• News New Blog Banner

  • Medicare Data Released; Analysis Will Require Time, Context

    The Centers for Medicare and Medicaid Services' (CMS) release of payment data sparked plenty of dramatic headlines across the country, but sweeping pronouncements may need to be approached carefully until the information is fully analyzed from multiple perspectives, including overall usefulness.

    On April 9, CMS opened public access to payment records on more than 880,000 providers, including almost 37,000 physical therapists (PTs), 48 of whom are listed in the top 2% of providers receiving payment. News sources quickly reported on the overall data, with some even offering an online tool to look up information on providers.

    While almost all media outlets tagged the release with headlines pointing to "big payouts" for a small percentage of providers—the New York Times' headline of "Sliver of Medicare Doctors Get Big Share of Payouts" being 1 such example—at least 1 news source noted the need for a more nuanced approach. In its article on the release, the Los Angeles Times reports that "federal officials cautioned against drawing sweeping conclusions about individual doctors from the numbers. High payouts do not necessarily indicate improper billing or fraud, they say. Payments could be driven higher because providers were treating sicker patients who required more treatment or because their practice was focused more on Medicare patients."

    APTA staff members are reviewing the data and its organization, and already have one caveat. “It’s important to look at this data in context,” said J. Michael Bowers, chief executive officer of APTA. “It should not be used to draw conclusions about physical therapists and physicians without information about expenses, quality of care, complexity of patients, and volume of  patients treated.”


    • It was interesting looking at payments received by some physical therapy clinics. While I would like to believe the clinic billed accurately and collected appropriately, I suspect there may be some coding issues. As in the case of my mother's care, her time spent in the clinic may have been 1 to 1 1/2 hours, but that should not have translated into 4 units of direct contact coding when NO dedicated provider was in attendance. I can sleep at night, can you??

      Posted by Pam Wood on 4/11/2014 6:04 PM

    • I am with Pam as far as the billing and coding issue problem goes. It is without question that PT's throughout the country are improperly billing. As with any group, there will always be those who choose not to follow the rules and should not be viewed as representing the majority of us who do. The things that keep me up at night is how to best manage my patients in accommodating schedules to insure proper treatment, care and billing...

      Posted by Mark Lombardi on 4/12/2014 9:34 AM

    • I run a small Outpatient physical therapy facility and the main focus of my practice is manual therapy. I had once worked for an individual where I felt I was paid labor and decided to go out on my own providing quality one on one care with my practice boasting 70% Medicare. In the last year, I have seen my revenue drop by $20 thousand. I had another part time PT who is no longer working with me due to relocation. Why is it that those of us providing quality care, are getting penalized by the system of the MPRS resulting in approximately 20% reduction on each claim. And then there are those that are making the hay out of gold.??

      Posted by Miri Ingwer on 4/16/2014 12:30 PM

    Leave a comment
    Name *
    Email *