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    Reformed Payment System: Your Feedback Is Needed

    APTA's goal is to reform payment for outpatient physical therapy services to improve quality of care, recognize and promote the clinical judgment of the physical therapist, and provide policymakers and payers with an accurate payment system that ensures the integrity of medically necessary services.

    To this end, the association is proposing a transition from the current fee-for-service, procedural-based payment system to a per-session payment system. APTA needs your feedback on the developmental draft of the Alternative Payment System to refine the system and enhance the model. You can learn more about the Alternative Payment System at www.apta.org/APS. After reading about the system, provide your feedback using this survey by June 15. The survey will only take a few minutes to complete. 

    E-mail advocacy@apta.org with any questions. 


    Comments

    Fee for service seems more appropriate
    Posted by Colleen LOuw on 5/18/2012 12:34 PM
    I am an owner of a vestibular rehabilitation practice whereby we perform the myriad of vestibular tests prior to initiating vestibular rehab/treatment. These tests are similar to what an Audiologist might perform in a vestibular lab setting. In this new format, how would the testings performed be billed and paid?
    Posted by James Buskirk -> >HVaB on 5/18/2012 12:43 PM
    I believe the proposed system is too complicated and requires too much subjective judgement by the therapist regarding which category to place the patient.
    Posted by Jason Sims -> >JS_AF on 5/18/2012 12:52 PM
    I believe this rewards undertreatment and will cause patients to be treated for longer periods of time. Therapists/practices concerned about making ends meet will provide fewer services at each visit knowing that it increases the profit margin of that particular visit.
    Posted by Chris Cameron on 5/18/2012 1:06 PM
    I am not in favor of reforming our payment system as proposed for the following reasons: added assessment responsibilities (i.e. non-patient care time commitment)placed on the clinician to classify severity of patient condition and intensity of service provided, classification being subjective and open to interpretation. This proposal creates a new opportunity for third-party payers to "judge" differently (i.e. disagree) with the classifications proposed by the clinician for specific patients for the purpose of decreasing or denying payment. This proposal supports further evolution of our patient documentation and clerical responsibilities towards payment justification rather than clinical care i.e patient status and treatment.
    Posted by Marti Miller -> >MT`= on 5/18/2012 1:25 PM
    When I started my career in physical therapy fifty years ago, per- session payment was the reimbursement system. As a group the APTA of Maryland cautioned the health insurance industry that their proposal to change to procedure-based system would result in an astronomical increase in fees almost immediately. And so here we are with a system that results in some daily P.T. charges higher than a consult visit to a specialty physician that involves an invasive procedure as well as the detailed examination. From my perspective as a clinician with experiences in every possible therapeutic setting except pediatric P.T., I have fears for the financial security of today's clinicians, encumbered by their professional debts as they enter our wonderful and satisfying profession. Forces much beyond our control will have unwanted effects on the long term finances of our colleagues.
    Posted by Herschel Budlow P.T. on 5/18/2012 1:38 PM
    I think this is a great idea to cut out unneccesary layers of busy work. I charge my cash pay patients a flat rate per visit. I know what I need per visit, and they know what to expect.
    Posted by James Moore on 5/18/2012 1:40 PM
    We definitely need better reimbursment system , but not the way reform payment system presented , it is not useable, confusing and it doesnot make any sense to me and it does not reflect what we do what pt needs and you can not categorize patients.they are induvidual not a number. it does not wotrh to change anything till you find better system. i dont approve the new reform payment system at all.
    Posted by Yalcin Ekren PT on 5/18/2012 2:10 PM
    A per session fee might work for orthopedic clinics that see multiple clients overlapping. In a rehab setting like ours, we are one to one at each session, 100% of the time. Please request changes that will not sabotage the rest of us.
    Posted by Pam McDowell, PT, DPT on 5/18/2012 2:29 PM
    DON'T CHANGE THE PROCEDURAL BASED PAYMENTS. I REPEAT. DO NOT!!!!!!
    Posted by Joanna Bilancieri on 5/18/2012 4:02 PM
    OK our "PT" clinic may or may not benefit from the proposal. There is not enough information posted for me to determine that. I have no useful guidelines to be able to pull up a sample patient population to recode and re-bill under the proposal to see if we can even financially survive your genius. So how can I support or oppose your experiment APTA ? MORE IMPORTANTLY, we will have TWO ways of billing if the experiment "passes": one for the PTs and another for the OTs and SLPs. I do know that this aspect WILL create another layer of problems and challenges that do not currently exist in our business. What say you APTA to this new problem that arises from solving an old problem? By the way, can I see some data on the old problem that the new system PURPORTS to solve ? Is the current system really that broken ? Remember that film you watched in Biomechanics class of the guy running on the treadmill and you all cringed when you saw his horrible mechanics? Then we asked you, "what would you do with this person?" Many students answered, "I would post here" or use an orthotic to fix this or that! To bad no one ever stopped to ask if the patient even had pain!!! Turns out, he had been happily running 5 miles/day, 3d/wk for the past 30 yrs with NO pain or complaints. APTA, did you see this video or were you texting in the back ? What kind of costs can a small clinic expect to incur as a result of the changeover ? Hmmmm, to renew my membership or not ? Bryan Pasternak
    Posted by Bryan Pasternak -> >HX]>I on 5/18/2012 7:24 PM
    I feel that this system will drain medicare funding very very quickly as these individuals will more likely fall under the high severity category. I also feel that it warrants less creativity and skill utilization by the therapist. It is important that we continue to practice all of our skills as appropriate for the patient and bill accordingly. Special skills like manual therapy require one on one time and may fade away in light of increased revenue. For example, a clinic may promote supervising more than one patient performing 30-45 minutes of therEx that requires less supervision as this would allow for increased overall profit.
    Posted by Ashley Guy -> @LV[?L on 5/20/2012 12:38 PM
    We went away from this 20 some years ago. We were at that time told by one of our insurance contractors who would not raise the $40/visit contract rate, to just give the patient $40s worth of PT! I think they still only allow $40!Care will absolutely go down to make ends meet. And I wouldn't count on more visits when everyone is limiting those too now. We won't be able to set our rates, the insurance companies will set them for us, and it won't be very much. I wonder where this is coming from, we PT members or Obama care supporters?
    Posted by Debbe on 5/20/2012 7:08 PM
    If we don't make changes Medicare has indicated they will do it for us. The APTA with a proactive movement with member involvement is to be commended and supported. Get involved folks before we are told how to bill.
    Posted by Bob Worden on 5/20/2012 9:15 PM
    Reporting Quality measures? Pay for Performance? Alt Payment Model? They all equal less time spent treating and more time trying to figure out how to get paid. This will lead to a single PT supervising mult non-qualified individuals.
    Posted by Richard Crawford -> >FR^BJ on 5/20/2012 10:32 PM
    For those therapists who have worked in the CPT code system all of their career will find change to be difficult. I think we are at a point in which we have an opportunity to establish a new type of charge system that goes beyond hot packs, massage and ultrasound and to utilize the best treatment methods for the problems that our patients have. It is based on good clinical judgement which is what we have wanted not based on time. It doesn't keep the therapist from doing manual therapy which may only take 5 minutes to do followed by an exercise program followed by a cold pack. Your productivity will be based on functional outcomes forcing us to provide care directed at the anticipated outcomes. It doesn't say that you can't use extenders such as PTAs and as a team you treat teh patient.
    Posted by Vanie L. Jones on 5/21/2012 11:05 AM
    Bryan Pasternak, I agree with most of what you stated. Vanie, who does HUMS anymore? It doesn't pay. PTAs are not considered extenders in most states. The non-qualified individuals spoken of are unlicensed personnel. My opinion of the problem with the proposed system is in the ease of further corruption due to self-referral at hospitals and POPS.
    Posted by Sean Hayes -> =NX`?M on 5/21/2012 5:00 PM
    I agree with many previous comments regarding the subjective nature of the categories. E&M procedural codes already exist and perhaps another solution is to have physical therapists use E&M codes and eliminate the "timed" aspect of procedural codes. The reality is our profession needs to stop abusing the CPT codes and our professional organization needs to continue to defend our practice without sacrificing our skill set to lesser qualified individuals such as ATC, Exercise Physiologists, and other non-licensed health care providers. We need to establish state practice acts that preclude working for POPTS or any other type of financially driven practice. We need to remind ourselves of the ACOs and what value will physical therapy bring in this model of reimbursement. Having physical therapists removed as "specialists" in many health care plans would reduce the co-pay financial burden on patients and shift cost back to insurance companies. Perhaps our profession needs to form a union in order to have collective bargaining rights with insurance carriers and policy makers.
    Posted by Kevin Basile -> >JR]DK on 5/22/2012 7:15 AM
    As much as I dislike how unions have evolved, I agree with Kevin. If Physical Therapy was protected so that Physicians and Chiropractors couldn't own/bill, then misuse of CPT's would decline significantly (as per studies I've read) and nothing would need to be wastefully changed again.
    Posted by Stephen Bregler -> ?KY]EF on 5/22/2012 12:02 PM
    I agree that this opens the door to denials or reductions in reimbursement by third parties (insurance companies). We already have to fight for payment, and I see this as a tremendous opportunity for insurance companies to argue category placement, and thus deny or restrict reimbursement. Also, who places them in the category? We here in Washington state are fortunate to have direct access, and are less hindered by the needs for physician referrals or prescriptions, but the rest of the country is not. Would we be granted autonomous judgement in placing patients into categories, or would this be another avenue controlled by physicians or even insurance companies? This system would make it open season for utilizing unskilled staff for patient management. "Shake and Bake" therapy is NOT skilled therapy, and this system would encourage that model of care (unskilled staff for modality use and exercise supervision, minimal quality contact by the therapist). Evolving our profession into one of autonomous, primary care, neuromusculoskeletal healthcare providers of choice requires that we be highly-skilled practitioners, and more importantly, actually deliver our services in a highly skilled fashion. Anything less dilutes our profession, decreases our legitimacy in the eyes of other healthcare providers and ultimately in the eyes of the public. This particular plan does not bode well for our autonomy as healthcare practitioners, and it puts the quality of our services in a precarious position, as it would be even easier than it is now to use unskilled providers for patient care by unscrupulous management. The system does need to change, but this is not yet the answer, at least not in outpatient, private practice. I applaud the APTA for working on this and encourage them to continue to do so. If we don't make changes then others from outside our profession will, and it is not likely to be favorable. As a longstanding member, I strongly suggest that the APTA listen to the voices of the members that have spoken here, and rework this alternative payment solution.
    Posted by Kenneth Ballenger -> >FWaDK on 5/25/2012 4:06 PM
    The alternative payment system for physical therapy services is not a good system. The system has a good intent to where we could get compensated per visit, but would not be appropriate for our profession. The alternative payment system is based on the severity of their condition in which the more severe the injury the better we would get compensated per session. This is basically discrimination. All patients, no matter what their severity of injury, should be able to access physical therapy and physical therapist should be compensated the same per time and work we provide with each patient per visit. Due to insurances limiting the amount of patients we can see in private practice per day and trying to force us to be one-on-one with every patient per hour, many offices are only seeing patients that have insurances that pay better per session and turning away those patients in which they do not get compensated well for. This would also happen with the alternative payment system proposed and physical therapist would more so see patients with more severity and turn away patients with less severity. In turn, many of these less severe patients could eventually have more severe problems in the future if they are not taken care of early. For our profession, more specifically in private practice, it is very important that a number of things happen. We either get compensated better for each patient so we can be one-on-one with each patient for an hour or we need to be allowed to see more than one patient per hour in order for us to survive financially. Many other healthcare specialists typically average four patients per hour. We are expected to charge the same amount that they get charged for 15 minutes for our one hour of service. Typically one to two patients per day will cancel or no-show, therefore we may only see five to six patients per day if we can only see one patient per hour. For the amount that we get compensated in private practice we would not be able to survive to cover our basic costs. Typically hospital-based therapists get compensated much more per session than we do in private practice, therefore they will survive. To my understanding in private practice we would have to see three patients in order to get compensated the same as a hospital-based therapist would for one of their patients. In private practice we need to be compensated better. If do not get compensated better per patient or be able to see one to four patients per hour and use other supportive staff to assist us, our profession is going to have a very difficult time staying in business. We all think of giving good quality care, but if our practices do not get compensated sufficiently to keep our doors open we will not be able to provide any care. If our physical therapy offices are not able to improve financially it will be very destructive for our profession. We will continue to be limited on the amount of physical therapist going into the profession since there will be no incentive for students to pursue a career in physical therapy and we would not be able to have the funds to put back into the profession to allow it to grow. Overall, each office needs to have the option to see one to four patients per hour. Some patients need more one-on-one care as compared to other patients and this should be our choice in order to give good quality care to each patient. In order for us to see more than one patient per hour we need to be able to utilize supportive staff to assist and we need to be able to bill one-on-one time for each patient. Due to insurance rules and the limitation of patients we can see per day and the lack of therapists many patients are not getting treated. Our compensation should be based on a per session visit, this way we can choose to provide the service that each particular therapist feels is best for that patient without having to worry about rules and restrictions on the type of treatment we perform. Patient feedback is the best information that we can get for quality care. If we do not provide good services to the patients because of the insurance limitations, they will go to alternative therapy offices and the private practice therapy offices will not survive. We should also be able to provide a service to the public and they should be able to pay cash for that service. These objectives are what our profession should be working on to better protect the physical therapy profession and enhance our profession to allow us to grow and continue to provide good care to all patients. We definitely need to change the system but a payment system depicted by severity is not the way to go.
    Posted by Randy Lindsey, PT, LAT, ATC on 5/25/2012 7:40 PM
    Hmm.... statistics are great, planning, cutting is great but when it come to YOUR MOTHER or Father who was independent and now after stroke need a lot of help and a lot of one on one time you will see this different way. However- it could be too late. Than you can only pray that policy will be change again. GOOD LUCK YOU WILL BE THERE TOO.
    Posted by Steve Johnson, PT on 6/21/2012 10:54 PM
    "An Alternative Payment System for Physical Therapy Services Developmental Draft for APTA Members March 15, 2012" Who are the authors? No author? Or maybe afraid to sign? It's like Optimal we have to do something so here it is. No use, no good, but we did a job and we can stay in office.
    Posted by John Logan PT on 6/21/2012 10:58 PM
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