"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

Tuesday, March 23, 2010

Is Health Care Reform Good for Private Practice Physical Therapists?

Here are three reasons why health care reform may be good for physical therapists in private practice (PTPP).
  1. Medicare Advantage
  2. Medicaid to Medicare
  3. Tax credits to small businesses
Under the health care reform laws being passed and signed into law right now Medicare Advantage funding is being cut.

Medicare Advantage (MA) plans are managed care plans that replace traditional Medicare, at the beneficiaries option, by paying part or all of the monthly $98 premium. The MA plan saves money by limiting the health care providers in the network and cutting traditional Medicare reimbursement up to 50% to physical therapists.

In Florida, one plan pays a $70 per diem where traditional Medicare used to pay $125.

These for-profit health plan cost the Medicare program more than traditional Medicare. According to the Medicare Physicians' Advisory Committee 2010 Annual Report to Congress:
"MA payments per enrollee are projected to be 113 percent of comparable fee-for-service (FFS) spending for 2010."
In Florida alone, according to Republican Representative Vern Buchanan...
"Over $200 billion would be cut from the popular Medicare Advantage program, and the Congressional Budget Office estimates these cuts will force two million seniors off their current plans."
That's over half of Florida's Medicare beneficiaries:

# Beneficiaries3,180,25644,831,390

Source: StateHealthFacts.org

Does Medicare get better physical therapy for their 113% premium?


Medicaid to Medicare
"Starting in 2014, anyone with an income below 133 percent of the poverty level — or about $29,327 in 2009 for a family of four — will be eligible for a rejuvenated Medicaid program.

Medicaid’s often anemic reimbursements will be increased to the same level as Medicare, making more doctors willing to accept it."
The shift from unprofitable Medicaid to profitable Medicare will further help private practice physical therapist providers in the state of Florida - probably more than in northern states because in Florida Medicare is the most profitable payer.

Many providers threaten to drop Medicare if the Congress drops reimbursement too low but for many providers that is simply not an option - Medicare is our best, highest margin payer.

Medicare is statutorily obligated to remit payment within 14 days of receipt of a 'clean claim' - with electronic billing services these days every claim is a clean claim.

Tax credits for small PTPP's

Finally, tax credits instead of deductions may help small businesses that provide their employees with healthcare benefits.

From the March 25th USA Today...
"Companies with no more than 25 employees and average annual wages of $40,000 could receive tax credits to help provide insurance to employees.

There is a catch, of course.

The business must pay 50% of employees' premiums..."
Not every PTPP will benefit from these changes and we may not see some of these changes for many years.

What are your thoughts about health system change and how will it affect physical therapists?

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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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