"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

Friday, May 8, 2009

The Sound and Fury of the Rothstein Debate at PT 2009

Should the Physical Therapy Profession Endorse Medicare Rules and Regulations as the Standard With All Payers?”
...the setting is genteel, their credentials impeccable but, rest-assured, this smack-down between Larry Benz, DPT and Steve Levine, DPT promises some fireworks but not much else.

The sub-text of this question reads as follows:
"Should Medicare allow less-skilled providers (eg: massage therapists and athletic trainers) to treat patients "classified" with conditions appropriate to their skill level?"(Dr. Benz' apparent position)
Or, should Medicare continue its current regulation requiring that PTs or PTAs provide all treatment to Medicare beneficiaries? (Dr. Levine's apparent position)

Medicare listens to professional societies for consensus positions on standards of practice - especially for specialties where standards of practice are not generally well-known.

But a consensus position from the American Physical Therapy Association allowing, for example, massage therapists to perform massage on Medicare patients fitting a manipulation classification is an open door for physicians to exploit the salary differential and staff their POPTS clinics with massage therapists and other, lesser skilled, physical therapy extenders.

Medicare spends about $3.6 billion (2006) on outpatient physical therapy and over $400 billion (2008) for all health care payments in the United States.

These "piles of cash" are vulnerable to exploitation by entrepreneurial physicians and other, business-minded operators.

Medicare and Medicaid comprise 50 percent of all US government improper payments in fiscal year 2008 (~$36 billion dollars).

Medicare and PT Professionalism

Will Medicare accept an APTA consensus statement in the name of "professionalism, clinical practice and business interests" that promises to cost the United States more money?



What's the real issue?

The issue should not be about the role of the PT extender - the issue should be about the role of the PT.
What is the future role of the physical therapist in the health care landscape of the United States going forward?
The 2009 Rothstein debate appears to be a sideshow to the real issue:
"Life's but a walking shadow,
a poor player
That struts and frets his hour upon the stage
And then is heard no more: it is a tale
Told by an idiot, full of sound and fury,
Signifying nothing."

Macbeth 5:5

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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 .

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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.