"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Sunday, February 22, 2009

A Blow to Autonomous Practice

How much therapy is enough?

Who decides? You?

Maybe not.

The recently published Transmittal 1678 (February 13, 2008) details resources you should use that...
"suggest the amount of certain (physical therapy) services that may be typical, either
  • per service
  • per episode
  • per condition
  • per discipline...
The resources are the following...
  1. Computer Services Corporation (CSC) Therapy Cap Report, 3/21/2008
  2. Computer Services Corporation (CSC) Therapy Edit Tables, 4/14/2008
To summarize:

One in eight physical therapy patients received a -KX modifier in 2006 ($1,740 capped amount).

Florida, New York and New Jersey were the three states with the highest percentage of therapy users over the cap.

These are the three most common physical therapy diagnoses billed to Medicare in 2006.
  • 781.2 Abnormality of gait
  • 724.2 Lumbago
  • 719.7 Difficulty in walking
However, the diagnoses most likely to exceed the cap were different:
  • 438.22 - Hemiplegia affecting nondominant side - 31.3%
  • 438.21 - Hemiplegia affecting dominant side - 30.9%
  • 438.0 - Cognitive deficits - 30.6%
"In other words, some beneficiaries with diagnoses, although less commonly observed, are more likely to surpass the cap threshold."
Only 2% of physical therapy users who exceeded their capped amounts accessed the hospital to continue their therapy.

Transmittal 1678 suggests that if your billing profile deviates much from these parameters then you may have some explaining to do.

Who wins?

CSC touts the therapy cap exception process as a win for patients (improved access) and for Medicare (lower costs).

Physical therapists, however, are micro-managed, clinical decision-making is aborted and financial risk is shifted to the provider.

Is this sustainable?


Not without the use of financially-motivated third parties (RACS) that treat health care providers as a revenue source.

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Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

"Make Decisions like Doctors"

Copyright 2007-2010 by Tim Richardson, PT.
No reproduction without authorization.

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American Physical Therapy Association
Consistent with the American Physical Therapy Association Vision Statement for Physical Therapy 2020, the American Physical Therapy Association supports exclusive physical therapist ownership and operation of physical therapy services.