APTA Responds to New York Times on Medicare Billing Article

Dear Editor:

Re: April 27 article, "One Therapist, $4 Million in 2012 Medicare Billing"

The American Physical Therapy Association (APTA) welcomes transparency in maintaining integrity in the delivery of physical therapist services to our nation's Medicare beneficiaries. 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 to ensure that physical therapist services continue to be provided in the best interest of the patient.

In regards to this article, however, readers should be aware that the data presented does not tell a complete story as it is limited to billing and utilization. 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).

The 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. APTA encourages Medicare to continue to collect additional data to provide a more accurate picture of the value of physical therapy that includes outcomes, patients served, and other clinical information.

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. As the article points out, data billed under one provider's billing number can cover multiple practitioners. However, the Medicare Benefit Policy Manual provides that if a therapist is not enrolled, his or her services must be directly supervised by an enrolled therapist, which means that the supervising physical therapist must be present in the office suite at the time the service is performed.

APTA continues to review the information and will soon release a full analysis that will include guidance to members on how to read and interpret their own data.


Paul A. Rockar, Jr, PT, DPT, MS
American Physical Therapy Association