The New York Times published an APTA letter to the editor about an article on the recent release of extensive Medicare payment information. The article used data on a single Brooklyn, New York, physical therapist (PT) who received $4 million in 2012 as an example of how physical therapy "has become a Medicare gold mine." The association continues to analyze the Medicare data and will be releasing a full report in early May.
"The data presented in this article does not tell a complete story," writes APTA President Paul A. Rockar Jr, PT, DPT, MS. "A vast majority of physical therapists demonstrate Medicare utilization patterns consistent with those expected within the profession. With regards to utilization, nearly 90% of physical therapists who bill Medicare Part B receive payments of less than $100,000 per year—with the majority of those receiving significantly less than that (67% receive less than $50,000 per year, and 40% receive less than $25,000)." In fact, only slightly over 10% receive Medicare Part B payments of $100,000, and less than .1%, or only 44 individuals, receive greater than $500,000.
The data used in the story are drawn from a recent release of extensive Medicare payment information on over 880,000 health care providers. The amount of data shared is large but limited, and includes only utilization data on services billed and paid under Medicare Part B. It does not include information for patients who are enrolled in any form of Medicare Advantage plan, those who receive coverage from other federal programs, or those with private health insurance. It also does not include data on the value, quality, or outcomes of the treatment provided.
"These data should be viewed in context, and should not be used to draw conclusions about individual providers without information about expenses, quality of care, complexity of patients, and volume of patients treated," Rockar writes.
The article does, however, bring to light areas of concern that APTA has noted in its preliminary review of the data. "In particular, APTA is concerned about outliers in the data, such as geographic disparities that are difficult to explain, and is analyzing the information to pinpoint variations in care that must be addressed," Rockar writes.
In addition, in its initial review of the data, APTA has noted outlying discrepancies in patterns of care, such as the use of modalities, support personnel, utilization of consistent procedures for the majority of patients rather than individualized treatment plans, and episodes of care that are difficult to explain based on professional standards.
Another issue with the data highlighted in the New York Times article is that it represents providers and physical therapists who are billing under an individual National Provider Identification (NPI) number, not an organizational NPI. "Data billed under one provider’s billing code can cover multiple practitioners," Rockar writes. "However, Medicare says that if the supervised physical therapists are not enrolled, the supervising physical therapist must be on the same premises."
Rockar writes that "The association is committed to reducing fraud, waste, and abuse and has launched a comprehensive campaign to address these areas of concern in the profession." That campaign, called Integrity in Practice, is a multifaceted initiative that was featured in the February issue of PT in Motion. Its goal is to highlight the profession's reputation for excellence and outline the work needed to honor and protect it.
APTA plans to make a full analysis of the data as it relates to PTs available by May 10. Included in the analysis will be guidance for members on how to read and interpret their own data.
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