Today's post comes from Ann Wendel, PT, ATC, CMTPT, of Prana Physical Therapy. Thanks, Ann!

Recently, the APTA posted information proposing an Alternative Payment System (APS). The proposed system would have three evaluation codes and nine treatment codes for physical therapists to use. According to the APTA, their goal with APS is to “reform payment for outpatient physical therapy services to improve quality of care, recognize and promote the clinical judgment of the physical therapist, and provide policymakers and payers with an accurate payment system that ensures the integrity of medically necessary services.”

The APTA is proposing to “reform payment for outpatient physical therapy services by transitioning from the current fee-for-service, procedural-based payment system to a per session payment system. APTA believes that a system that categorizes patients based on the severity of their condition and intensity of the interventions required better reflects the professional clinical reasoning/judgment and decision making by the physical therapist, improves provider compliance, reduces administrative burdens surrounding current payment models, and is consistent with and enhances payer recognition of the value of physical therapist-directed care.”

While I believe that all physical therapists would agree that a simpler coding system is desirable (especially if it improves quality of care, promotes the clinical judgment of physical therapists, and enhances payer recognition of the value of physical therapist-directed care), not all physical therapists believe that the APS as proposed is the best system to adopt.

Last week’s #solvept discussion involved physical therapists employed in various settings problem solving the issues with both the current and proposed payment systems. Some of the statements that stuck in my mind include:

  • Severe does not equal severe (what is perceived as high severity by one therapist may be perceived as low severity by another)
  • Complexity does not equal complexity (see above)
  • If treatment of a “high severity” patient pays more, one can easily abuse the system
  • If four “low severity” patients in an hour pays the same as one “high severity” patient per hour, then physical therapists are still being paid on a “time = money” scale rather than a “value = money” scale
  • Severity and complexity may have nothing to do with outcome, and the public, physical therapists, and payers need meaningful outcomes tied to cost/payment
  • The severity/complexity model may be more useful in some settings (e.g., acute care) than in others (e.g., outpatient orthopedics) leading to the question: “Is more than one payment system needed to address all physical therapy settings?”

It was a good discussion, fueled by the passion of those therapists present. I emphatically agree with what one therapist said at the end, “I love treating patients. I just want to get paid for doing what I love!” I find myself saying this over and over lately; I just want to make a living doing what I love, and it is getting increasingly more difficult to do so.

The Physical Therapy Business Alliance (PTBA) addressed the issue of making a living while saddled with educational debt with an official statement regarding the APS in an Evidence in Motion blog post on June 13. Here are the highlights of the post that caught my eye:

  • A four-unit visit in 2012 is paid at 32% less than 20 years ago (actually closer to 40% when accounting for the impact of group therapy billings and MPPR).
  • Debt burden for becoming a licensed physical therapist (attaining a DPT) has risen by approximately 30% in this time frame.
  • Because of rising tuition rates and declining reimbursement and salary rates, it is becoming increasingly difficult to draw candidates to become physical therapists. This situation will become a greater problem due to the demand for physical therapy services to care for an aging population.
  • Lack of unrestricted Direct Access to physical therapy on a national level and lack of use of physical therapists as the point of access for musculoskeletal conditions leads to rising healthcare costs in an already overburdened system.

The PTBA proposed a solution: a value-driven payment model (VDP) that rewards physical therapists for clinical outcomes and performance. PTBA states:“It is the position of the PTBA that the time for radical payment reform is now. As a professional association, PTBA is committed to the Triple Aim value of health care reform, which is comprised of 1) measurable quality care, 2) exceptional patient experience, and 3) lower cost of care. At its core, the Triple Aim concept is fundamentally rooted in the concept that payment methodology should be based on a balance of quality and cost.”

The PTBA proposes: “The establishment of a simple and transparent model in which three timed codes for care rendered by or under the immediate direct supervision of the physical therapist” (see below).

Type of Code Time Payment
Brief Up to 20 min. $60
Intermediate Up to 40 min. $110
Full Up to 60 min. $150

They also propose that “payment would include outcome-driven incentives such that providers are rewarded for outcomes and efficiency.”

I expect that over the next few months the discussion will continue until legislators decides upon a new payment model for physical therapists. I think we can all agree that the time has come for the public and medical community alike to recognize physical therapists as a valuable, autonomous member of the healthcare team. If we all want to continue to do what we love, it is time to get involved in the discussion. 

Attend Ascend 2018 - Regular BannerAttend Ascend 2018 - Small Banner
  • Odd Provider Out: Why PT Exclusion from MIPS is Bad for Future Payments Image

    articleMay 4, 2016 | 6 min. read

    Odd Provider Out: Why PT Exclusion from MIPS is Bad for Future Payments

    It’s official: rehab therapists are just a sashay away from exiting the PQRS dance floor. That’s because last week, the Centers for Medicare & Medicaid Services (CMS) issued a proposed final rule that, if adopted, will put into effect the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA). And that, in turn, will give the green light to the Merit-based Incentive Payment System (MIPS) , a brand spankin’-new quality data reporting program that consolidates PQRS , …

  • The Bundle Conundrum: Should PTs Participate in CJR? Image

    articleNov 9, 2016 | 6 min. read

    The Bundle Conundrum: Should PTs Participate in CJR?

    There a lot of hot topics in health care right now. Among top trending terms like “Affordable Care Act,” “pay-for-performance,” and “value-based care,” you’ve also probably heard “Medicare bundled payments”—specifically, “CJR” (or Comprehensive Care for Joint Replacement ). It’s a new bundled payment model from CMS, and it is of particular importance to outpatient rehab providers. As this article explains, “CJR will support better care for patients who are undergoing elective hip and knee replacement surgeries—the two …

  • New Ways to Get Paid: The Case for Bundled Payments Image

    articleJan 17, 2017 | 7 min. read

    New Ways to Get Paid: The Case for Bundled Payments

    If you’ve been in business for a while now, you’ve probably gotten pretty used to the standard healthcare fee-for-service payment model: you provide a service, you bill for said service, and then you get paid for that service. Well, times are a changin’. While practitioners will still provide services and receive payment, that payment will soon be dependent on performance (i.e., outcomes data). In other words, you’ll get paid based on the value you offer your patients—not …

  • 7 Shades of Coding Controversy (PTCPS Special Report, Part 2)  Image

    articleFeb 11, 2016 | 16 min. read

    7 Shades of Coding Controversy (PTCPS Special Report, Part 2)

    In the first post of this three-part series, I provided an in-depth look at the history and philosophy behind the APTA’s proposed Physical Therapy Classification and Payment System (PTCPS). If adopted—and as of now, that looks pretty likely—this CPT coding overhaul would completely change the way physical therapists code for the services they provide. The kicker? PTs could be required to begin using the new codes—some of them, anyway—as early as January 1, 2017, with full implementation …

  • Farewell, 97001: How to Use the New PT and OT Evaluation Codes Image

    articleOct 12, 2016 | 8 min. read

    Farewell, 97001: How to Use the New PT and OT Evaluation Codes

    Hear ye, hear ye: We hereby declare that as of January 1, 2017, all PTs and OTs must begin using a new set of CPT codes to bill for therapy evaluations and re-evaluations. Actually, if we are being perfectly accurate, we’re not declaring anything; CMS and the AMA are—and we’re merely the messengers. You might find it hard to believe, but with this CPT coding update, the evaluation and re-evaluation codes that PTs and OTs have come …

  • CMS Can See Clearly Now, Releases PQRS Strategic Vision Image

    articleMay 21, 2015 | 3 min. read

    CMS Can See Clearly Now, Releases PQRS Strategic Vision

    All month long, we’ve talked about the healthcare industry’s rapid evolution from the fee-for-service Stone Age to the pay-for-performance Enlightenment Period. Yes, payment reform is upon us , but don’t take our word for it—take it straight from America's largest payer of healthcare services: The Centers for Medicare and Medicaid Services (CMS). In an effort to “contribute to improved healthcare quality across the nation,” CMS recently published the Physician Quality Reporting Programs Strategic Vision , detailing a …

  • CPT Update: Why the Valuation of the New PT and OT Eval Codes is Problematic Image

    articleJul 19, 2016 | 9 min. read

    CPT Update: Why the Valuation of the New PT and OT Eval Codes is Problematic

    The purpose of any type of reform is to drive change. And that’s certainly true when it comes to healthcare—and healthcare payment—reform. But, change often comes slowly—and in the wake of Medicare’s recently issued proposed physician fee schedule for 2017 , I have to wonder whether it’ll come too slowly for physical and occupational therapists. That’s because, while the Centers for Medicare & Medicaid Services (CMS) voiced its support for replacing the existing CPT codes for physical …

  • How the Affordable Care Act Impacts Patient Payment Collection Image

    articleMay 16, 2016 | 5 min. read

    How the Affordable Care Act Impacts Patient Payment Collection

    You take the good; you take the bad. You take ’em both, and you have healthcare reform. Like most government-led initiatives, healthcare reform in general—and the Affordable Care Act (ACA) in particular—has inspired a lot of passionate debate. And that’s because, while it has expanded health coverage to millions of previously uninsured people (woo-hoo!), it also has given way to some less-than-positive consequences. One such effect: the trend toward increased patient financial responsibility (whomp, whomp). Out-of-Pocket Overload …

  • 3 Common Rehab Therapy Credentialing Mistakes Image

    articleJul 18, 2018 | 6 min. read

    3 Common Rehab Therapy Credentialing Mistakes

    Proper credentialing is a crucial step in running a successful physical therapy clinic. If your clinic and therapists aren’t properly credentialed with insurance providers from the get-go, your bottom line might suffer. And it’s not just new clinics that are susceptible to making credentialing mistakes; in fact, any clinic that has gone through a change in ownership, rapid growth phase, or any other transition might find itself mired in credentialing headaches. But before we get to the …

Achieve greatness in practice with the ultimate EMR for PTs, OTs, and SLPs.