, and initiating payment reforms. We often have pursued these initiatives with partners across the professional societies and trade associations that are part of the larger rehabilitation and physical therapy community.
One part of our efforts has been to systematically change how physical therapists are paid, by moving away from the current unit-based model to a system that focuses on patient management. We chose to begin the process by working with the American Medical Association (AMA) Current Procedural Terminology (CPT) Editorial Panel and AMA/Specialty Society Relative Value Scale Update Committee (RUC). This process has established a strong foundation and complements additional efforts to integrate standardized patient assessment and quality in order to meet the principles for payment reform outlined by APTA's Board of Directors.
We recognize that much interest and anxiety has been focused on these efforts, and APTA is committed not only to developing a model that advances our profession, but to providing our members and partners with the information, resources, and support to transition and implement new models of patient classification for the purposes of payment. We have made considerable progress, and in that spirit I would like to provide an update on the status of payment reform for physical therapy.
Our efforts to reform payment through the AMA established processes has evolved significantly over the past couple of months, as the result of negotiations and opportunities. First, through collaboration within an AMA work group of 12 different health society entities, APTA's original proposal from December 2012 has been modified and split into an evaluation component and an intervention or treatment component to reflect the 2 major areas of a physical therapy episode of care.
The evaluation component has expanded from the current evaluation code (97001) to 3 tiered levels of evaluation. The reevaluation code has been maintained. These 4 codes were approved by the CPT Editorial Panel, and initial values for the codes were approved following APTA's survey of members over the summer and the association's presentation to the AMA RUC in October 2015.
The intervention or treatment component has been modified from the original 9-code matrix that factored patient severity and clinician intensity of work and expertise. Again through negotiations within the AMA work group, the intervention or treatment component is as of now a linear set of ranked codes. This code set maintains a patient management model and integrates patient severity and clinician intensity of work and expertise, incorporating the International Classification of Function nomenclature of body structure and function. In addition, the proposal includes separately reported codes for services that are not represented in evaluation or body structure and function codes.
This model is still being developed in collaboration with the AMA work group, which will continue to advance a patient management framework. APTA is committed to continuing its leadership in improving the current model that the association has developed, piloted, and collaborated on with stakeholders. To achieve this aim, APTA will use expert panels, researchers, and other stakeholders in the coming months to improve on its work and on the proposal to be presented at future CPT panel meetings.
Finally, over the past several years AMA and CMS have identified CPT codes that they believe are misvalued and need to undergo revaluation. From the code set that physical therapists use on a daily basis, CMS recently identified 10 codes to be addressed and revalued in 2016. APTA will actively participate in this process-in conjunction with our ongoing payment reform efforts-to ensure that it does not impede our transition to a new system, as our desire is to implement the new codes rather than having the current ones revalued.
In closing, the APTA Board of Directors is committed to creating opportunity and fostering success for physical therapists across all practice settings and for all the populations we serve. For almost a century, physical therapists have found a great environment in which to establish their practices and serve their communities by improving the health of individuals. Advancing our profession-in part through reforms to the way we're paid for our services-for the next generation of physical therapists and physical therapist assistants is our shared value and commitment. I look forward to continuing an open dialogue with members and stakeholders to ensure that we are a community of professionals working together.
Sharon Dunn, PT, PhD, OCS
President, American Physical Therapy Association