Wednesday, March 27, 2013
Working Together in Challenging Times
The physical therapy profession is facing additional cuts to Medicare payment for services starting April 1.
Dating back to last year, APTA has provided crucial information about these upcoming cuts in all-member e-mails, News Now articles, social media messages, and via the APTA.org homepage. Still, we know that some physical therapists are unaware of what's ahead.
That's why I'm urging you to share this information with your colleagues, which can be as simple as forwarding the link to this blog post.
These cuts will impact physical therapists financially and may affect the access to care our patients receive. Additionally, as health care providers continue to bear the brunt of payment reductions, there is also an emotional toll to these changes, and it's important that we support one another in these challenging times.
I've talked with many physical therapists from across the country, and I know that these challenges are real. I see and feel it in my own practice as we work as a management team to continue to provide the patient care needed by so many with resources that continue to shrink. It is becoming more and more evident that from a financial and reimbursement aspect we are facing a "new normal" that is often hard to understand.
Those familiar with our national advocacy efforts know that APTA works year-round to protect payment for physical therapy services - advocating intensely to repeal the therapy cap and to prevent the MPPR and other cuts from going into effect. Unfortunately, despite successes in many legislative and regulatory areas, physical therapists are not immune to the repeated changes affecting all Medicare providers.
Although APTA alone cannot change the course of sequestration, the association will continue to look for opportunities to fight the MPPR cuts. However, with or without congressional action on these items, these challenges necessitate our consideration of payment reform. It is becoming increasingly clear that we cannot sustain the current payment system - not for ourselves, and not for our patients.
That's why APTA is developing an alternative payment system - the physical therapy classification and payment system (PTCPS) - for outpatient services. The need for reform is clear, and we want the opportunity to help shape payment reform to reward the clinical expertise physical therapists bring to the health care system, rather than having payment reform imposed on us.
Payment in the future will be based on data that demonstrates value, patient engagement, and quality outcomes. The proposed PTCPS embraces that model with the goal of not just improving payment but also quality of care.
No proposed system will be perfect, and while many have embraced this change, other physical therapists have expressed their concern. But with the challenges facing payment in health care, change is essential.
I encourage you to read about APTA's alternative payment system, PTCPS, and consider its impact for the future. But more importantly I urge you to spend 5 minutes sharing the resources at APTA.org with your colleagues to prepare for these challenges in our present.
Do you have an estimate as to the "average" amount the reduction be in payments? Thanks.
Andy Kelly, PT
Posted by Andrew Kelly
on 3/29/2013 2:35 PM
A lot of "chit-chat" but, no really short and useful information in this blog
Posted by Tom Romeo
on 4/1/2013 9:14 AM
Glad to see these comments. These cuts are huge!
My analysis reveals that the payment for a typical 60 min visit will be reduced in the $22 to $30 range depending on your Medicare locality allowed amount. This reflects an 18% to 20% reduction in payment for that 60 min visit compared to the allowed amount.
It is an 8% to 10% reduction compared to what you were paid in 2012.
It is an 11% to 13% reduction compared to what you have been paid during the first quarter of 2013.
This will force changes in how we treat Medicare patients unless we want to go out of business. Profit margins are already thin and reducing payment while increasing the administrative burden is just not going to work.
Posted by Chuck Felder, PT, DPT, SCS, MBA
on 4/1/2013 10:39 AM
i am a licensed PTA for over 22 yrs.i have recently been feeling the squeeze of the medicare and insurance cuts in my outpt facility in a retirement community. patients's co-pays have increased per visit with some of their insurance company's as well as the limit to the number of covered visits. in addition to that i am seeing an increase in the insurance companies that will cover PT only visits- will NOT cover a PTA to treat the patient. i feel like my career/livelihood is at risk. would an inpt setting offer me more job stability/ security????
Posted by s. couture
on 4/13/2013 6:43 PM
As a current DPT student I find it just as important to keep up to date with the ever-changing world of healthcare. I liked how you described this process and the "new normal." We recently learned about the alternate payment system in class and I agree that it has the potential to improve quality of care. You suggested talking to co-workers about this issue. I think that it would also be helpful for clinical instructors to discuss this topic with any students they may have so that we may be better prepared when we graduate.
Posted by Kate Hojnacki
on 5/15/2013 6:48 PM
With being a second year physical therapy student, it is a scary time knowing there may soon be cut-backs around the time of our graduation. However, through reading this article and recently realizing many other ways that the APTA is advocating for physical therapy and planning for its future, makes me realize how important the member fees are to the APTA. I agree we need to continue to support each other and our profession whether it be through advocacy, spreading the word, or research. I have recently been exposed to the Alternative Payment System as mentioned above in class. A good way to inform more therapists of this new system may be to contact educational institutions and ensure they are teaching this in their programs. As outpatient physical therapy will be next clinical setting, I will be sure to bring up this topic and discussion and spread the word of what is up ahead.
Posted by Kristen Schuman -> ALYZBK
on 5/17/2013 5:44 PM
This blog is a great opportunity to bring about discussion of the ever-changing healthcare system. I am currently a DPT student and have recently been exposed to some of the changes taking place. Not only have I discussed them in the classroom, but I've also seen them on my clinical rotation. I would agree that many physical therapists are unaware of the changes taking place. I spent time discussing the new changes with staff on my first clinical, and while the conversation was lively, I felt most of us had no clue as to what was truly going to happen in the near future. Additionally, I'll admit to sometimes skipping over APTA emails due to the influx in my inbox. This limits my understanding of the legislature being passed and the new laws soon to be in effect. I know I'm not the only person that falls into this trap though. I feel most of us can do a better job at researching what is going on in the physical therapy realm of legislation, so that we can better educate ourselves and our colleagues on the changes to come.
I like the idea of the alternate payment system, PTCPS, brought up in this blog. Due to the constant changes occurring with reimbursement, it is imperative that physical therapists come up with a new model to counteract the effects of sequestration. This may be the model that can do that. However, I noticed that it is structured mainly around the outpatient physical therapy setting. Is there a way to include some of the other settings in this alternate payment system? What are some ideas for approaching the changes to come in other settings (IP-rehab, acute, SNF)? I'm sure the APTA is currently working on addressing this issue for many physical therapy settings. My only concern is that outpatient physical therapy will receive the majority of the attention and benefits of new legislation, thus leaving behind the other settings and making them more vulnerable.
Posted by Tyler Newton
on 5/17/2013 7:46 PM
I am a second year DPT student and while reading this posting I felt a sense of urgency to completely understand the changes that are taking place in the Health Care System. The resources in this article were particularly helpful for me to not only educate myself but also be able to educate my future clinical instructors regarding these changes. Since I have not begun to practice these changes will be my norm, but it is still good for me to understand how previous payments for service have taken place. Even though I was recently exposed to the Alternative Payment System in one my classes, it was nice to further gain and understanding of what exactly is changing and why it is necessary. I really do think it is important to be able to accept the changes and find good alternatives as to how to combat the budget cuts and the necessity for health care reform. One way to promote awareness of these changes would be to contact various Physical Therapy Educational facilities about the changes so that the institutes can educate their students. This should facilitate discussions within the various clinical sites enabling these students and clinical instructors to have greater awareness.
Posted by Kelsey Kennedy
on 5/24/2013 4:32 PM
As a second year DPT student and one that has not experienced the outpatient setting during clinicals at this time, I found this blog very enlightening. Although we have learned about the attempt to amend the current system, it is difficult to fully understand coding and billing without having practiced it myself. It is clear that a change must occur. Whether the proposed alternative payment system is the answer or not, government provided health care should enable the physical therapist to provide nothing less that best practice for its patients. I do however wonder how the alternative payment system would work despite its subjectivity in regards to "grading" the complexity of patients.
Posted by Jessica Staton
on 5/27/2013 6:59 AM
Dr. Felder, thank you for your analysis and providing us with a representation of the impact these cuts will have on our profession. This is extremely helpful considering I am a DPT student and there is much to learn about reimbursement in healthcare ... Although reform needs to happen, do you think the PTCPS is the best alternative payment system? One possible result of a per session payment system is therapists providing decreased quality of care secondary to equal payment regardless of services provided. I understand we cannot control the acts of others and this unethical practice is (hopefully) few and far between, but it must still be considered when implementing the best alternative payment system for our profession.
Posted by Drew Rogowski -> AMPZ?N
on 5/27/2013 11:14 AM
Great discussion! I am also a DPT student and recently completed an 8-week outpatient clinical rotation. While I agree that a new payment system needs to be implemented, possibly the PTCPS, I do feel that there is something we can all do now to slow impending cutbacks and decreasing caps. My class recently completed an administrative rolls class in which we discussed the new therapy caps and possible consequences of going over what Medicare Part B has stipulated as a yearly maximum. The more physical therapists comply with Medicare, the easier it is for them to continually cut our services. I implore every practicing therapist out there to go beyond the cap and advocate for those patients you feel deserve more treatment. If no one asks for additional units, outpatient physical therapy services will continue to see decreased caps. Act now and stand up for your profession and your patients!
Posted by Adam Cagnet
on 5/27/2013 8:04 PM
Really interesting discussion. As a DPT student we have really been pushed to understand medicare rules and regulations as well as how this affects our future profession. I agree with Adam's coments above. More therapists need to be willing to go above the cap, despite manual review, for those patients that need more therapy. I am also interested to see how PTCPS changes therapists mind set out medicare. While I agree reform is necessary, it also seems that education on how to use the system to best benefit both the PT profession and our patients/clients will be a long but vital process. Does the APTA have any webinars or education courses on this topic planned?
Posted by Jennifer Reynolds
on 5/28/2013 10:10 AM
Really interesting discussion. As a DPT student we are encouraged to understand the medicare rules and regulations and how they affect our profession. I agree with Adam's comment above. It is important that therapists are not afraid to go above the cap because of possible review by medicare. We need to be advocates for our patients and our profession. Also, I am interested in how the PTCPS code transition will go. From my time in the clinic I noticed that some therapist are very well versed in the latest and greatest of PT, while others are not. Is the APTA planning any CEUs, online education or webinars? If not how do you feel the transition will be received by therapists as a whole?
Posted by Jennifer Reynolds
on 5/28/2013 11:21 AM
I am in 100% agreement with the first post, being that change is essential. It is comforting to know that PTs across the country have taken notice and are committed to finding change and hopefully this will be for the better of our profession and patient care. Like many have already stated, we have no idea what things will look like once the Affordable Care Act fully takes effect, but must be prepared to respond when necessary. At this time, we must only venture a guess as to what patient care will look like and how we will be compensated for our services. It is highly beneficial to be prepared and I would be very happy if all this carries through. What we need to do in the meantime is continually advocate and explain to those with legislative power the need for something like this. Although I myself have not experienced the Outpatient clinic so far in my clinical rotations, I can guarantee that I will be watching and observing my colleagues that I will have the opportunity to work with and hear their thoughts on the issue. PTCPS appears to grasp a new light on compensation and hopefully the legislative powers will see the benefits that could be had in the future.
Posted by Kyle Sanders
on 5/28/2013 8:31 PM
I found this blog post very interesting as a second year DPT student who just completed an administrative roles class that covered insurance types as well as Medicare rules and reimbursement. I agree that advocacy and changes for our profession regarding reimbursement need to be fought for in these uncertain times. I appreciate how much we were encouraged as students to stay up-to-date on these issues for the betterment of our patient care and profession as a whole. I do agree that a per session payment system (such as PTCPS) would be ideal for the PT profession (as well as many other healthcare professions), but one must consider the potential for unethical practice given this system. There has already been a great deal of problems in the outpatient setting with therapists over-utilizing reimbursement services. However, that should not prevent a system like this from being utilized. I believe that if there is enough education for therapists about the implementation of this service, it sounds like a great alternative to the payment systems we currently face. I look forward to learning more about this topic and will be sure to ask my future clinical instructors is they know about it!
Posted by Katie Campbell
on 5/29/2013 7:46 AM
I appreciate this blog and advocacy for physical therapy. I agree with the above comment by Kristen Schuman that it's so crucial we continue to come together and fight for our profession. There are many students and PTs that are currently working that simply don't want to pay the dues to be apart of the APTA. Those dues are being spent by our leaders in APTA to fight for us. Also, if they were APTA members, they might have an idea about these changes that are coming about.
As far as the changes go, I will play devil's advocate for a minute. Our country spends more money on healthcare than any other country, yet we are down the list when it comes to how healthy we actually are. I understand our culture is different than many of those other countries that are on top, but Japan for instance, pays their teachers more than their physicians and they are living longer than anyone else. I'm only stating this because I can see why the healthcare profession is getting stabbed at for cuts in cost. What we must do as PTs is not only advocate for our own cost cuts, but also that we are one of the best in preventative care. Our outpatient facilities especially can start finding more business in preventative care when teaming up with a local gym, ie. a YMCA. We could also do a little better on advertisement to the public as to what we can do for them now that every state has direct access.
Posted by Micaela Hornstein -> AMR]CN
on 5/29/2013 9:55 AM
We face a lot of challenges moving forward in our profession. Many people in my area are being moved to health savings accounts and off of traditional insurance plans that pay for physical therapy. It's a trend that as a practice owner is disturbing. Co-pays are reaching levels of 50.00 for those with insurance and keeping their patient visits to a minimum. At what point will our salary structure begin to falter? For the 20 years I have been practicing salary levels for PT's have doubled and reimbursement has been cut in half. It will be interesting to see where the future takes us.
Posted by Charlie Mills
on 10/10/2013 6:35 PM
Working together will make us aware of different issues and help us in solving these. Together we should try to come with those therapies which are convenient for the patients and give them relief.
Posted by Bolee
on 11/20/2013 7:41 AM
As a student PTA, it is good to know that these changes are happening so it doesnt hit by surprise later, but also can make a person nervous at the fact that it could hurt the field of physical therapy as well as the postions available for a PTA. Obviously insurance companies want to pay less and pysical therapists want to be paid more, but cuts will affect the patients as well. A cut in reimbursment rates can affect the field as a whole. With less money can lead to less positions available, leaving an increased number of patients needing therapy and a decreased number of therapists to treat them, as well as less supplies and space to use to treat. It could affect PTs and PTAs with reimbursement troubles, but if certain insurance companies don't want to pay for the treatment of the PTA, that will greatly decrease the job opprotunites for this profession. It could take all we can do as a PTA from submitting better documentation to showing an insurance representative one on one that the patient is benefitting from the therapy and that it is necessary for the patient to recover. If our documentation is showing consistant progess with our patients, insurance like medicare shouldnt be able to cut the amount they pay us back. It will affect the quality of treatment the patients will recieve and they ways we are able to treat them.
Posted by Chad Parsley
on 12/9/2013 2:28 PM
I am a Student Physical Therapists Assistant and reading through this topic of decreasing payment for PT professionals hits me hard. The issue of some patients not being able to see a PTA is also discouraging. I agree that payment will be and should be based on data that demonstrates value, patient engagement, and quality outcomes. As written above I do agree with the fact that we as PT professionals getting pay decreases will lead to emotional issues but us being the PT professionals that we are should not allow that to carry over into providing insufficient care for our patients. I believe that reimbursement decreases leading to pay decreases is a big problem to me as a future PTA and to Physical therapists. I believe with proper documentation and patients proven progress shows that we PTA's are a valuable part of a patient's path to recovery. I believe with the changes in health care that reimbursement from the companies could and should be re-evaluated so that we as health care professionals can provide treatment that will best serve the patient's needs which ultimately will lead to better patient outcomes without us having in the back of our minds whether something will get paid or not. A patient should always know that they can walk into any clinic and get the best treatment that will benefit them the most and will not be given only treatments that are billable by insurance companies.
Posted by Garrett Ray
on 12/9/2013 2:35 PM
We all need to continue to advocate for ourselves...showing that physical therapy reduces costs to insurance companies overall. Patients moving to health savings plans to cover physical therapy expenses just underscores the value of these services. Ride out the storm.
Posted by Rehab Orthopedic Medicine
on 6/16/2014 8:52 PM
I was discussing this issue with the owner of an outpatient clinic and the owner mentioned a few good points:
- Reimbursements will cease to exist very soon. You will have to follow the same track as Chiropractors; they are very good at marketing and are used to working for cash only.
- Physical Therapy is a field that’s meant strictly for “Specialists”, therefore the future looks fairly grim for most of the Physical Therapists. The profession will have no choice, but to obtain positions in Skilled Nursing and Long Term hospitals, where their profession was meant to be anyways.
- Insurance companies recognize that the profession is saturated and that’s why the profession has stepped out of its own discipline and attempted to expand their services to something out of their discipline, therefore the insurance companies will not reimburse for services that should be provided by its rightful specialists, Fitness Trainers, Massage Therapists, Pilates Instructors, Athletic Trainers, etc.
Posted by Veteran Physical Therapy
on 1/9/2015 8:02 PM
Being that this is my last semester as a PTA student, I'm worried about the cutbacks that I will be facing when I go out there and start treating. I have been following this issue for a while. I have inquired about this topic with my clinical instructors and staff during my affiliations and will do so in my last. I believe that there should have been more exposure during my education to help prepare us before we graduate. I believe that reimbursement decreases leading to pay decreases is a big problem to me as a future PTA and to Physical therapists. By showing the Insurance companies that PTAs can provide proper documentation and outcomes in patients recovery with the quality of care should change the reimbursement for care. Nevertheless, I realize the importance of working together with in this profession. I strongly believe in the APTA for advocating for us on many issues. As outpatient physical therapy is my last setting, I would definitely discuss this topic further and relay it to my fellow classmates.
Posted by Thomas Arnall -> BLW^CH
on 2/17/2015 6:37 PM
article useful for me,
Thank you very much..
Posted by bufet minimalis
on 7/2/2015 12:51 AM
Interesting comments on this blog from many students and few veteran PTs.
1). I disagree fully with the comment that PTs should just be in nursing homes and hospitals. Although, the world of PT began out of nursing soldiers after WWI and became increasingly needed after WWII. Physical therapy in Europe in Orthopedics had a sound beginning in England with James Cyriax an orthopedic surgeon who stopped surgery and found EFFECTIVE ways to improve patients by conservative measures. Dr Cyriax worked exhaustively and provided numerous case studies to our profession that many have been proven in modern research methods as an effective treatments. Flynn et al documented over 10 years ago that non specific manipulation techniques of non specific low back pain is just as effective as specific manipulation. Dr Cyriax, our father of PT, had the assistance of a Physiotherapist, James DeConinck in DeHaan, Belgium to train many Physiotherapist that we identify in the states as big names, McKenzie, Dos Van Winkel (IAOM), Paris. Unfortunately, capitalism has made obtaining valid information from Cyriax a forest of crap with loads of special tests and numerous treatment techniques that do nothing more for us therapist to be effective but keeps us coming back to buy more classes of crap. Furthermore, our Physical Therapy schools are spewing out PT students that have a great set of knowledge but absolutely no skill to perform it.....hence an ineffective clinician!!!!
I have been out of PT school for over 15 years and I have been in private practice for over 10 years as a clinic owner. The proposed payment system on value is just another complicated mess. This will bring very little to the table to bring reimbursement in check because how will that validate an 80 year olds improvement? The LEFS? Which requires the patient to "precieve" their function- give me a break! You hope the 80 year old fills out the sheet when the barometric pressure isn't changing! My point: Value based services is a great idea, unfortunately it will fall square on its face. We will see fraud where large orthopedic companies will condition patients responses to keep their reimbursement up. They will have a team of lawyers come up with the most "legal" way to maximize reimbursement and not care one ounce on the quality of service that will be provided. Furthermore, they will drive the treating clinicians into the ground as it was in late 1990s early 2000s.
Friendly reminder to you students, I graduated in 1999 when the balance budget act was in full swing. I worked for Select Medical outpatient clinic as a new graduate part time at 17.00 dollars per hour! That is right 17.00 per hour!!! Furthermore the regional manager threaten to fire me if I did not "fall in line" and see 4 patients per hour and bill each of those patients for 1 hour. I left as quickly as I could to find another job which was only PRN and it was the worst experience of my life. My point, be careful where you go to work and know that it is still common practice to see practioners over charge and commit Medicare fraud, they will have you treat more than one patient at once....fraud!!! They will make you work in a clinic with big rooms and have you supervise an undertrained tech....fraud!
My point to the APTA, I am a fond member, why are you not revising and helping Medicare track down these clinics that are doing the above things? So much of this behavior occurs and so many PTs get jaded because their corporations made it seem common practice. These are things that are easily tracked and can be corrected. You must have the clinic environment right and supportive of the therapist for the therapist to provide quality service. A big room with tons of patients with improperly trained staff is not the way to do it. Why are we going to base our reimbursement on what the patient precives as better? Fixed the system we have and enforce the rules clinics can run ethically and still be financial ok if you are an effective therapist. APTA come visit my practice, I can show you!!!!
As for the educational system, while I was sitting in San Diego going through my Orthopedic Maunal therapy certification course, Ola Grimsby stated that American therapist have a great knowledge base, but you cannot treat a patient with a book in your hand. I think this is so true, I did my labs in school I did my 3 internships, however I was an idiot with my hands as a clinician. Unless you are mentored, and further your clinical hands on education you will continue to be an ineffective practitioner. Another point, I went through many orthopedic courses and a certification program, I did not learn the correct techniques of cross fiber until I went to Belgium. That is how ineffective our educational system is here in the states to produce a clinician verse a knowledgable PT with no hands.
Posted by James Trout
on 8/6/2015 8:01 AM
I am becoming increasingly frustrated by GCode and impairment modifier requirements. Why can't I bill for the 15minutes it takes to re-assess pts at progress and D/C visits? It takes time to re-assess strength/ROM and concordant signs/symptoms and review goals, however, by medicare rules and regulations this time is not billable? Am I misunderstanding the legislative language?
Posted by DKDuck
on 8/27/2015 8:57 AM