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  • CMS Releases Report on Alternative Payment Systems for Outpatient Therapy

    A long-awaited set of reports on outpatient therapy payment alternatives has been released by the US Centers for Medicare and Medicaid Services (CMS).

    According to CMS, its Developing Outpatient Therapy Payment Alternatives (DOTPA) project had 2 main purposes: "to identify, collect, and analyze therapy-related information tied to beneficiary need and the effectiveness of outpatient therapy services, and to explore payment method alternatives to the current financial caps on Medicare outpatient therapy services." Research for the report began in 2011.

    The report states that "The research presented here does not aim to provide a completed, finalized model for a new payment system. Instead, selected characteristics that exist for an alternative payment system are discussed within the context of [the diversity of outpatient therapy]."

    APTA staff is reviewing the reports and will use the findings to inform its decisions and recommendations around payment policy.


    • Will the APTA be rendering a summary of this massive report?

      Posted by Mary R. Daulong on 5/2/2014 5:11 PM

    • We have been self employed now since 1999 and have seen Many changes over the last number of years; however, The majority of changes have not been in our favor. Now, we are facing life threatening changes in light of the ACA, and the Changes due in October. We are trying extremely hard just to Stay in business and not lose our homes. Now, you want to Throw another rock into a poorly written system to hurt us Even moore? Please stop helping us. Your help cost us too much and only empowers big government.

      Posted by Mike Stewart on 5/2/2014 10:54 PM

    • Folks the only alternative payment system that will work for the PT profession or for that matter the entire healthcare sector is the following: the country pools all of the healthcare dollars into one large self-funded insurance pool that works like a health savings account but is owned and operated by the consumer. Health insurance is then only used as a secondary coverage after the patient first uses up to $9000 out of their private account. The patient pays the providers directly at the time of service from their private account and their is no insurance middleman. Providers compete for business based on skills and on price and there are no insurance networks and no health care systems that hold a monopoly on care. PTs it is time to say No to the insurance lobbyists and the APTA should get behind real reform that will allow for therapists to stay in practice! This is true universal health coverage and true affordable care...

      Posted by Ned Bruns on 5/3/2014 10:59 PM

    • Mike, respectfully do you think APTA is driving this or providing a negotiated proactive strategy to what is coming from CMS? This has been on the horizon in open discussion as a proactive-responsive strategy since at least 2005. I have been in practice since 1976 and in private practice since 82’. I totally agree and empathize with your frustration and pain across the additional time, labor and costs we have burdened in the past 2 or more decades. Again respectfully, if you haven’t; when you have taken the opportunity to read and decipher just the past 10 years in miles of reports and demands from CMS and additionally consider the variance in practice, what do you suggest is a better alternative to what ALL of physical therapist practice (not just APTA) is being dealt? I am sure APTA BoD and staff would be interested as would I. Thanks. Stephen McDavitt

      Posted by Stephen McDavitt -> =IT] on 5/4/2014 6:42 AM

    • Ned, you are on the right track. The consumer is misguided in thinking that their insurance company cares about them and their health. They DON"T. They care about receiving their monthly premium. The money needs to be controlled by the consumer and PTs will do well.

      Posted by Grayson Gentzel -> =GP[<N on 5/14/2014 6:21 AM

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