Friday, June 30, 2017

PTAs Included in TRICARE? House Committee Takes First Steps

TRICARE, a major part of the US Department of Defense health care system, has long insisted that physical therapist assistants (PTAs) aren't payable under the program—and for just as long, APTA has advocated that there's no reasonable basis for the exclusion. Now it looks as if APTA's position may be gaining some ground.

On June 28, the US House of Representatives' Committee on Armed Services approved changes to the 2018 National Defense Authorization Act (NDAA) that gives the US Secretary of Defense marching orders: conduct a review to figure out how to bring PTAs, occupational therapy assistants, and other support personnel in the TRICARE payment system. The changes, brought forward by Reps Ralph Abraham (R-LA) and Ruben Gallego (D-AZ), were incorporated as part of the committee's mark-up of the NDAA.

The NDAA will move on to a vote by the entire House and, if approved, will be taken up by the Senate. Current language calls for the report from the Secretary of Defense to be completed by April 1, 2018.

"The amendment in committee is only a first step but an important one," said Michael Hurlbut, APTA senior congressional affairs specialist. "It's a change that we hope will ultimately lead to coverage of PTAs under TRICARE."

APTA will continue to monitor progress of the legislation and provide updates.

Comments

Thank you for this information. As a PTA, I hope this exclusion is changed.

Posted by Stephanie Gastley on 7/1/2017 11:09 AM
I have two comments: First, this is making it sound like PTAs are not currently covered by Tricare, but they are. The APTA has released something a little while that was concerning on the topic but PTAs are clearly listed in the Tricare manual as covered providers. I work in a clinic that sees 50% if not more Tricare patients and we have not had a problem with reimbursement for the physical therapy assistants. It is true that Tricare isn't paying for OT and SLP assistants though. Second, I think that the question of Tricare' reimbursement for assistants is part of a larger issue. It is hard for physical therapy as a profession to argue that we deserve higher reimbursement for our services and requiring doctorate degrees, while simultaneously arguing that an assistant with an associate's degree is equally qualified to treat. I think it's important that as a profession we come to an agreement on some way around this obstacle. Tricare seems to be leaning towards just transitioning out assistants. I've also heard the thought that just as we are categorizing complexity of patients on our evals, we can do this for treatment. With this categorization you could have assistants treat low and maybe moderate complexity patients with a contingent difference in reimbursement based on the complexity of treatment.

Posted by Zacharye Mustafa on 7/1/2017 7:40 PM
This has never made any sense (that a LPTA) could not work with Tricare patients. Why do military bases hire LPTAs in their hospital Physical Therapy facilities where they work on both active duty personnel, their dependents and retired military veterans? Also, this is degrading to those LPTAs who have been in the practice more than 5 yrs, may have other related degrees, taken several years of additional continuing education courses and may have additional certifications. Some Physical Therapists may not even come close to measuring up to some LPTAs experiences. It is like saying DPTs are better than PTs. No truth in that for sure.

Posted by Judy on 7/1/2017 10:04 PM
Great news let's keep the momentum and make that change!

Posted by Lori Garone on 7/3/2017 2:43 AM
I hope it continues in the right direction!

Posted by Alexis Gibbs on 7/5/2017 4:12 PM
Zacharye, You need to be careful with your wording. Just because a PTA "only" has an associates doesn't diminish their value or their ability to provide quality skilled care. I'm a PTA who also holds a Master's degree in exercise physiology. While I realize that may not be the norm, it's also a bit pretentious to assume that PTA's can't provide enough value for the Therapy profession as a whole to demand higher reimbursement. Quality PT companies and quality physical therapists utilize PTA's in a way that further that clinic/companies ability to care for their patients while also educating/mentoring PTA's to further our ability to treat. I'm not suggesting PTA's are "equal" to PT's, whatever that may mean and I know there are limitations to being a PTA. But it really irks when PT's see PTA's as some sort of detriment or hindrance to what they want to do or accomplish. Hopefully Tricare wises up and allows PTA's to treat their customers.

Posted by Nate Just on 7/5/2017 4:35 PM
"Second, I think that the question of Tricare' reimbursement for assistants is part of a larger issue. It is hard for physical therapy as a profession to argue that we deserve higher reimbursement for our services and requiring doctorate degrees, while simultaneously arguing that an assistant with an associate's degree is equally qualified to treat. I think it's important that as a profession we come to an agreement on some way around this obstacle. Tricare seems to be leaning towards just transitioning out assistants. I've also heard the thought that just as we are categorizing complexity of patients on our evals, we can do this for treatment. With this categorization you could have assistants treat low and maybe moderate complexity patients with a contingent difference in reimbursement based on the complexity of treatment." Zacharye, you are correct in your assessment of how this is being handled and where the profession is heading in the future. For some reason, it seems that the "powers that be" are not concerned about the trends regarding reimbursement as it relates to PTAs. However, the writing on the wall is such that the profession is cutting its nose to spite its face. The PTA degree is at least 20 years behind progressing (or at least a plan in place) towards the bachelor's level. Those who have made these decisions (and voted in favor of the continual position that an associate's degree level is appropriate) are not the ones who will be impacted the greatest with the shift that is coming. There are already states where PTA treatments are reimbursed at a lower level and the diagnosis complexity status is all part of tracking statistics of billing and provider actually providing the treatments. Over the past 20-25 years there has been an ongoing hiring "craze" of PTAs by facilities/organizations due to lower salary costs but equal billing income. Do you not think payers have become wise to this? "You" say, "Ok, big deal it doesn't affect me because I am a PT". Wrong, wrong, wrong. When reimbursements drop for PTA provided treatments, the logical cause of this effect will be lower wages for PTAs, which will lead to fewer PTAs coming into the profession (eventually), and then a shortage of PTAs but the ability to reverse course will be long past. This will put more workload on PTs due to shortages and if you think that documentation will be more succinct and faster in the future you are mistaken. There will only be more and more items to document, resubmit, re-evaluate, etc... The work will increase on PTs and "they" will have done it to themselves out of fear that PTAs may infringe on their profession (strange since they voted to have PTAs in the first place...over 40 years ago) and start to think themselves (or perform) as equals to them in the medical setting. Preposterous. There are limits in place by Practice Act and PT Rules that have been in place for decades and will never change. Those PTAs who step beyond these boundaries do, and should, face the discipline actions they deserve. The gap continues to widen and the end result will be a "doom" of the profession and an eventual reduction of all reimbursement rates, and a shrinking workforce of both PTs and PTAs except for in the hospital setting. There is a great Proverb that says "The borrower is slave/servant to the lender". The PT profession is slave to the provider of payment services and the profession has done nothing to provide a platform of defense against the downhill slide regarding PTAs and their future use due to lower reimbursement rates. When you see a gradual trend towards lower PTA average salaries across the nation, you will know that these things are taking place. It may already be too late because even if a plan of progression of the PTA to a bachelor degree level happens tomorrow it will be 10-15 years before the first graduates start to emerge. I have been a PTA for 11 years and have already seen much change regarding PTAs and this trend will pick up speed in the coming 5-7 years (if that long). Egos abound in this profession and for all the wrong reasons. The patients are the ones who will "suffer" in the end because patients per practitioner rates will rise and "one-on-one" times will decrease. No one benefits from this...and then the reputation of our entire profession will suffer because good, appropriate time and care will not be what it once was and patients will look elsewhere for cheaper and more personal interaction (chiropractors, massage therapists, personal trainers, group exercise personnel, athletic trainers, spa treatment employees, health food store staff, the internet salesmen, etc...). This dialogue and rhetoric is nauseating because I have seen it go on and on for 13 years now - and nothing changes for the better despite the proverbial kool-aid being passed around and PTAs being patted on the back for "advanced recognition" but no real change to progress them; or better still, to protect them.

Posted by Barron Shultz -> @FTaAM on 7/5/2017 5:21 PM
I would like to know in which state Zacharye is working. We too had PTAs treat but then the article by APTA stating they could not got us to asking questions and we were told they should not although it was a little unclear in the wording. Also PTAs were working in and even running the military base PT clinics here. Other private practices stated they were going to keep doing what they had always done. We are stumped.

Posted by Joy Corwin on 7/5/2017 5:22 PM
I agree with Judy. As a PTA of 6 years I have more continuing education then a lot of DPT's that are 10 years into there career and also have better application of those skills. As a field in the health care community, we move against insurance companies and quit letting them control health care needs.

Posted by Brian H on 7/5/2017 7:24 PM
As a PTA and a Veteran this exclusion is very personal to me. My experience as a Navy Hospital Corpsman and Navy trained PT Tech make me a great asset to our veteran patients. I am familiar with military culture, the VA system, and understand veterans needs and issues. As a Veteran I know how difficult access to care can be. More and more veterans are opting for community based treatment programs and I believe that the inclusion of the use of PTA's in their treatment will further improve our already limited access to health care. I would like to express my gratitude to the APTA and our representatives for working to make theses changes. With gratitude and respect, Katie Tabayoyon PTA

Posted by Katie Tabayoyon on 7/5/2017 7:29 PM
As a future PTA, and a veteran that hopes to one day work in a military facility. I hope that Tricare will recognize, compensate and include all of the therapy teams.

Posted by Michelle Tully -> CNYcCG on 7/5/2017 9:08 PM
Hello Mr. Mustafa, Can you share where you found this PTA's are covered. Do you know the section or rule where this listed. I agree the PT is the one to assign the appropriate patient to the PTA. I think since reimbursement is low in our profession to argue for less is not needed. The PT is still in charge of this patient. I would like to help those who have served with the skills I possess. So...I hope this makes it through.

Posted by Richard Johnson on 7/5/2017 9:11 PM
If we continue to market that we need a doctoral degree to supervise exercise programs and modalities then we will be treated as secondary providers with little to offer. Let our PTAs treat patients while we use our doctorally trained brains to evaluate and make difficult health care decisions. I spent 27 years in the Army and our techs (whether a PTA, ATC, or some other profession) did a great job. Let's not underutilize ourselves!

Posted by Page Karsteter on 7/5/2017 10:04 PM
Paige, I would hope you find PTA's who able to assist you by more than supervising exercise and doing modalities. There are plenty of PTA's who are able to do more than that.

Posted by Nate Just on 7/6/2017 8:27 AM
I served 20 years in the Navy, 18 years as a PT Technician (PTA equivalent) and 13 of those years I was a Licensed PTA in two states. As soon as I retired I was told I couldn't treat Tricare patients as a LPTA. So for me I was good enough to treat active duty, retirees and their dependents while on active duty but not authorized as an LPTA. It has never made sense to me. I hope the government makes the necessary changes to this rule.

Posted by Steve on 7/6/2017 10:14 AM
I began my PTA career in the Air Force in 1986, became a licensed PTA in 1992, and have been practicing in one way or another ever since. From the day I left the AF, I was told that I could not treat TriCare (and its equivalent variations) patients unless I worked directly for the VA system in a VA clinic. Since I do not just rely on other's words, I looked this up in each of the states that I have been licensed in and one that I may get a future license in. In all cases, PTAs are not allowed to treat VA patients outside a VA clinic/hospital setting. Although I do not presently know the references from where I got my information, I know this to be accurate since I work in an educational setting and the ACCE keeps me abreast of the topic when I ask about it. Due to my personal experiences with this topic, I am happy that it is being brought up again. I hope those in power see the insult for what it is--especially to the veteran PTAs!

Posted by D. Evans (PTA & Veteran) on 7/8/2017 4:57 PM
I want to clarify my comment before. We have not had problems with reimbursement for PTAs but it appears that this may be more soon to come and such that no one had told us yet not to utilize PTAs. We are slowly moving Tricare patients off of our PTA's caseloads.

Posted by Zacharye Mustafa on 7/10/2017 12:00 PM
To read the policy go to the Tricare Policy Manual 6010.57-M, February 1, 2008 Providers, Chapter 11, Section 10.1, Servicez Renderex By Employees Of Autborizex Independent Professional Providers. 3.0 Exclusion Services performed by a PTA who is employed by an independent provider, may not be cost shared.

Posted by Kiz Reeser on 8/8/2017 10:16 PM

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