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  • APTA Statement on Payment System Notes Changes, Anticipates Further Dialogue

    Intended to move the profession away from a unit-based approach and toward a system based on patient management, APTA's proposed payment model for physical therapists (PTs) may have evolved since the model first was developed in 2012, but according to APTA President Sharon L. Dunn, PT, PhD, OCS, the goal—"to better articulate and demonstrate our value"—remains unchanged.

    In a statement issued this week, Dunn outlines recent developments in APTA's work with the American Medical Association (AMA) Current Procedural Terminology (CPT) Editorial Panel and AMA's Specialty Society Relative Value Scale Update Committee (RUC) to retool the evaluation and intervention/treatment coding systems for PTs. The main idea: to create a new model of patient classification system that builds on managing the patient to create a better payment system.

    Dunn writes that the association's efforts "have evolved significantly over the past couple of months, as the result of negotiations and opportunities." Those changed efforts now include a system that splits the physical therapy episode of care into 2 major components—evaluation and intervention or treatment—and further arranges the intervention or treatment codes as "a linear set of ranked codes."

    According to Dunn, the model is still being developed, and will be refined through collaboration with "expert panels, researchers, and other stakeholders" for future presentation to the CPT panel.

    Dunn adds that the payment reform efforts will include participation in the proposed process by the Centers for Medicare and Medicaid Services (CMS) around 10 physical therapy codes that CMS has said need to be "revalued" in 2016. APTA wants to see to it that this revaluation "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 the statement, Dunn writes that she looks forward to "continuing an open dialogue with member and stakeholders to ensure that we are a community of professionals working together."


    • In the past, when Medicare said they were going to decrease our payments by "25%", because were are under the physician's fee schedule, and AMA said NO,our reimbursements actually went up. Once we go out on our own fee schedule, if Medicare says they are decreasing our payments by "25%", and APTA says NO, Medicare will decrease our payments. APTA does not have the power to stop them like the AMA. Medicare needs physicians, they do not need physical therapists. Just some food for thought.

      Posted by Steve Harada on 11/2/2015 1:13 AM

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