"I'm sorry, Mrs. Smith, but we can't continue your physical therapy - you've hit your Medicare Cap."Physical therapists in America every day face Mrs. Smith. I've faced Mrs. Smith.
"But I'm doing better and I've not missed even one of my 16 visits. My doctor wants me to finish another month of PT - why won't Medicare pay?"
"Well, that's just it - Medicare will pay but your physical therapist's documentation shows you ARE better and we're afraid if we let you come for more PT then Medicare will deny payment."
"Can't you write down how much physical therapy helps me and how I NEED this?"
The above conversation is hard on Mrs. Smith and hard on physical therapists.
The new proposed Severity and Intensity Alternative Payment System is supposed to help physical therapists write notes that show how much Mrs. Smith needs her physical therapy.
The American Physical Therapy Association's (APTA) draft of the proposed Alternative Payment System for Physical Therapy Services describes how physical therapists can write notes that show Medical Necessity for Physical Therapy.
Medical Necessity is important when you need to justify your Plan of Care - for example if you apply the -KX modifier to attest that your patient needs PT in excess of the 2012 Cap of $1,880 for combined PT and Speech services.
Guccione et al in the September 2011 PT Journal described in detail their concept of how the Severity and Intensity model will work.
The Severity and Intensity model proposes a daily case rate to pay physical therapists' based on the mental effort and judgements we make during a patient visit.
The Severity and Intensity model will de-emphasize time as most valuable component of the physical therapist's service. The Severity and Intensity model will describe...
"...a broader conceptualization of work that emphasizes continuous examination and the multiple components of clinical decision making and patient care management will facilitate the determination of medical necessity and appropriateness of care."Non-members of the APTA can read an overview of the Draft here.