Re: 2008 Medicare Physician fee Schedule

[Guest guest]

, I'm an OT in PP, also in FL, and the OT eval charge also

decreased. However, all the other " standard " charges did show a slight

increase.

Ron

--

Ron Carson MHS, OTR/L

Hope Therapy Services, LLC

www.HopeTherapyServices.com

===============<Original Message>===============

On 1/3/2008, cpiazza@... said:

> Dear List,

>

> I am a PT in private practice in FL and have questions about the new

> 2008 Medicare Physician Fee Schedule. I am in locality " Rest of Florida "

> and it looks like the reimbursement for PT Evaluation decreased. I

> though that we had a .05% increase. What is the difference between PAR

> and NON-PAR amounts? Last year I was non-facility. Thanks for any help.

>

>

> Piazza, PT, DPT, ATC, MTC

> Progressive Physical Therapy, Inc

> Ormond Beach, FL 32174

>

[Guest guest]

Rhoda/

I just went out to CMS website (you can find a link out on PTManager.com)

and noted that CMS website has NOT published 2008 rates yet. What site are you

making the rate cut determination from and are you getting the correct

information?

Jim <///><

**************Start the year off right. Easy ways to stay in shape.

http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489

[Guest guest]

, I am in Illinois, and did not get any increase at all, in fact,

some of my procedures were cut almost $2 per unit.

Rhoda Astronomo, PT

President

R.A. Physical Therapy, PC

Illinois

From: PTManager [mailto:PTManager ] On Behalf

Of Piazza

Sent: Thursday, January 03, 2008 7:08 AM

To: ptmanager

Subject: 2008 Medicare Physician fee Schedule

Dear List,

I am a PT in private practice in FL and have questions about the new

2008 Medicare Physician Fee Schedule. I am in locality " Rest of Florida "

and it looks like the reimbursement for PT Evaluation decreased. I

though that we had a .05% increase. What is the difference between PAR

and NON-PAR amounts? Last year I was non-facility. Thanks for any help.

Piazza, PT, DPT, ATC, MTC

Progressive Physical Therapy, Inc

Ormond Beach, FL 32174

[Guest guest]

Hi Jim,

Since I am located in Illinois, I searched our FI website

(WisconsinPhysician) for the new 2008 Medicare Physician Fee Schedule.

Here’s the link:

http://www.wpsmedicare.com/part_b/fees/schedule.shtml

So, I assume this is correct since it’s from our FI’s website?

Rhoda Astronomo, PT

President

R.A. Physical Therapy

Illinois

From: PTManager [mailto:PTManager ] On Behalf

Of JHall49629@...

Sent: Thursday, January 03, 2008 7:59 PM

To: PTManager

Subject: Re: 2008 Medicare Physician fee Schedule

Rhoda/

I just went out to CMS website (you can find a link out on PTManager.com)

and noted that CMS website has NOT published 2008 rates yet. What site are

you

making the rate cut determination from and are you getting the correct

information?

Jim <///><

**************Start the year off right. Easy ways to stay in shape.

http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489

[Guest guest]

Please keep in mind that while the conversion factor

is a .5% raise, the relative values for work expenses,

practice expenses, and geographical cost index may

have decreased for some of the CPT codes causing an

overall decrease in reimbursement for each CPT code.

In addition, the work value that is published for each

CPT code will be reduced by 11.94% in 2008 compared to

10.1% in 2007 prior to be multiplied to the conversion

factor. This could cause a decrease in the

reimbursement in 2008 when compared to 2007.

Rick Gawenda, PT

President, Section on Health Policy & Administration

APTA

--- Rhoda Astronomo wrote:

> , I am in Illinois, and did not get any

> increase at all, in fact,

> some of my procedures were cut almost $2 per unit.

>

>

>

> Rhoda Astronomo, PT

>

> President

>

> R.A. Physical Therapy, PC

>

> Illinois

>

>

>

> From: PTManager

> [mailto:PTManager ] On Behalf

> Of Piazza

> Sent: Thursday, January 03, 2008 7:08 AM

> To: ptmanager

> Subject: 2008 Medicare Physician fee

> Schedule

>

>

>

> Dear List,

>

> I am a PT in private practice in FL and have

> questions about the new

> 2008 Medicare Physician Fee Schedule. I am in

> locality " Rest of Florida "

> and it looks like the reimbursement for PT

> Evaluation decreased. I

> though that we had a .05% increase. What is the

> difference between PAR

> and NON-PAR amounts? Last year I was non-facility.

> Thanks for any help.

>

> Piazza, PT, DPT, ATC, MTC

>

> Progressive Physical Therapy, Inc

>

> Ormond Beach, FL 32174

>

> [Non-text portions of this message have been

> removed]

>

>

>

>

>

> [Non-text portions of this message have been

> removed]

>

>

________________________________________________________________________________\

____

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[Guest guest]

Rick,

You may be correct in your statement but this just points out the

mumbo-jumbo relative to this whole process and one that remains a mystery. How

the

three values can be systematically reduced while pretending to provide an

" increase " is a falsehood that continues to plague us as a provider. No intent

to

demean you as you are just the messenger but this infuriates me and is one of

the reason's I decided to retire. Needless to say, I think APTA should be

howling at these reductions.

A. Towne

**************Start the year off right. Easy ways to stay in shape.

http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489

[Guest guest]

: It's tough for me to see that one of the reasons you retired

was because of the frustrations surrounding " reimbursement " ... while I

was in PT school at Arcadia in the early '00's you were a highly

regarded PT with a forward-thinking, respectable, thriving practice in

Ohio that I think took one of my classmates as a student ().. if

I remember, some of our professors used you and your practice in

various ways as an example in our business classes (perhaps you didn't

realize this!)

Anyway, I share your frustrations with " reimbursement " and wish we as

a profession had a totally different reimbursement or payment system..

one based on a balance of incentives i.e. " Clinical Outcomes " balanced

with " time spent with clincian " . Instead, our Outpatient reimbursement

is based on a confusing quagmire of factors in the vein of

fee-for-service - and unrelated to Outcomes. Because of this

" fee-for-service " model, our practitioner's (and clinic's) incentives

revolve around " Units/treatment " and " Productivity " . Moreover, third

party payors can simply ratchet back their " fees for service " WITHOUT

any ratioanale, as we're seeing with the new Fee Schedule.

In my opinion, ONLY when our underlying incentives move from the

Financial to the Patient Centered (i.e. Outcomes) will our profession

really move forward. The many well-meaning clinicians out there

deserve to be supported by a well-meaning reimbursement/payment system.

Again, tough to see you go, as I know you were good for the profession

and your community...

Ty Keeter DPT, MHA

Director of Rehabilitation

SNF in Boulder, CO

>

> Rick,

>

> You may be correct in your statement but this just points out the

> mumbo-jumbo relative to this whole process and one that remains a

mystery. How the

> three values can be systematically reduced while pretending to

provide an

> " increase " is a falsehood that continues to plague us as a provider.

No intent to

> demean you as you are just the messenger but this infuriates me and

is one of

> the reason's I decided to retire. Needless to say, I think APTA

should be

> howling at these reductions.

>

> A. Towne

>

>

>

> **************Start the year off right. Easy ways to stay in shape.

> http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489

>

>

>

[Guest guest]

I've let this issue sit dormant for a long while, but Ty Keeter's comments got

me off my duff.

He said that he wishes for a " a totally different reimbursement... system...

based on a balance of incentives. "

Nobody would disagree with that sentiment. But no third-party payment system

will ever produce it. Please consider that the perfect " incentive balancer, " the

ONLY true incentive balancer, is the PATIENT. It is the patient, after all, who

needs the service, and therefore the patient who should determine the service's

value. Not the provider, not the insurer, not the government. We work now for

the payer. The payer is our ultimate " client. " Isn't it only right that the

client should be the patient?

Alas, we have ceded service value analysis over to distant third parties, whose

only involvement with patient care is financial management. Remember that the

third-party focus on financial management will NEVER---CAN never---change,

because financial control is their business by definition. And that is the root

cause of the horrid mess we are in today. Third parties have grown so used to

cost control that today they brazenly define what medical care is (that is what

the CPT code book is, by the way, handily managed by an unholy alliance between

the AMA and the US government), what it is worth, who gets it, and under what

circumstances. The result is what we see today: A non-patient-centered, hugely

expensive, poorly titrated, and irrevocably complex mess.

Some well-intentioned folks (like Ty) believe that outcome measurements will

solve this mess. They are wrong. Third-parties will use outcome studies as they

have used every other service analysis tool to date, as just another blindly

swinging cudgel. (Don't misunderstand me... I am a big supporter of outcome

studies, but as a professional self-improvement measure, NOT as a financial

tool.)

Now since we've decided that medical care is a virtual human right, and that

government must either pay directly for it or mandate that it be paid for by

employers, then the solution must be to get that system as close as possible to

private pay, which is truly the only system that triggers patient-centered value

analysis. That means Healthcare Savings Accounts, and not the in-name-only,

government and big-insurance-controlled pseudo HSAs we have now. I mean

patient-controlled HSAs, with very few if any limitations. (For those of you

unfamiliar with the concept, please do some research.) HSAs offer patient

freedom, dramatically lower costs, and a merciful end to so much hurtful

complexity, process, and paperwork.

We are all sick and tired of fighting third-party battles, and more so of living

in fear of financial ruin or worse because we haven't complied with the latest

inscrutable rule or regulation. (It is a crying shame that we must depend on

Rick Gawendas just to keep ourselves out of jail!) When will we realize that

there is no good in these systems for patients or providers? When will we gather

courage enough to attack the root problem instead of merely diddling with the

fringes?

Dave Milano, PT

Rehabilitation Director

Laurel Heath System

________________________________________

From: PTManager [PTManager ] On Behalf Of Tyler

[tykeeter@...]

Sent: Saturday, January 05, 2008 12:48 AM

To: PTManager

Subject: Re: 2008 Medicare Physician fee Schedule

: It's tough for me to see that one of the reasons you retired

was because of the frustrations surrounding " reimbursement " ... while I

was in PT school at Arcadia in the early '00's you were a highly

regarded PT with a forward-thinking, respectable, thriving practice in

Ohio that I think took one of my classmates as a student ().. if

I remember, some of our professors used you and your practice in

various ways as an example in our business classes (perhaps you didn't

realize this!)

Anyway, I share your frustrations with " reimbursement " and wish we as

a profession had a totally different reimbursement or payment system..

one based on a balance of incentives i.e. " Clinical Outcomes " balanced

with " time spent with clincian " . Instead, our Outpatient reimbursement

is based on a confusing quagmire of factors in the vein of

fee-for-service - and unrelated to Outcomes. Because of this

" fee-for-service " model, our practitioner's (and clinic's) incentives

revolve around " Units/treatment " and " Productivity " . Moreover, third

party payors can simply ratchet back their " fees for service " WITHOUT

any ratioanale, as we're seeing with the new Fee Schedule.

In my opinion, ONLY when our underlying incentives move from the

Financial to the Patient Centered (i.e. Outcomes) will our profession

really move forward. The many well-meaning clinicians out there

deserve to be supported by a well-meaning reimbursement/payment system.

Again, tough to see you go, as I know you were good for the profession

and your community...

Ty Keeter DPT, MHA

Director of Rehabilitation

SNF in Boulder, CO

>

> Rick,

>

> You may be correct in your statement but this just points out the

> mumbo-jumbo relative to this whole process and one that remains a

mystery. How the

> three values can be systematically reduced while pretending to

provide an

> " increase " is a falsehood that continues to plague us as a provider.

No intent to

> demean you as you are just the messenger but this infuriates me and

is one of

> the reason's I decided to retire. Needless to say, I think APTA

should be

> howling at these reductions.

>

> A. Towne

>

>

>

> **************Start the year off right. Easy ways to stay in shape.

> http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489

>

>

>

[Guest guest]

Dave,

I think one of your statements is part of the problem Healthcare has become a

" virtual right " . A right is something that you have that does not interfere

with anyone else's " rights " . Life - no problem, liberty, OK, pursuit of

happiness - great. Health care. . .hold on. In order for someone to get

healthcare there has to be someone to provide it. A PT has to take time away

from his family or his pursuit of happiness to provide it to someone. The

provider then needs to be compensated for his time away. Because of these

restrictions health care should never be considered a " right " it is a service

provided to the population - an allocation of resources(time, money, personnel)

that has been determined to be more valuable than if used somewhere else.

I also whole heartedly agree that HSA's are the optimal way to prove worth - you

are worth what the PATIENT feels your value is to him, not what a third party

feels. When the government attempts to control the healthcare industry the

inevitable conclusion will be less providers based on the diminished financial

opportunity, diminished services due to the above - then rationing of care.

This has been shown to be true in any economic situation throughout history.

Mark Milleville PT

Wheatfield Physical Therapy

North Tonawanda, NY

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[Guest guest]

Jim

I was able to find my information on the First Coast Options website (the

Florida Medicare carrier). What is confusing to me is that the terminology has

changed. I was a non-facility last year. This year the rates are listed under

PAR amount and NON-PAR amount. I'm not sure yet which one to follow.

Piazza, PT, DPT, ATC, MTC

Progressive Physical Therapy, Inc

Ormond Beach, FL 32174

________________________________

From: PTManager [mailto:PTManager ] On Behalf Of

JHall49629@...

Sent: Thursday, January 03, 2008 8:59 PM

To: PTManager

Subject: Re: 2008 Medicare Physician fee Schedule

Rhoda/

I just went out to CMS website (you can find a link out on PTManager.com)

and noted that CMS website has NOT published 2008 rates yet. What site are you

making the rate cut determination from and are you getting the correct

information?

Jim <///><

**************Start the year off right. Easy ways to stay in shape.

http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489

<http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489>

[Guest guest]

Non Par means that you and/or your facility are not participating with the

Medicare program. Par means that you are participating. If you don't know

which you are, call your Medicare Provider Representative and ask them. Most

providers usually chose to participate.

Jim Hall, CPA <///><

General Manager

Rehab Management Services, LLC

Cedar Rapids, IA

319/892-0142

**************Start the year off right. Easy ways to stay in shape.

http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489