Developing Outpatient Therapy Alternatives

I just participated in an open-door session with the company that contracts with Medicare to develop a new way to pay physical therapists.

The firm, RTI International, has developed a web page called Developing Outpatient Therapy Alternatives that will have resources for clinicians to study an anticipation of the new measurement instruments.

On August 13th, the podcast of today's free, two-hour open door session will become available and I will post of provide a link here.

The new payment system is designed to prevent a re-occurrence of the Congressional/Executive S.N.A.F.U. on July 1 that I blogged about here, here and here.

Bottom line, the new payment system is seeking a way to 'risk adjust' patients so that Medicare can pay $50 for a simple ankle sprain and $2000 fro a complicated rotator cuff rehab. These numbers are make-believe but they make the point.

Consider for example two patients - each has the diagnosis 724.4 (Lower Back Pain). All Medicare has now is data from the claim form: that is the diagnosis 724.4 and the billed charge.

By the way, 724.4 is not a physical therapy diagnosis, it's just a CPT code that conveys little actual information.

Medicare would like information that helps them do the following:

1. Anticipate cost
2. Know how bad the patient is
3. Know how long the patient will be seen
4. Know how much better the patient will get

The new measurement instrument would most likely be a paper or web-based questionnaire that the patient and the clinician fill out together and update regularly, possibly as part of the Medicare Progress Note (every 30 calendar days or 10 treatment session - whichever is less).