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  • A Permanent Fix to the Therapy Cap: Improved Access for Medicare Patients Comes With Pending APTA-Opposed Cut to PTA Payment

    The looming threat of a hard cap on physical therapy services under Medicare has been eliminated.

    As part of a sprawling bipartisan budget deal passed today, Congress enacted a permanent solution to the problematic hard cap on outpatient physical therapy services under Medicare Part B, ending a 20-year cycle of patient uncertainty and wasteful short-term fixes.

    Ending the hard cap has been a high priority for APTA since its introduction in 1997 as part of the Balanced Budget Act. Legislators' backing for repeal reached a tipping point in 2017, when lawmakers developed a bipartisan, bicameral agreement to end the cap. Congress failed to enact that deal in 2017, but elements of the plan are included in the 2-year budget that was approved today.

    That's the good news. The bad news is that Congress chose to offset the cost of the permanent fix (estimated at $6.47 billion) with a last-minute addition of a payment differential for services provided by physical therapist assistants (PTAs) and certified occupational therapy assistants (COTAs) compared with payment for the same services provided by physical therapists (PTs) and occupational therapists (OTs), respectively. The payment differential, which was strongly opposed by APTA and other stakeholders, states that PTAs and OTAs will be paid at 85% of the Medicare physician fee schedule beginning in 2022.

    That pending payment differential under Medicare is somewhat comparable to that between physician assistants and physicians, but it was added to the budget bill late and without warning. It wasn’t part of the 2017 bipartisan agreement legislators reached, nor was it part of any discussions or negotiations on Capitol Hill since then.

    When the proposed differential was added to the budget deal late Monday night, the association quickly reached out to congressional offices with proposed amendments. None were accepted. Friday morning, Congress passed the massive budget legislation that includes increases for military and domestic spending, adding an estimated $320 billion to the federal budget deficit.

    “Stopping the hard cap is a victory for our patients, and for our dedicated advocates,” said APTA President Sharon L. Dunn, PT, PhD, board-certified orthopaedic clinical specialist. “For 2 decades we have held back the hard cap through repeated short-term fixes—17 in total—that were achieved each time only through significant lobbying efforts by APTA and other members of the Therapy Cap Coalition. In that time, the hard cap was a genuine and persistent threat to our most vulnerable patients, a threat we saw realized earlier this year when Congress failed to extend the therapy cap exceptions process. Today that threat has been eliminated.”

    Dunn said the January 1, 2022, implementation date for the opposed PTA payment cut provides time to explore solutions with the Centers for Medicare and Medicaid Services (CMS) as it develops proposed rules.

    “APTA will leverage its congressional champions, the APTA Public Policy and Advocacy Committee, and the PTA Caucus on strategies to address the CMS activities,” Dunn said. “Our collective efforts will drive the association’s work to ensure that guidance to implement the new policy is favorable to PTAs and the profession, while ensuring access is not limited for those in need of our services.”

    The legislation enacted today provides a fix for the therapy cap by permanently extending the current exceptions process, eliminating the need to address this issue from year to year. Among the provisions included in the new policy:

    • Claims that go above $2,010 (adjusted annually) still will require the use of the KX modifier for attestation that services are medically necessary.
    • The threshold for targeted medical review will be lowered from the current $3,700 to $3,000 through 2027; however, CMS will not receive any increased funding to pursue expanded medical review, and the overall number of targeted medical reviews is not expected to increase.
    • Claims that go above $3,000 will not automatically be subject to targeted medical review. Instead, only a percentage of providers who meet certain criteria will be targeted, such as those who have had a high claims denial percentage or have aberrant billing patterns compared with their peers.

    Over the coming days, APTA will provide additional details on the budget deal, including the impact on home health. For home health, the deal includes positives related to rural add-ons, a market basket update increase of 1.5% in 2020, and use of home health medical records for determining eligibility. However, it also requires a switch from a 60-day to a 30-day episode in 2020 and eliminates the use of therapy thresholds in case-mix adjustment factors.

    “While this package does not afford APTA with everything we would have liked, we should take a moment to celebrate closing the door on a 20-year advocacy effort that has challenged our ability to ensure timely and appropriate services to patients,” Dunn said. "Reaching this milestone affords APTA the opportunity to expand our advocacy agenda to implement more fully our vision to transform society by optimizing movement to improve the human experience.”


    • Does the Practice of Physical Therapy and Speech and Language Pathology still have a combined KX of $2010 and a soft cap of $3,000 combined?

      Posted by DougBates on 2/9/2018 2:39 PM

    • Will these rules apply the same to hospital-based outpatient facilities? Thanks!

      Posted by mari on 2/9/2018 2:49 PM

    • Does this legislation change the payment association between speech therapy and physical therapy? Will the medical necessity modifiers be placed on patients seeing PT and SLP when they reach a combined $3,000? Or will the modifiers be required only when an individual discipline reaches $3,000?

      Posted by Jefferson Holm on 2/9/2018 3:05 PM

    • Does the $3000 threshold apply to all OP providers, as previously hospital based were excluded from the cap?

      Posted by Sue Condon -> @NVc? on 2/9/2018 3:45 PM

    • Question, how is Medicare going to process claims at 85% for PTA when claims do not contain PTA names or NPI# because they are NOT credentialed directly with insurance.

      Posted by Michelle Carter on 2/9/2018 4:59 PM

    • With Medicare lowering their allowables this year, we now get paid the same as welfare, which we were going to drop for being so low! Getting so there's no money in PT anymore.

      Posted by Debbe on 2/9/2018 6:44 PM

    • so important!!..Patients need the extra therapy sometimes to heal properly!

      Posted by Susan S. Rabin, on 2/9/2018 11:46 PM

    • What does the Therapy Cap mean for PTA’s? Will other insurance venues fall into step with Medicare? Do PTA’s still have a place in the Physical Therapy Profession?

      Posted by Marigerard Wardrop PTA on 2/10/2018 6:32 AM

    • This is not the solution. Already, the Pt’s are bombarded with redundant paperwork and repeat coding requirements. When do they have time to do all treatment with a patient? Healthcare is no longer about the patient’s needs. It is about who’s pocket is going to get padded better. So disappointed.

      Posted by Irina Cortinas on 2/10/2018 8:50 AM

    • This is a slap in the face for the PTAs, current and upcoming. This dims my future for the profession I love.

      Posted by Carolyn Troyer on 2/10/2018 9:03 AM

    • Next up: divide SLP and PT services.

      Posted by Norm on 2/10/2018 9:51 AM

    • $3000 certainly is better than $2010. Is this effective immediately?

      Posted by Leah Hamoy on 2/10/2018 10:48 AM

    • If I didn’t have extensive Physical and Occupational Therapy for the past few years I would be unable to use my arm & leg on my left side. My situation from a fall left me as a 3 man assist: which is just as it sounds. I now can walk and use my arm in thanks from Therapy and Hardwork! So when I was told in January my prescription for a year of water exercise was almost used up I was completely distressed. Thanks for all you have done to get me to this stage to my Therapist and Surgeons, I’m Praying for this cap to be recalled. In the long term it’s cheaper than surgeries and it does work if you work with them. Thanks

      Posted by Patricia OBrien Nixt on 2/10/2018 2:08 PM

    • Without well paid assistant therapist there is no way to cover the increase in service demand!

      Posted by Nicole Sambas on 2/10/2018 4:52 PM

    • Congratulations to the APTA.. keep up the good fight. Now we need to expose hospital systems who charge and bill commercial insurances 300% to 400% more and collect at a much higher level than the private practioner. Also we need to expose hospital systems who you their tentacles to create a feeder system to keep patients within their high cost clutches.

      Posted by Bernie Blystone on 2/10/2018 9:22 PM

    • Why is it that the PT profession just keeps taking the hits? My office relies heavily on our PTA staff. I’m one of them. If reimbursement for our care is effected we will not be able to stay in business. What’s the point of the Kx if there will be no one to deliver good care. 85 percent reimbursement is not acceptable. This will hurt everyone, not just the PTAs.

      Posted by Karen Wrisley on 2/10/2018 9:32 PM

    • The APTA opposes a lot of things. They just never succeed in making a difference. I know, I know, probably because not enough people are members of course.

      Posted by Bryan S O'Connor on 2/10/2018 10:40 PM

    • Maybe we should step back and consider if it might actually be appropriate to reimburse differently for services provided by someone with an associate's degree versus a master's or doctorate degree. What does the evidence say regarding the use of PTAs and outcomes?

      Posted by Erik Pohlman on 2/11/2018 8:11 AM

    • In a time when there is very little, if any, increase to the physician fee schedule, it seems that every time we turn around there is another avenue in which our reimbursement is being diminished. How can such reductions in payment be proposed with a straight face?

      Posted by William Bieker -> CFW_@I on 2/11/2018 1:33 PM

    • With regards to the assistants, they have proposed that there will need to be a modifier developed by Jan 1, 2019 that will be ready to be used by Jan 1, 2020 and then impact reimbursement by Jan 1, 2022. This modifier will denote who delivered the services.

      Posted by Stephanie Schoenberger on 2/12/2018 8:43 AM

    • I think it is time for the APTA to weigh in heavily on traditionally non health care issues like Tax Cuts. When such non health care legislation seriously affects the nations ability to pay for health care, we should weigh in and bring up how that legislation will cause health funding issues. Medicare has been underfunded since the 80's, when small government ideology took over a certain party. The nursing Profession has taken a lead in seeing their role as a voice for social discourse leading to better health of the nation. We should follow until we can lead.

      Posted by Jonathan Holtz -> AHY[B on 2/12/2018 9:32 AM

    • There are PTAs that have NPI#, because I have had one for over 20 years. There are PTs that don't have a NPI#. In this profession we should all be registered with CMS. I have been on the other side of paying claims also and it does come down to provider # and how many claims have come through on that patient with that particular insurance company. Claims are counted, which are your visits if there is a limit.

      Posted by Carla Holmen -> =IU]>L on 2/12/2018 11:55 AM

    • PTA rate cut - We can't deny the practice by several agencies that recruit just one PT to do evals/recerts and several assistants to do the Txs. With more community colleges churning out assistants every year, jobs for PTs was diminishing. In a way, this was a good move to ensure PTs still had jobs on the table.

      Posted by Morton Dave on 2/12/2018 3:48 PM

    • 1) Give me back the therapy cap with the exceptions rule and don’t touch my reimbursement for PTAs. Our profession never “wins”. This is NOT a win. 2) I never understood the purpose of the exceptions rule and didn’t mind it as we are suppose to prove medical necessity and skilled care from day one and not just on day “KX” and thereafter. 3) Between the rediculous MPPR rational, regulatory 1-on-1 care, and now the PTA reduction...I say fine, pick our battle and fight to remove the requirement on 1-on-1 care and add PTs as medical providers that can opt out of Medicare and call it even! 4) Granted quality of care will sacrifice with double booking plus, but our profession is being redefined out of our control and killing it, let alone the hospitals in bed with insurance companies to monopolize healthcare by making it impossible to survive more payment reduction and regulation and therefore choking the life out of every medically based private practice out there. Physicians practices alike.

      Posted by Mike W. on 2/12/2018 11:06 PM

    • I'm a little confused how this reimbursement of 85% will affect Home Health Services provided by PT assistants and or OT assistants I am under the impression may be wrongly so but I think not that Home Health Services are considered part A services please clarify that

      Posted by Kelly on 2/13/2018 9:05 AM

    • I also am curious how Medicare will process claims at 85% for the PTA when claims do not contain PTA names or NPI as they are not credentialed directly with insurance.

      Posted by Rochelle Friend on 2/13/2018 10:57 AM

    • Is PT considered a separate rehabilitation service or is it still combined with speech therapy under the new regulations?

      Posted by Julie DeVahl -> @MVaE on 2/13/2018 11:23 AM

    • Where in any body's intelligence does this bill equal a permanent repeal of the therapy cap? This is absolutely NO different than what we have had the past 10 years with the exception that it is actually worse for everyone including the patient. Further it burdens private practices with sustaining the burden of the MCR fee schedule longer (with the KX modifier) disallowing the switch to secondary insurances as a primary once the 'hard cap' is reached. Before this bill was $2010,now thanks to the efforts of the APTA, is now $3000. This issue is not the CAP it is the outrageous below cost fee schedules. Now with the 'pay-for' which reducing the fees for PTAs, lets see how many of us will be willing to hire PTAs. PTAs have a vast difference in knowledge of that of PTs yet costs facilities least 3/4 or more of a that of a PT. At best I can expect to break even on a PTA . The Alaska Workers Compensation Medical Review board last summer already had passed a resolution reducing their fee schedule to that of medicare and reducing services by PTs and OTs to 85% of the MAR. Now that MCR has reduced the fee for PTAs does that mean Alaska will see a 30% reduction for PTAs? Frankly, I am so disappointed in the unbelievable acceptance of these types of 'concessions'. The APTA under the quise of caring about our medicare populations just made it even harder for small business in private practice to truly care for our medicare populations. Welcome aboard large corporations who will continue to consume smaller businesses, eliminate 'inefficiencies' by closing locations in remote areas further limiting access, shortening appointment times and eliminating competition all in the face of Congress and APTA, AARP and the giants who have developed as a result of the ACA. All who fought in the name of disaster for this bill to be passed should be ashamed. I'm ashamed to say I bought into it as well until reviewing our overall costs this past years to see truly what we are losing by accepting this bill. I have been praying that it wouldn't pass. Now that it has, sadly we may all be looking for a new job!

      Posted by Tina McLean -> =GY[<F on 2/13/2018 1:03 PM

    • I have been helped to heal various injuries by my PT. All I was offered from my doctors was pain medicine. The careful, caring and knowledgeable approach by my PT allowed me to heal without any drugs at all. Extending my time in therapy was rare, but thank goodness it was available when I needed it.

      Posted by Barbara Keer on 2/13/2018 2:23 PM

    • Question, how is Medicare going to process claims at 85% for PTA when claims do not contain PTA names or NPI# because they are not credentialed directly with insurance. (Also asking for OTA) Is this effective immediately?

      Posted by Ronnie on 2/13/2018 6:19 PM

    • There goes the incentive to pursue the upcoming PTA/OTA bachelors programs. There goes everyone's salaries--including clinicians. If the market becomes saturated with clinicians, look for reduced salaries. Already happening with assistants. So much for those extra years and student loans pursuing a DPT degree.

      Posted by Daniel Van Dyck on 2/13/2018 6:55 PM

    • This is a joke, right?

      Posted by Larry Lester on 2/14/2018 11:49 AM

    • Who ever thought that by paying a PTA 85% of the MAR was the right thing? My respects to all my PT colleagues, but a LPTA with 20 plus years of experience in the field of Lymphedema and orthopedics should not be judge by the credentials or lack off..... so wrong in many ways.

      Posted by Oscar Pozzoli, LPTA, Vodder-CLT on 2/14/2018 4:23 PM

    • Thanks for all your hard work! Many members don't understand that we have to fight every step of the way to prevent being shut out or severely limited to help balance the budget. This is not dissimilar to what we have now and that is a blessing. Kudo's to those and to all of our patients who fought hard for this!

      Posted by Kay Scanlon on 2/14/2018 4:46 PM

    • Many of you have had the question about how the 85% will work. It will be done using a modifier. All PTA claims will need to have a modifier added to them that decrease reimbursement by 15%. This modifier is to be created by the AMA this year and will be in place in the AMA guide for 2019. Although Medicare is not planning to enact the cuts until 2022, private payers can (and likely will) start requiring the modifier very early. An unfortunate "pay for" in this bill.

      Posted by Troy B on 2/14/2018 5:13 PM

    • It is about time that reimbursement for PTA services is lower than that of a PT! 85% is not low enough but it's a start. If a PTA with a 2 year degree can do what I do as a PT with 7 year doctoral degree, then we are really in a troublesome situation! Obviously, I possess skills in evaluation and assessment that a PTA doesn't, but as PT, I am also better at treatment techniques. It's about time that payment for a lesser service is recognized and corrected.

      Posted by Emily Beard on 2/14/2018 9:14 PM

    • CMS will release a new modifier identifying services provided by Assistants. The modifier will start in 2020 but not result in reductions until 2022.

      Posted by Marsha Lawrence -> ?GQ_? on 2/14/2018 9:44 PM

    • Ronnie- CMS will create a new modifier that provides a will be required to add to CPT codes provided by assistants.

      Posted by Richard Klemmer on 2/14/2018 9:57 PM

    • How will this affect inpatient PT/PTA's billing under DRG's? Will we still have to attach a modifier for the 85% rule in the hospital setting?

      Posted by MBD on 2/15/2018 10:24 AM

    • This is not a win. More money for more visits does not equate with better care. We should be fighting for better reimbursement and PTs should be working towards better outcomes in fewer visits.

      Posted by Kyle Sela -> @HP`>K on 2/15/2018 10:38 AM

    • 1. To all PTs who think your degree automatically makes you better than a PTA. You are simply wrong and I hope you leave our profession. 2. I was very disappointed that this bill removed the hard cap as I am a hospital based outpatient PT and that it did not separate speech and PT. I am disappointed that APTA failed and may not renew my membership based on this. 3. APTA really needs to get a handle on the abuses of multi-state SNF companies, OP companies, and private clinics whose fraudulent practices are the reasons we have this cap in the first place. Treat the cause not the symptoms.

      Posted by Ben Marchisio on 2/15/2018 10:46 AM

    • I'm not sure about all that I'm reading,therefore I have questions & concerns. I will be on Medicare in 2 1/2 years.For the last 5 + years, I have been getting dry needling from my physical therapist as many as 26 times a year. It really helps reduce my pain level,amount of narcotics and keeps me much more mobile. I not only have typical back issues associated with aging,osteoporosis, fibromyalgia& myofascial pain syndrome. Sometimes,I may also get heat,hands on therapy or water therapy. Believe me,getting 20 or more needles is not a joy,but it can be very effective. For my conditions,I've tried everything and all things out there. They must not cap,nor reduce these benefits!!

      Posted by Bonny Jo Castellano on 2/15/2018 12:24 PM

    • Emily Beard - A degree does not make you any better than anyone else. I've seen plenty of PTAs just as good as PTs, seen some pretty louse PTs also.

      Posted by John Smith on 2/15/2018 3:34 PM

    • This type of legislation may lead to the PTA and COTA beginning their own separate Professional Associations. A Physician Assistant does not belong to the same Professional Association as the Physician. Nor should they. Issues that affect the PTA and COTA should be advocated for and addressed by those in that profession. Relying upon a professional Association that is made up of a vastly larger group of professionals with a different degree is not going to result in significant advocacy for the minority. It is something to consider.

      Posted by David B on 2/15/2018 5:04 PM

    • You are going to find good, bad. skilled, unskilled, experienced, and unexperienced clinicians among PTs and PTAs alike. Those characteristics then become irrelevant to the larger conversation. I don't agree at all with reimbursement being different between PTs/PTAs, because ultimately the PTA is an extension of myself and I value that greatly. However, I think it is naïve to make the argument in terms of "a PTA is just as good as a PT." It is not a matter of a PT being "better than" a PTA, it is matter of degree level and what practice acts allow each to do. I work with excellent PTAs who have incredible insight, ideas and provide exceptional patient care. That doesn't change the fact that there IS an inherent hierarchy in the profession. To ignore that will not help our collective cause. The argument (and education for those making the rules) needs to focus on the value of the PT/PTA team as a whole rather than the specific degree level.

      Posted by Anna Staehli Wiser -> BJXb=K on 2/16/2018 10:21 AM

    • I have read all comments posted so far and I am yet to see any questions about the so called "cost of the permanent fix" estimated at $6.47 Billion. This so called "cost" is being leveraged against us. Maybe I'm missing something, but I can't see how a permanent fix to something which we have been, with a lot of lobbying and hard work, able to use the last 2 decades can now have an associated cost of $6.47 billion? We still have a threshold, which has been REDUCED from $3700 to $3000, so I can't understand how this "fix" is costing $6.47 billion? As for lowering the reimbursement rate for PTAs and OTAs, any reimbursement reduction is a major loss to our profession no matter what designation you personally have. I have seen nothing but reductions for at least the last 10 years. The reductions have several different names MPPR, Sequestration, PQRS (additional time to document), FLR (additional time to document), soon MIPS (additional time to document), actual fee schedule reductions, etc.... I would like to see an estimated savings our profession creates when patients are able to avoid surgery because of the treatment they receive from people in our profession. That estimate would be worth using to counter the $6.47 Billion being used to justify another "reduction"!

      Posted by Shay on 2/16/2018 10:36 AM

    • Emily Beard! I feel sorry for you and the rehab staff that work with you. Good luck in keeping up with documentation and treatments. PTAs do and have done great work with patient's.

      Posted by Jason T on 2/16/2018 2:15 PM

    • This is really making me think twice about going into PTA. I have started looking into other career options.

      Posted by Jeremy on 2/17/2018 8:27 AM

    • Forward thinking schools, like Clarkson College in Omaha, Nebraska; saw this coming. They have pushed the PTA degree to a Bachelors of Science. Time to close the gap on education and raise the bar for PTAs as they have done for PTs who are now required to achieve doctorate, instead of Masters level education. The market is being flooded with mediocre education to achieve PTA. Time to look at the trend setters.

      Posted by Joss Vanderhoof on 2/19/2018 11:53 AM

    • I was a PTA for 5 years and went to PT school. I went to school to be independent and make more money, help more people. I now own my private practice and have hired and worked with numerous PTA's. They are cost effective, work hard and are irreplaceable. That being said, I'm trying to hire a PT for about 25% more than a PTA, and can't seem to do it. This clearly is a sign that market pressures are favoring more pay for a PT than the PTA and in our economic, free market system, this simply means others understand this and are making changes in reimbursement. To those who consider this a being a move from a $2,010 cap to $3,000, just treat the patient as necessary and give great care. I face the dilemma of paying my practices bills and discharging patients who haven't "capped" out. I believe in the free market system and I see this legislation as a win in spite of reduction to PTA's because it levels the field for me against all the HOPTP's. I worked at a hospital outpatient practice and it was a cake walk, so much money and no caps for the urban providers. If you’re a HOPT provider, I don’t blame you. It’s great pay and you are really secure and don’t have to worry about these changes or reimbursement. I agree with Shay, our evidence-based studies have been good, but not resulted in the intended credibility and certainty not the increased reimbursement that should have followed after years of research concluding what we all know. We, as PT's and PTA's nearly have the market cornered on comprehensive, effective care that restores function, decreases pain and reduces health care costs. We need to continue to get more active in our association and continue to support/demand more from our associations like this win. Keep evidence-based studies going but more regarding the economics of our services, less focus on the clinical aspects, we have enough of those and they take up resources needed to justify our continued existence and maybe our professions chance to flourish.

      Posted by Joe on 2/19/2018 8:13 PM

    • For anyone with more questions--check out the free recording of our February 15 APTA "Insider Intel" program: explanation of where things stand, plus a question and answer session. http://www.apta.org/InsiderIntel/2018/2/15/

      Posted by APTA Staff on 2/20/2018 7:44 AM

    • Ben Marchisio, you stated "I was very disappointed that this bill removed the hard cap as I am a hospital based outpatient PT and that it did not separate speech and PT." Though I agree that they should have fixed that whole neglected comma thing, I wonder what you mean with the first part of your statement. As a hospital outpatient PT, you were not subject to the cap before, right? Are you saying you are upset that the bill removed the hard cap for non-hospital based OP clinics, which is a privilege you already enjoyed in a hospital-based system? I mean, it didn't change your status, right? It only changed the status of your competition... Isn't that better for patients, overall, especially considering that hospital OP clinics can charge a ton more for exactly the same services as a private practice clinic? What I see is that this puts private practices and hospital-based clinics on somewhat closer of a level playing field.

      Posted by Erik Pohlman on 2/20/2018 4:30 PM

    • There appears to be a significant lack of understanding on this topic. The fee reduction for PTA's was a last minute pay-for that was never previously discussed nor did the APTA ever advocate for it. The fact that it was never discussed as an option is what is upsetting to me. The threshold amounts don't really matter other than having to place a modifier on amounts above it to double attest that the care is medically necessary. Therefore separating PT and SLP isn't a big issue. Advocating for fair reimbursement and having Congress realize and understand how the care we provide can save money as well as reduce downstream costs is essential. This is where are collective voices are needed. It is all of our responsibility to advocate for our profession, not just our professional association. I think the APTA has done an amazing job and am hoping the momentum will continue. And for those of you that saying you are reconsidering becoming a PTA or will leave because of the reduction, that is quite unfortunate but perhaps it is best if you take that route. Keep in mind that nurse practitioners and physician assistants are paid at 85%!!!

      Posted by Dan Curtis on 2/28/2018 9:27 PM

    • I have been a PTA for 10 years and am a strength coach. It is very upsetting to see this happen and even more upsetting that PTs are saying it’s about time that PTAs get cut to 85%.? PTs and PTAsare a team, at least we are supposed to be. For a PT to become more of an autonomous practitioner and be able to have direct access etc who is going to help with all the patients and make sure they are getting good care? Better exercise advancement? That is what are whole curriculum is based on. Progressing within a POC. Unbelievable how entitled the profession is becoming. We all got in here to help people get better, not to see who is better. Also I know many PTAs, including myself who feel we can provide pretty good interventions. Hopefully, we can all come to our senses and realize that it is not about the letters after our name, but the teamwork and compassion we show to get people better.

      Posted by Mike Headtke on 2/28/2018 11:35 PM

    • Thank you APTA, clinicians and others who have helped to push through this issue. This is a great victory for PT’s and other rehabilitation professionals. After reading the posts I don’t think bashing people for working so hard on this issue for so many years is productive. Like anything passed in our gevernment it is flawed and needs fixing by intelligent design or lack there of, I can’t figure. What I do know is that the marginalization of the PTA’s through payment reductions is just another way to keep this profession and others under someone’s thumb. With direct attempts to muddy the waters by competing professions and increased paperwork demands we all have a lot more to advocate change and fight for. How long do we do this without striking to get the media coverage and making our issues a “stand alone” problem. When we succumb to riding to coat tails of other legislation we will continue to take one step forward and two steps back. We need to be on the forefront of policy making and media coverage. The only way to do that is to remove the gloves and throw a sucker punch!!! That being said for those that practice defensive medicine you can continue to think the hard cap is reason to discharge a patient. It really isn’t... On another hot button issue. Easing the bar of education Isaack good idea, but let us not forget that PTA’s have a more unites for their AS than someone with an AA. The crossover to a BS isn’t a great leap if the PTA classes are reclassified as upper division. It should include EVP with regards to evaluation of research and statistics. I do believe in the PTA degree level needs some dusting off, but let us not get it twisted, a clinician isn’t better because they can pass tests. PTA’s can be awesome without advanced proficiency recognition by the APTA or a higher degree.

      Posted by Trevor D’Souza, PT, DPT on 3/7/2018 7:35 AM

    • Thanks to APTA efforts and the negotiation power of our lobbyists, it is clear that our profession has been targeted to cut down on reimbursement. I am not sure if Medicare, and other insurances have considered to compare cost effectiveness of therapy services as compared to other health care professions, I am sure that Physical Therapy will always come on the top. Also, has anyone challenged the unfair monopoly that is being played by the big hospitals, and the larger networks. I think if we enforce stark law and challenge internal referrals done by the hospitals we will be in a much better shape. Good luck to all.

      Posted by Dr Ben Soliman, RPT, MOPT, DPT, FAAMOPT on 3/14/2018 2:40 AM

    • First, it amazes me that they require a PT to get their Doctorate which is just more money to the Universities, but yet they keep lowering their reimbursement. If they are Doctors of their profession they should be paid that way, but they don't. I don't see any caps on Primary care doctors whom only seem to brush the patient off to specialist after specialist. Yet it costs you hundreds of dollars to walk through the door. Lowering the reimbursement rate of PTA's forces private practices to employ more PT's which will increase payroll so in turn lowers the treatment time and sufficient care of a patient just to cover the payroll costs. Secondly, having caps and review boards only in these professions is an insult and hurts patient care. I cannot tell you how many patient's we want to treat so they can stay self-sufficient and pain free but we have to turn them away because they are on a fixed income and their benefits keep getting cut. Not sure how paying a PT clinic between $65 and $100 for treatment is killing a mass budget. I think they should look more closely at Primary Care Physician costs and Hospital costs. For instance, an aircast boot should not cost $300 when it can be bought at a store for $80.00. Why isn't the government looking into that ridiculousness!!! This all irritates me.

      Posted by Lisa on 4/6/2018 10:58 AM

    • There has been much said about the looming reduction of the reimbursement for PTA's and I must agree with most of the comments. It is not only unfair to the PTA profession it is unfair to the practice owners that are already struggling to keep the lights on in light of the declining reimbursements for services. The whole "Permanent Fix To Medicare Cap" is a farce!! As noted in the article above, we still are required to KX anyone that exceeds the $2010.00, they lowered the review threshold to $3000 from $3700, and they reduced the reimbursement on CPT codes that are frequently used by therapists in the rendering of services!! Any one with even a little bit of business sense can see this is not a better deal!! While those that sit in their high towers making the rules continue to vote themselves raises and better benefits they continue to cut the income and benefits of those that are out working for them!! Then to top off this injustice they vote to cut the reimbursement for services rendered by a PTA to 85% of those SAME SERVICES provided by the PT's!!! Am I the only one that sees this smoke and mirrors game the politicians are playing?? They want everyone in the therapy field (including the APTA) to think that we have gained a victory when in fact they gave us a worse deal than the one we had before. I have been in the therapy profession for 30 years and every time a politician sticks their sticky fingers into a deal they're the only ones that stand to benefit!! I have 4 more years to retirement and I cannot wait to leave the profession I have REALLY LOVED for many years because of all these ridiculous changes!!!

      Posted by Randy Veroline on 4/27/2018 10:50 AM

    • Oh my, DITTO Randy Veroline - this is a farce!

      Posted by Sarah on 4/27/2018 3:23 PM

    • This means that services provided by a PT is 15% more magical than services provided by a PTA. My PT colleagues who support this lisiglation by congress to cut down reimbursement for PTAs, understand that there is not a huge difference between the license exam you take vs the exam we take as PTAs. Yes there is a difference but this can be resolved by restricting community colleges and private colleges in USA allowing so many graduates every year. When the supply is too high, there demand will obviously be less. Reducing the reimbursement of PTAs to 85% means the profession will only see PTs providing care because no PTA will want to go into a profession that does not really care for the work they do. If pay really needs to be cut, that should happen for the doctors who spend hardly 2 minutes looking at patients and without even listening to the patient’s concern and root of the cause, they prescribe medications that have only temporary effects and harm in the long run!!!!!!

      Posted by Comm Entator on 4/27/2018 8:09 PM

    • I feel as though the PTA payment differential will prompt some outpatient clinics to change their treatment models in order to maintain PTA staff. (keeping PTAs maintains lower overall costs for them) They may be compelled to have PTs sign off on treatments performed by a PTA. It seems this new reimbursement schedule could lead to PTs doing more paperwork and less treatment. This upcoming mandate will effect both PTAs and PTs adversely.

      Posted by Cathy Roy on 6/10/2018 9:16 AM

    • Perhaps it is time to unionize our profession.Never been a big union guy but it sure does seem that we continue to take it in the shorts.

      Posted by William Morrison on 8/16/2018 11:55 AM

    • Some outpatient facilities have already stopped using PTA’s; in return PT’s will have a lot of extra work on their hands on top of the required MC documentation. To Emily- it’s common sense that all healthcare professionals gain their skills and knowledge by experience. As a PTA of 23 years I have new grads with doctorate degrees asking me about treatment strageties and plans; I feel when the PT programs turned into doctorates was a mistake. To be a master or a doctor of something takes more than your labs and a years worth of hands on clinical internships, it takes years of practice. When the public sees a professional with a title of doctor in front of their name, as a physical science, you better know your stuff- experience is what counts, not 6 years of lectures and labs and research, and 1 of Clinicals. No disrespect to PT’s what so ever as I work with and have learned from some of the best and have the utmost respect for our profession. But if you don’t start to think differently about PTA’s and our profession as a whole you won’t be an asset to our profession.

      Posted by Nancy on 8/24/2018 4:40 AM

    • I think Medicare should pay 20% less for any provided services by PTA because most of facilities abuse PT and using PTA so you will find in nursing homes one PT supervises 4 PTA and the work for PTA more than PT. APTA should work for PT in fair and tries to change supervision from 1 to 4 to 1 to 2 .to be fair for PT

      Posted by Ahmed Elmansy on 8/31/2018 10:51 AM

    • In response to Emily, just because you are a PT does not mean that you are better at "treating " patients. You clearly have not worked with competent, well educated PTA's. What do your comments say about PT's that were educated at the certificate or Bachelor's level? A blanket statement like yours is ridculous.

      Posted by mike spitz on 8/31/2018 11:10 AM

    • We take a hit every year with no CoL increases -a built in cut. Now a cut on top of that. NCBCBS pays us 70% of the Medicare rate in private practice and the local hospital system is billing $500 to $600/hr for a therapy treatment and receiving a much higher percentage..hospital CFO told me they collect 70-80% of their charge to commercial insurances.

      Posted by Sherman Burnell Blystone on 11/8/2018 11:12 AM

    • Come on! Ridiculous comments from the PT on here claiming “about time that PTA’s be reimbursed @ 85%! Citing that it’s about time there was a difference in a “2 year degree” ...when you darn well know it’s a 3 year degree! In addition....there is no next step! No Bachelor’s degree and now no Master’s Degree.... jump right up to a Doctorate??? That doesn’t even make sense! Very well trained PTA’s who are licensed and continually educated on best practices are supplying excellent care to their patients. They are now being phased out of their jobs over this!!! They are still entering PTA programs only to be unemployed!. Awful.

      Posted by Diane Plumley on 1/23/2019 10:37 PM

    • It is not a 2 vs 7 year comparison! As a PTA with a Bachelors degree in athletic training, I have had 6 years of schooling (not 2). Only 1 years difference from a DPT. 4 years of that 7 for a DPT isn't even related to physical therapy! Also, my classes used the EXACT same textbooks as the local DPT program.Same therex same neuro, same Ortho etc. Our licensure exam is nearly identical. reimburse differently for the part that is different (evals) however Gait training, therex etc should be and generally is identical if performed by a PTA or DPT especially if we are basically taking the same class it is the same service and should be reimbursed equally!

      Posted by Joshua Klas -> CIWaCN on 2/3/2019 1:23 AM

    • As a PTA with 25 years experience and diligent continuing education over last 25 years, this ruling is a slap in the face. I’ve seen PT’s go from Bachelor of PT to now “doctorate”. They spend too much time on theory and not enough on treatment strategies. A recent DPT student on his last rotation was clueless with what to do with a TKA! We are a team. My PT’s value my contributions and often ask for guidance with their patients. I recently had an outpatient transfer to me from a Only PT clinic and she was very impressed at the one on one time I was able to provide. She said the previous DPT handed her sheets of exercises and as she did them, without supervision, he treated 3 other patients. How is this increasing this patients perception of Physical Therapy? I’m very lucky to work for a great company where we work as a team. I’m not treated badly and my ideas are valued. I also do not equate my knowledge base with that as a PT, but with 25 years experience, I’ve had the privilege to work with some great PT’s and PTA’s. There also needs to be a easier way to bridge to DPT degree for PTA’s like COTA’s and nursing degrees. Also I am not a member of the APTA due to the fact they do not represent PTA’s. We need our own organization that lobbies for us. I’m scared for my job because I’m at the top of my pay range. The biggest issue is after 25 years, I still LOVE what I do. I don’t want to switch careers.

      Posted by Kim Sawyer on 2/13/2019 12:05 PM

    • Should be pushing for a 15% increase in PT pay and leaving PTA reimbursements where they are at; and yes pushing PTA to a BS is a great idea- assuming they get more PT and not just 2 years of general studies.

      Posted by JAMES MAWHINEY on 8/22/2019 10:37 PM

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