Speakers: Helene M. Fearon, PT, and Steve Levine, PT, DPT, MSHA
Summary: Since adoption of the Balanced Budget Act in 1997, The Centers for Medicare and Medicaid Services (CMS) has been engaged in reports and projects in an attempt to develop a new payment system for therapy services. These CMS contractor reports have generated significant data and will likely serve as a basis for new models of payment, but have not yet resulted in the implementation of a new payment system that would serve as an alternative to the present procedure-based fee schedule system and arbitrary therapy caps. Recent policy changes, including the multiple procedure payment reductions (MPPR) and continued regulations that inhibit the delivery of cost-effective and efficient physical therapist care, have created not only the opportunity, but the necessity to make bold moves forward with an alternative payment model for physical therapists.
APTA has also been developing a conceptual framework for a new payment system for a number of years. This concept is now moving to the next steps of modeling and implementation. Some of the key concepts that would be the basis for change include having at its core the clinical expertise and judgment of the physical therapist, reducing the oppressive administrative burdens, and dramatically changing the manner in which physical therapists services are communicated to third parties - specifically moving away from procedural, time-based coding. The desired impact of these and other characteristics of an alternative payment system would include:
- An improved reflection of the provision of consistent, quality, evidence-based care,
- The reduction of unwarranted variations in practice resulting in decreasing benefits and payment for physical therapy, and
- A manner in which to demonstrate value for physical therapists as key collaborators in the changing healthcare environment.
As APTA's advisors to the AMA's CPT Editorial Panel, where new codes will be developed reflecting the alternative payment system, and the Relative Value Update Committee (RUC), where the values for new codes that translate into payment are determined, Helene Fearon, PT and Steve Levine, PT, DPT, MSHA, have been involved in the discussions and development of the conceptual model and continue to work with APTA and other consultants to bring the model through the next phases of development and implementation as an alternative system to the current inadequate and burdensome methodology.
Join these recognized experts to understand the environment that has necessitated a transition from the current procedural and time-based codes to a one in which the clinical judgment and decision-making of the physical therapists is reflected in a coding structure, the current options being discussed and developed related to payment for the future, and how a transition to a new payment system will likely impact your practice.
Objectives: Overview of Content:
Review of why the current procedural based reporting and payment system is an unsustainable model in the third party pay environment.
- Objective:Gain an understanding of the critical timing of this effort
Describe the key components of the alternative payment system including the way in which clinical judgment and decision-making will be a prominent feature of its application to physical therapist practice.
- Objective: Learn how this model will require physical therapists use of a common nomenclature in describing patients presentation as well as the clinical services they deliver.
Outline of the timeline for further development, physical therapy professions feedback and external stakeholder communications and third party pay implications.
- Objective: Plan for participation in the review, and the provision of critical feedback as well as learn how to advocate for change as the process moves forward.
