A state Senator teaches Physical Therapists how to lift correctly

Florida Senator Mike Bennett (R-Bradenton) came to Medical Arts Rehabilitation, a private practice physical therapy clinic in Palmetto, Florida from 4-6pm on Tuesday May 18th.

The Senator is the fifth from the left.

He gave about 20 physical therapists and physical therapist assistants a wide-ranging tutorial on the political process and how physical therapists can create change for our patients, for our practices and for our future.

Making political friendships along common interests and combining their money and number of voices was the overall theme of Senator Bennett's talk.

Some of the highlights of the Senator's talk:

• He was surprised to find out that orthopedic surgeons can still legally operate POPTs, imaging facilities and clinical laboratories in Florida since the passage of the 1992 Florida Statute 456.053 Financial arrangements between referring health care providers and providers of health care services.
  
  Doctors are exempt from the 1992 self-referral law if they meet two simple criteria:

They employ the physical therapist and only treat the doctors' patients - no outside referrals.

They are physically on-site at all times when patients are being treated.

• Free Money!
  
  One of the only pieces of healthcare legislation to pass the 2010 session was the Medicaid Anti-Fraud bill that promises to save 25% of the entire Medicaid budget.
  
  To legislators worried about a state budget with falling revenues and no chance of raising taxes the thought of putting bad guys in jail and GETTING PAID to do so is very attractive.
  
  One provision of the Anti-Medicaid Fraud legislation prevents close financial arrangements between physicians and home health agencies.
  
  
• One suggestion was to revisit the 1992 legislation with the intent of preventing close financial arrangements between physicians and other providers like PT, imaging and labs, similar to the 2010 Anti-Medicaid Fraud law.
  
  
• The Senator suggested creating alliances with like-minded constituencies that face similar challenges from physicians, eg:

Audiologists

Optometrists

Radiology services

Insurance companies (surprise, surprise!)

"It's too big to lift by yourselves", he said. "You can't do it alone, you'll need to make friends".

Imagine that, a state Senator teaching physical therapists how to lift correctly.

Medicare Experts Recommend Physical Therapists Get a Comparative Billing Report

We've just completed the Classification Seminar with Special Guests Jim Needham, former CEO of a local physician owned physical therapy (POPTs) clinic and Belinda Holmes, healthcare auditor for accounting firm Kerkering Barberio on Saturday, November 7th.

Our audience of physical therapists and physical therapist assistants was very interested in Jim's talk:

"Competing with POPTs under Healthcare Reform"

We will have Jim's audio and PowerPoint available very soon. Also, Jim is being interviewed by Jeff Worrell on PT Talker this Friday the 13th.

Belinda had many good recommendations for physical therapists in private practice (PTPP) to build a Medicare compliance program in her talk:

"Medicare Defense Strategy: The RAC Attack"

The #1 question asked by our audience members after the seminar was on one topic raised by Belinda.

Belinda recommended that private practice owners get themselves a Comparative Billing Report from your local Medicare carrier - here in Florida your Medicare Part B carrier is First Coast Service Options.

You need to write a letter on your letterhead and request a specific six-month time frame for specific providers identified by National Provider Identifier (NPI) number.

Sorry, this option is not available for those providers billing as groups or 'incident to' the physician services (POPTs).

Here is the contact info for the Florida Medicare Part B carrier.

Statistical and Medical Data Analysis (phone: 904-791-8006)

First Coast Service Options
Statistical and Medical Data Analysis
P.O. Box 44288
Jacksonville, FL 32231-4288

There is no fee for providing these reports.

New seminar scheduled

Send in your application now for our next scheduled Classification Seminar on November 21st. You can apply here.

'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).

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'.

	PTPP	Physician
Claim Lines
Ultrasound	7.6%	10.6%
Electric Stim	2.8%	9.4%
Massage	1.0%	4.7%
Payments
Ultrasound	2.4%	4.2%
Electric Stim	1.2%	6.5%
Massage	0.7%	4.2%

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).

The Audacity of Hope for Physical Therapists

Physical therapists may be able to take hope from new legislation in Congress that promises to outlaw physician ownership of hospitals on the premise that such arrangements are a conflict of interest.

The new legislation is attached to The Children's Health Insurance Program Reauthorization Act (SCHIP) as part of HR 2.

HR 2 passed 289 ayes to 139 nays in the House of Represenatives on January 14th, 2009. It's companion bill now goes to the Senate for consideration. The American Medical Association is lobbying against this bill on the basis that it limits physicians' rights.

Can legislation that prohibits physician ownership of physical therapy clinics (POPTs) be far behind?

One can only hope that the Obama administration is taking a hard look at POPTS not only as a conflict of interest but also as a cost-cutting measure to reform health care.