ALEXANDRIA, VA, September 4, 2009 —The American Physical
Therapy Association (APTA) is urging against the adoption of payment
policies outlined in a Government Accountability Office (GAO) report1 released Monday that recommends
the Centers for Medicare and Medicaid Services (CMS) reduce Medicare
payments for physical therapists and other health care providers who
perform multiple procedures on the same patient on the same day. Under
this proposal, providers would likely be reimbursed for these services
at a rate that is below the cost of providing the services to their
patients. Such payment rates would severely hinder the ability for some
providers to keep their practices open. If practices do close, there is
a strong likelihood that patients will have limited access to physical
therapy services and other necessary procedures, says APTA.
According to GAO, provider fees may not always reflect "efficiencies"
when certain services are performed together, such as reading a
patient's chart once before performing multiple procedures. In an effort
to avoid duplication of payment, GAO recommends that CMS systematically
review commonly performed procedures and implement a multiple procedure
payment reduction (MPPR) to capture efficiencies in both provider work
and practice expenses, where appropriate. GAO based its conclusion on a
review of a sample of the most costly service pairs, which, GAO says,
included certain physical therapy services. However, the report does not specify the service
pairs that were used in making this recommendation. GAO says that the
report "focuses on illustrating the value of CMS's taking a more
systematic approach, rather than focusing on specific service
"We believe that the GAO report is fundamentally flawed in its
construct and conclusions," said APTA President R. Scott Ward, PT, PhD.
"It is inappropriate for GAO to release this report without identifying
in the report the 149 code pairs on which it based its assumptions.
GAO's analysis of the valuing of the CPT codes for physical therapists
is incorrect as it failed to recognize that the time spent on pre- and
post-service activities is spread across the number of services in a
'typical' physical therapy session to avoid duplication of practice
expenses. In addition, the report shows that GAO is unaware that a
significant number of the CPT codes reported by physical therapists are
direct 15-minute timed codes, and therefore, clearly, there is no
duplication of service time."
In addition to implementing MPPR policies, GAO recommends focusing on
service pairs that have the most impact on Medicare spending and
monitoring provision of services affected by any new policies it
implements to ensure that providers do not change their behavior in
response to these policies.
Physical therapists are highly-educated, licensed health care
professionals who can help patients reduce pain and improve or restore
mobility - in many cases without expensive surgery or the side effects
of prescription medications. APTA represents more than 72,000 physical
therapists, physical therapist assistants, and students of physical
therapy nationwide. Its purpose is to improve the health and quality of
life of individuals through the advancement of physical therapist
practice, education, and research. In most states, patients can make an
appointment directly with a physical therapist, without a physician
referral. Learn more about conditions physical therapists can treat and
find a physical therapist in your area at www.moveforwardpt.com.
1. Medicare physician payments. Fees could better reflect
efficiencies achieved when services are provided together. http://www.gao.gov/new.items/d09647.pdf. Published
July 2009. Accessed September 2, 2009.