Doc Fix will affect physical therapists, too

We done this three times already in 2010 but the 21.29% cut in the Medicare Physicians' Fee Schedule is again scheduled to go into effect on June 1.

To prevent the cut, The American Jobs and Closing Tax Loopholes Act of 2010 (the 'Doc Fix') (HR 4213) is scheduled for a vote this week.

Dr. James Rohan, President of the American Medical Association, explains and defends the 'Doc Fix' in this C-Span video.

Passing HR 4213 will cost more money. The Doc Fix will...

...increase budget deficits by about $115 billion for fiscal years 2010 and 2011 and by about $84 billion over the 2010-2015 and 2010-2020 periods...

Dr. Rohan's position is that current Medicare rates are 20% under a break even cost to keep our offices open.

HR 4213 proposes a 3.5 year payment increase, so long as cost growth on services doesn't grow too much.

After 2013, payments will update consistent with the current law. That means in 2014 doctors and private practice physical therapists will see a dramatic 30% reduction in payments.

I saw Rosa today in PT...

I treated a very sweet lady named Rosa today. Rosa weighed in at over 225 pounds at a little over five feet tall. Rosa presented in the clinic with her rolling walker and her daughter in tow.

Rosa had a physician employed by an insurance company who did everything she could to keep from sending patients to physical therapy because she was financially penalized for referrals to costly ‘ancillary services’.

Rosa had seen pain management, rheumatologists, internists and orthopedic surgeons for persistent unilateral rib pain. Rosa had fallen twice in the period she had been seeking help. She had refused injections and had asked for physical therapy on more than one occasion.

Rosa’s daughter insisted that her mother needed electrical stimulation. The daughter’s chiropractor used electric stimulation twice a month on the daughter's neck ‘for over a year’ to the daughter's apparent satisfaction.



Rosa could barely stand up in from the chair but she ended up that day with me doing many varieties of performance testing:

• Timed Up and Go Test
• Functional Reach Test
• Balance and Reach Test
• Timed Tandem Standing
• Timed Single Leg Standing
• a few impairment measures.

To Rosa's surprise, movement felt better. She could feel the spasms in her rib easing as I had her reach out over her base of support. I could see the daughter was visibly impressed at the tasks I was getting her mother to do.

Rosa left that day feeling better and didn’t get sore the next day. She declined the electric stimulation on the first visit because of time.

Patients like Rosa can often benefit with just one type of treatment intervention. In Rosa' case, reaching offered the greatest immediate benefit.

Rosa's Story is an Example

Rosa's story is an example of the clinical benefit offered by standardized testing. Also, each of the measures mentioned above produced a valid and reliable measurement. Some of the measurements have known change scores that reflect true change to assess progress. Finally, some of the measures are predictive for falls. Improving these measures should decrease the patients' risk of future falls.

Mock Audit

Our clinic started using predictive performance measures after we had a mock Medicare audit performed on five of our "Bulletproof" charts. The audit pointed out 'weaknesses' in our Medicare compliance program, namely, the insufficient use of performance measures in high risk populations.

Your clinic Medicare compliance program can benefit, as mine did, from following guidelines promoted by the Office of the Inspector General, namely:

• Conducting internal monitoring and auditing;
  
• Implementing compliance and practice standards;
  
• Designating a compliance officer or contact;
  
• Conducting appropriate training and education;
  
• Responding appropriately to detected offenses and developing corrective action;
  
• Developing open lines of communication; and
  
• Enforcing disciplinary standards through well-publicized guidelines
  

The five charts I sent out for audit have been very helpful to me in upgrading, updating and further "Bulletproofing" my private practice physical therapy Medicare compliance program.

To learn more, sign up for the free Bulletproof PT decision-making tutorial below.

Financial Evaluation and Treatment

How to fix the financial crisis...

...and help private practice physical therapists at the same time.

These recommendations by James K. Galbraith, a scholar at the University of Texas at Austin to the U.S. House of Representatives on February 26, 2009 make a lot of sense to a private practice physical therapist like me...

• a permanent increase in Social Security benefits would help offset the losses that the elderly population, as a group, is suffering on its equity investments and its cash holdings. A thirty percent increase in Social Security benefits would not repair individual losses, but it would keep the elderly out of poverty as a group, and relieve severe difficulties in many individual cases.


• a payroll tax holiday would powerfully ease the financial situation of America's working families, giving them roughly an 8.3 percent pay increase and their employers a comparable reduction in the cost of keeping them on the job. Many mortgages would be paid, and many cars purchased, that otherwise would default or go unsold.


• a reduction in the age of eligibility for Medicare would be a powerful response to the industrial crisis, permitting many older workers who would like to retire but who cannot afford to lose health insurance to do so. This would relieve health burdens from private industry, while not infringing on the employer-insurance systems still in effect for the prime-age workforce. Note that transferring workers from private health care to Medicare in this age bracket has no real economic cost: the same health care is provided to the same people. In fact, the reduction in private insurance claims and bookkeeping constitutes a real saving.

Read Point #4 to get Mr. Galbraith's preface and conclusion - better yet, read his whole speech.

Now, getting all of this done without raising taxes... Impossible?