PIP Relief in 2013 for Florida Physical Therapists?

Physical therapists in Florida should continue the conversation with their patients and with their elected representatives if they expect the 2012 PIP anti-fraud law to change.

I was excited on Friday when I learned about the March 15th, 2013 decision by Circuit Judge Terry Lewis.   Judge Lewis granted the plaintiff's (a chiropractor) motion for a Temporary Injunction challenging the constitutionality of the 2012 PIP Act. This Act bars physical therapists, among other providers, from seeing auto accident victims without new, expensive and burdensome credentialing and licensing.  Full details are available at the Florida Physical Therapy Association web site.

According to attorney's familiar with this case, Judge Lewis' order will have a wide-reaching impact in Florida.  The following professions and conditions are specifically identified:

"1. Emergency Medical Condition - Judge Lewis' Order prohibits the use of an emergency medical condition as a prerequisite for payment of PIP benefits. This means that all Floridians will now benefit from the full $10,000 that they already have to pay for in PIP insurance coverage. This means that Chiropractic Physicians may primarily evaluate and treat those injured during motor vehicle crashes.  

2. Licensed Massage Therapists - Judge Lewis' Order prohibits the denial of payment for benefits for services provided by Licensed Massage Therapists.  

3. Acupuncture Physicians - Judge Lewis' Order prohibits the denial of payment for benefits for services provided by Acupuncture Physicians.  

4. Chiropractic Physicians - Judge Lewis' Order prohibits the denial of payment for benefits for services provided by Chiropractic Physicians.  

This lawsuit, challenging several provisions of the Florida Statutes, was filed in Leon County because that is where the State Agency in charge of enforcing these provisions resides.   

Importantly - this grant of Temporary Injunction applies throughout the entire State of Florida. Although some suggest that it might only apply in Leon County - that result makes little sense and would require that any statutory challenge be filed independently in every County - regardless of whether the State Agency charged with enforcing that statute resided in that that County.  

Although we certainly expect the State to appeal what we consider a well thought out, reasoned, and legally sufficient Judicial Order, the State's Appeal will be considered based upon an abuse of discretion - where the trial court would have had to abuse its discretion - something that will be difficult to prove given the large amount of data, briefing, and argument involved to date."

An open question is how does Judge Lewis' decision impact physical therapists in private practice? Specifically, can we now treat our auto accident patients without running afoul of the 2012 PIP Act?

Two more reasons I got excited last week were two bills introduced in the State Legislature: SB 594 and HB 709.  These bills exempt Federally-credentialed (Medicare) clinics from the 2012 PIP Act.  The Senate bill won unanimous approval, 8-0, by the Health Policy Committee on March 20th but the House bill has not moved yet.  According to Capitol insiders, the House bill needs to move now in order reach the Governor's desk by the end of session on May 3rd.

Further, these Capitol insiders don't expect Judge Lewis' Temporary Injunction to hold and physical therapists may not see relief in the 2013 legislative session.

"Keep up the pressure in your districts," they told me. "We've got a little momentum and some good media but we've still got a long ways to go."

Picking Physical Therapists' Pockets...

Physical therapists in private practice (and other settings) should understand where most our dollars come from.

In Florida, with our large elderly population, about half of my practice income is Medicare reimbursement.

That reimbursement is getting smaller - not due to budget cuts - but due to the activities of specialist physicians.

We haven't had an actual Medicare reimbursement cut since 2002.

Despite the media hoopla about the effect of the (Un)Sustainable Growth Rate on the Medicare Physicians' Fee Schedule, the Congress of the United States has failed to implement budget balancing reforms on Medicare reimbursement.

Year	Projected Update to the SGR	Actual Update to the SGR
2002	-4.8%	-4.8
2003	-4.4%	1.4%
2004	-4.5%	1.5%
2005	-3.3%	1.5%
2006	-4.4%	0.2%
2007	-5.0%	0%
2008	-10.1%	0.5%
2009	-10.6%	1.1%
2010	-21.3%	0%
2011	-27.4%	0%

So why has my relative income continued to decline?

The Relative value Update Committee (RUC) of the American Medical Association each year recommends changes to Medicare reimbursements that reward specialty physicians yet penalize general medicine and preventative services.

Specialists are picking physical therapists' pocket and most physical therapists don't even know it!

The media and our own professional political advocacy would have us focus most of our attention on the SGR. However, the RUC is, according to Dr. Brian Klepper...

"...the greatest obstacle to turning around our healthcare system and our economy."

Dr. Klepper details the scope and scale of this problem in his August 2012 blogpost The Most Powerful Health Care Group You’ve Never Heard Of

Dr. Klepper has also formed the advocacy group called Replace the RUC to generate public awareness of this shadowy politcal group.

Who thinks physical therapy codes are under-valued relative to certain other medical procedures?

Which codes? Which procedures?

Thanks for commenting.