APTA’s next steps in overhauling the flawed payment system for physical therapist services include a 2014 pilot program to investigate the impact of APTA’s proposed model and a 2015 campaign to educate members on new payment systems in health care. Both were adopted by the Board of Directors at its April meeting, in preparation for a targeted 2016 implementation of a new system.
APTA began in 2012 to draft and refine an alternative to the current fee-for-service Medicare payment system, in part responding to a Board policy adopted in 2011 that endorsed the development of an alternative payment system, and in part as a response to calls from the Centers for Medicare and Medicaid Services (CMS) for a new methodology—the goal of both being a system that would fairly compensate health care providers while doing away with the sustained growth rate (SGR) and arbitrary therapy caps that have confounded providers and CMS alike for more than a decade.
The Physical Therapy Classification and Payment System (PTCPS) is the result of extensive member evaluation of the initial draft. Members provided input on a severity-intensity framework as a basis for payment, the appropriate unit on which to base payment, the proposed evaluation levels, the examination and intervention levels, overall value of the proposed system, supplemental support needed to implement the system, and whether the system effectively reflects the clinical judgment of the physical therapist.
Most recently, during the February 2014 meeting of the AMA CPT Editorial Panel, APTA proposed a new CPT code structure reflecting the PTCPS. While the panel complimented APTA on the proposal, it postponed voting on it, saying the magnitude of the changes to the existing physical medicine and rehabilitation (PMR) code family warranted more time and a pilot test to provide more support and validation for the new codes.
The Board in April committed up to $500,000 to fund the pilot, and APTA will seek collaborative partners to help offset costs. For the pilot, PTs will seek to determine appropriate per-session CPT codes to describe physical therapist services in 2 ways: review of clinical vignettes and chart review of existing medical records of patients.
On the education side, APTA will develop a comprehensive plan to educate members on the new outpatient physical therapy model and other payment models emerging from health care reform, such as collaborative care models, bundling, and new postacute payment models.
To see the full discussion on this and other topics from the April Board of Directors meeting, watch the archived livestream of all open sessions.
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