"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, July 19, 2009

'Skilled' Physical Therapy still not settled

'Skilled' physical therapy has been buzzing about lately - if you were lucky enough to catch the Rothstein Debates at PT 2009 in Baltimore then you may already be aware of what I'm about to tell you.

A new report from Developing Outpatient Therapy Alternative (DOTPA) describes, in excruciating detail, the distribution of $4.3 billion dollars paid for Medicare outpatient therapy in 2007.

The report also shows who billed what, for who and where. Without getting into the gory details (I don't want to spoil the ending for you) there are some data here that may give us some insight into physical therapist 'skill'.

This first table shows claim lines while the second table shows payments. Note the columns to the right, labeled 'PTPP' and 'Physician' (POPTs).

dotpa therapy utilization: table 14
click the image to enlarge

This second table shows very much the same pattern in payments.

click the image to enlarge

I'll break it down a little more by carving out the rows for 'Ultrasound', 'Electrical Stimulation' and 'Massage Therapy'.

Claim Lines
Electric Stim2.8%9.4%
Electric Stim1.2%6.5%

I wonder what it is about the Medicare patient that demands twice as much ultrasound therapy when seen by a physical therapist employed by a physician?

Do patient findings drive 4-6 times as much electrical stimulation in a POPTs clinic as in my clinic?

Why are physical therapists even billing for massage? Oops! Maybe it's not physical therapists...

With all due respect to my peers who work in physician's offices - the numbers don't lie.

I don't know if the difference comes down to skill, dollars or undefinable but the implications seem clear.

Greater passive modality usage and fewer 'hands on' procedures leaves less room for physical therapists to practice their skills.

Get the full report from Developing Outpatient Therapy Alternatives (DOTPA) and Research Triangle International (RTI) here (Utilization Report 2009).

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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.