Physical Therapists Travel to Washington to Change Medicare Reimbursement for the Better
Here’s What Every Therapist Should Know
On July 22, 2013 physical therapists from across the United States, chosen by the APTA’s Private Practice Section lobbied Congress in Washington D.C. They were tasked with the very important goal of discussing some of the current problems with Medicare reimbursement—issues that range from the Sustainable Growth Rate and its negative impact on payment rates, to therapy caps that limit patients’ access to the best possible care. At the end of the first ever “fly-in”, solutions to many problems affecting therapy jobs were reached.
As many already know, the current payment scheme makes it hard for physical therapists to earn reasonable reimbursements when they treat Medicare patients, who are perhaps the neediest group when it comes to allied health services. Because of the recession and economic hardship felt all around, Congress has called a moratorium on payment reductions every year—while this is great news for therapists who would otherwise see a 29% drop in payments from Medicare, many did not want to revisit the short-term fix again next year; they lobbied for change now.
A short list of the problems physical therapists have lobbied Congress to address and solve:
Sustainable Growth Rate (SGR): The SGR is crippled by 1997’s Balanced Budget Act; physical therapists are lobbying to replace this dinosaur with the Medicare Physician Payment Innovation Act of 2013 (H.R. 574). This bill would repeal and replace the SGR formula that determines Medicare payment rates, ensuring that therapists are paid fairly and commensurate with the current value of their services.
Medicare Therapy Cap: Another part of 1997’s Balanced Budget Act that negatively impacts therapists is the Medical Therapy Cap. PTs wish to replace this with the Medicare Access to Rehabilitation Services Act (H.R. 713/S. 367), which would permanently repeal the arbitrary annual per-beneficiary cap for physical therapy, occupational therapy and speech-language pathology services. This bill would eliminate a lot of paperwork and frustration for therapists across the United States, and better yet give continuous and higher quality of care to their patients.
Multiple Procedure Payment Reduction: One of the goals of lobbying Congress was to stop this practice, wherein Congress uses inaccurate data to reduce payments to physical therapists and use the savings to patch the flawed SGR formula.
“Substitute therapists” policy: When physical therapists in private practice take a leave of absence, current government policies prevent them from hiring a qualified replacement. APTA’s private practice section has asked Congress to add physical therapists to the list of professionals allowed to bring qualified temporary substitute professionals when the practice owner needs to be away.
Medicare Opt Out: Because physical therapists are not presently permitted to opt-out of Medicare and treat these patients privately, PTs are lobbying Congress to be included in the list of professionals allowed to do so; they believe this option enables them to better serve their patients.
Curbing Fraud and Abuse: Part of the physical therapists’ lobby was in recommending cost saving measures for Congress, so that over-utilization of therapy services is no longer as prevalent.
Positive Change Happens When You Align your Talents with Like-minded Forces
Whether they work in private practices or for healthcare employers, therapists can all agree that high-quality, cost-effective physical therapy is something every patient deserves. If you’re looking for therapy jobs that foster ideal relationships between therapists and patients, then American Traveler Allied wants to know you; just call 1-800-617-0608 or apply online to connect with a consultant today. Positive changes are coming to the healthcare landscape, and we look forward to meeting dynamic, innovative and highly adaptable clients who embody all that and more. Talk to you soon!
**Information used in this article was taken from The Lund Report’s Story on Medicare Reimbursement and from this therapist’s story about the fly-in in The Post-Journal.