Re: Re: PT Aides and 97110

[Guest guest]

Jon,

 

Thank you for understanding the valid and justified stance we as PT owners have

in making changes to the contractual third party payor system we operate under.

 

Your cool headed reasoning and solid understanding of history with a realistic

point of view on that " steep uphill battle " was well received.

 

I am also apologetic of my emotional threads that come from years of trying to

operate with a higher expense line due to investing in costly hard assets that

drive our quality of care. I am making a profit (barely, and slowly dropping

below the break even point) but I am not seeing the margins like before due to

a decrease in volume (thanks to a big conglomo hospital buying up doctor

practices and pressuring them to refer within the system), and dropping

reimbursement rates.

 

I am modeling out a cash basis idea with a new staffing mix and want nothing

more than to keep providing quality of care with this model. I am just afraid

(petrified really) to ask a pt to pay for their PT services while they are still

paying a premium for their insurance benefits that includes PT. I just hope they

see me as being the best PT in the area and be willing to go self pay with me

rather than the other PT down the street.

 

Still searching for answers.

 

Thanks for your response.

 

With gratitude,

Hankins, PT

Synergy Therapies, LLC

To: PTManager

Sent: Sunday, August 21, 2011 9:00 AM

Subject: Re: PT Aides and 97110

 

,

Speed bump #1 APTA vs. AMA:

I'm not sure how much influence the APTA has on the AMA. Convincing the AMA

that radical changes in the physical medicine and rehab CPT definitions are

needed would likely be a steep uphill battle. However, that doesn't mean it is

not worth the effort for APTA members to suggest this to our representative

leadership. A well organized petition might be a good first step.

Objectively, if you look at the APTAs statement against POPTS and the progress

(or lack thereof) they have made over the last 28 years in efforts to eliminate

them, you might get a glimpse of a similar kind of uphill battle we would face

in attempts to " revamp " the CPT definitions.

An article from 2005 titled An American Physical Therapy Association White

Paper: Position on Physician-Owned Physical Therapy Services (POPTS) gives a

little background regarding the APTAs stance and effort to eliminate POPTS.

Bottom line: 28 years later, POPTS still exist and are growing in number. One

might conclude that the APTAs fight has been less than effective. At least they

continue the fight!

Link: http://aptaco.org/POPTS%20White%20Paper%20final.pdf

Speed bump #2 Third party payers:

Convincing third party payers to increase their reimbursement amounts would seem

to be an even steeper uphill battle (or a pipe dream). Third party payers

benefit from continuous reductions in reimbursement rates, allowable visits, and

total allowed coverage amounts. In addition, they benefit from making it as

difficult as possible for providers to submit and receive payment for their

services. There is just no incentive for them to be a participant in

simplifying our coding or billing processes let alone increasing reimbursement.

Speed bump #3 Pay for performance:

Below is a link from M.D.s perspective that discusses a few of the difficulties

that would be encountered with a " Pay for Performance " (PFP) system. On the

surface, PFP may sound like a good idea. However, creating and implementing a

functioning PFP system would be quite daunting both in time and expense. Third

party payers would be the creator and manager of such a program not PTs and we

already know where their motivation lies. It's far easier and less costly for

them to simply keep cutting reimbursement and passing on more cost to the

consumer. Have you noticed this trend? Even if PFP programs are eventually

implemented, one might wonder who bears the responsibility of the metrics

tracking and if the potential 1-2% increase in reimbursement will be offset by

the increased effort required for compliance. I can assure you, insurance

companies do not want a net decrease in their profits to result from a PFP

program. PFP will not be a windfall for

PTs.

Pay for Performance article Link:

http://www.healthways.co.uk/newsroom/articles/Managing%20the%20Metric%20vs%20Man\

aging%20the%20Patient.pdf

Lastly, I feel I must apologize for the apparent negativity of this post. I

would like to think I'm a " glass half full " type of person. My statements are

based mostly on retrospective observation of the APTAs effectiveness with POPTS

and the trending of third party payers over the last 20+ years.

In time, cash based services may start looking better and better when compared

to declining third party reimbursements.

1. No long waits for a protracted APTA fight against the more powerful lobby of

the AMA,

2. No CPT restrictions

3. No restraints from contractual agreements (Medicare).

The only restraint would seem to be the creativity of the PT business owner.

Jon Mark Pleasant, PT

>

> How do we change the CPT code definitions? Does PT-PAC do it, or do we work

through the state level, then to the federal level? I know in today's healthcare

market, we are seeing a decline in reimbursements. The MPPR, the possible ~ 30%

reduction in Medicare reimbursements next year, etc, is making us all realize

these definitions of one on one is pigeon-holing us into a tight spot. One on

one does not cover our costs, or give us adeguate margins on the visit.

>  

> We can run a tight ship, but costs of providing quality care; ie - on site

pool therapy or any other major investment that increases the value of our

treatment, are driving us private practice owners to rethink how we schedule,

how we treat (EBM - based of course), what we purchase, and how to create

other revenue streams.

>  

> I say raise our reimbursement rates, then we can do more one on one. Or better

yet, pay us for quality (incentivizing us to invest more $ into what we do to

get the pt better faster), not quantity. Then everyone is happy (pt, provider,

owner, payor, etc), not for the sake of getting wealthy but to make an honest

living, even in today's tight economy.

>  

> Hankins, PT

> Synergy Therapies, LLC

>

>

> To: PTManager

> Sent: Saturday, August 20, 2011 11:17 AM

> Subject: Re: PT Aides and 97110

>

>

>  

>

>

>

> The definition for certain billing codes is one-on-one treatment.  If we do

not deliver one-on-one services yet bill that code is it not fraudulent

billing?  If we want to do more than one-on-one then the code must be

changed.  At least that seems to ultimately be the crux of the matter.

>

> Carroll , PT

>

> Chattanooga TN

>

> PT Aides and 97110

>

>  

>

> Posted on behalf of a PTManager who does not want to be ID'd

> ***************************************************************************

>

> Thanks Rick and others,

>

> The focus on one on one care is killing our profession and will be the final

> nail in the coffin of our profession.

>

> Is it a skilled activity to have a PT or PTA stand by grandma and count her

reps

> so you can bill 97110 rather than group? The PT determined the need for the

> activity, set the parameters of the exercise and fully observes it's set up by

a

> (you fill in the blank).

>

> We all hear, and repeat, how great we are but that clinic down the street

> doesn't spend time with the patient, blah, blah, blah. Remember the knife cuts

> both ways. For the respondents to this post and others in a similar vein I

have

> a few questions: Do you collect objective, standardized, risk adjusted

outcomes

> as well as patient satisfaction data? Justify your " quality of care " with

data,

> if you can't the rest is just hot air. Time does not equal quality or ethics.

>

> What about the OP clinics where the PT is there on a Monday doing evaluations

> and PTA co-visits for the week not to return till the following Monday to do

it

> all over again. Who is making the program changes, progressions, modifications

> when the PT is not on site for the remainder of the week? On the other hand

the

> OP clinic with a full time PT/owner, onsite 50 hours/week, with an aide or

two.

> This PT is in constant contact with knowledge of what each patient's status

and

> makes program changes daily.

>

> My heart goes out to the younger PT's that have huge student loans with

> expectations of big salaries. My heart also goes out to the facilities whose

> individual PT productivity doesn't " cover their nut " , " you want me to see >10

> visits/day and do an eval but what about the ethical one on one care? " Time

does

> not equal quality or ethics. The tipping point that our profession will be a

> loss leader when health care contracts are signed is close at hand.

>

> Meanwhile, EP and ATC's do " functional testing " for cash with less training

> quoting PT research to justify their conclusions. What do we do, " hey they

> can't do that " . Yet these groups also get referrals from physicians for post

op

> " rehab " at your local gym. Why? Simple answer, many of us are too passive with

> our interventions. What do we do as PTs? Complain and cry foul but are

> unwilling to consider alternative practice settings or adding these skills to

> our tool box.

>

> Quoting Norm from the old TV show CHEERS. " its a dog eat dog world out their

and

> I'm wearing milk bone shorts " . We are wearing the shorts and giving away more

> milk bones. When are we going to turn around and take on the dogs?

>

> The leaders of our profession have put us into the " one on one treatment " box

> which is completely unsustainable. Now its a mantra tied to quality and

ethics.

> Time does not equal quality or ethics. State boards are there to police the

> fraud, overutilization, and improper care issues so let them.

>

> As a profession we need to raise our productivity, and consider alternative

> practice settings to meet the needs of the consumer and market place, or lower

> our expectations of pay and benefits. There are other groups out there more

> than willing to step in for PT. Profit is not a bad thing but is hard to

> justify the hours and stress for 6%.

>

> , I would ask that you withhold my name and email from this post. As a

> fellow private practice clinician/owner in the killing fields day in and day

out

> for the past 20 years I feel that I am jousting with windmills some days. If

you

> can not withhold I understand, then do not post. We are far too passive as a

> profession.

>

>

[Guest guest]

We all assume this is the case if the current payment system remains in place.

How we are paid by CMS most likely will be different in the next several years,

most likely based on an intensity and severity scale. New codes would be needed

to describe the various levels. That could be our chance.

Rick Gawenda, PT

President

Gawenda Seminars & Consulting, Inc.

http://www.gawendaseminars.com

> ,

>

> Speed bump #1 APTA vs. AMA:

> I'm not sure how much influence the APTA has on the AMA. Convincing the AMA

that radical changes in the physical medicine and rehab CPT definitions are

needed would likely be a steep uphill battle. However, that doesn't mean it is

not worth the effort for APTA members to suggest this to our representative

leadership. A well organized petition might be a good first step.

>

> Objectively, if you look at the APTAs statement against POPTS and the progress

(or lack thereof) they have made over the last 28 years in efforts to eliminate

them, you might get a glimpse of a similar kind of uphill battle we would face

in attempts to " revamp " the CPT definitions.

>

> An article from 2005 titled An American Physical Therapy Association White

Paper: Position on Physician-Owned Physical Therapy Services (POPTS) gives a

little background regarding the APTAs stance and effort to eliminate POPTS.

Bottom line: 28 years later, POPTS still exist and are growing in number. One

might conclude that the APTAs fight has been less than effective. At least they

continue the fight!

> Link: http://aptaco.org/POPTS%20White%20Paper%20final.pdf

>

> Speed bump #2 Third party payers:

> Convincing third party payers to increase their reimbursement amounts would

seem to be an even steeper uphill battle (or a pipe dream). Third party payers

benefit from continuous reductions in reimbursement rates, allowable visits, and

total allowed coverage amounts. In addition, they benefit from making it as

difficult as possible for providers to submit and receive payment for their

services. There is just no incentive for them to be a participant in simplifying

our coding or billing processes let alone increasing reimbursement.

>

> Speed bump #3 Pay for performance:

> Below is a link from M.D.s perspective that discusses a few of the

difficulties that would be encountered with a " Pay for Performance " (PFP)

system. On the surface, PFP may sound like a good idea. However, creating and

implementing a functioning PFP system would be quite daunting both in time and

expense. Third party payers would be the creator and manager of such a program

not PTs and we already know where their motivation lies. It's far easier and

less costly for them to simply keep cutting reimbursement and passing on more

cost to the consumer. Have you noticed this trend? Even if PFP programs are

eventually implemented, one might wonder who bears the responsibility of the

metrics tracking and if the potential 1-2% increase in reimbursement will be

offset by the increased effort required for compliance. I can assure you,

insurance companies do not want a net decrease in their profits to result from a

PFP program. PFP will not be a windfall for PTs.

>

> Pay for Performance article Link:

http://www.healthways.co.uk/newsroom/articles/Managing%20the%20Metric%20vs%20Man\

aging%20the%20Patient.pdf

>

> Lastly, I feel I must apologize for the apparent negativity of this post. I

would like to think I'm a " glass half full " type of person. My statements are

based mostly on retrospective observation of the APTAs effectiveness with POPTS

and the trending of third party payers over the last 20+ years.

>

> In time, cash based services may start looking better and better when compared

to declining third party reimbursements.

> 1. No long waits for a protracted APTA fight against the more powerful lobby

of the AMA,

> 2. No CPT restrictions

> 3. No restraints from contractual agreements (Medicare).

>

> The only restraint would seem to be the creativity of the PT business owner.

>

> Jon Mark Pleasant, PT

>

>

> >

> > How do we change the CPT code definitions? Does PT-PAC do it, or do we work

through the state level, then to the federal level? I know in today's healthcare

market, we are seeing a decline in reimbursements. The MPPR, the possible ~ 30%

reduction in Medicare reimbursements next year, etc, is making us all realize

these definitions of one on one is pigeon-holing us into a tight spot. One on

one does not cover our costs, or give us adeguate margins on the visit.

> > Â

> > We can run a tight ship, but costs of providing quality care; ie - on site

pool therapy or any other major investment that increases the value of our

treatment, are driving us private practice owners to rethink how we schedule,

how we treat (EBM -Â based of course), what we purchase, and how to create

other revenue streams.

> > Â

> > I say raise our reimbursement rates, then we can do more one on one. Or

better yet, pay us for quality (incentivizing us to invest more $ into what we

do to get the pt better faster), not quantity. Then everyone is happy (pt,

provider, owner, payor, etc), not for the sake of getting wealthy but to make an

honest living, even in today's tight economy.

> > Â

> > Hankins, PT

> > Synergy Therapies, LLC

> >

> >

> > To: PTManager

> > Sent: Saturday, August 20, 2011 11:17 AM

> > Subject: Re: PT Aides and 97110

> >

> >

> > Â

> >

> >

> >

> > The definition for certain billing codes is one-on-one treatment. If we

do not deliver one-on-one services yet bill that code is it not fraudulent

billing? If we want to do more than one-on-one then the code must be

changed. At least that seems to ultimately be the crux of the matter.

> >

> > Carroll , PT

> >

> > Chattanooga TN

> >

> > PT Aides and 97110

> >

> > Â

> >

> > Posted on behalf of a PTManager who does not want to be ID'd

> > ***************************************************************************

> >

> > Thanks Rick and others,

> >

> > The focus on one on one care is killing our profession and will be the final

> > nail in the coffin of our profession.

> >

> > Is it a skilled activity to have a PT or PTA stand by grandma and count her

reps

> > so you can bill 97110 rather than group? The PT determined the need for the

> > activity, set the parameters of the exercise and fully observes it's set up

by a

> > (you fill in the blank).

> >

> > We all hear, and repeat, how great we are but that clinic down the street

> > doesn't spend time with the patient, blah, blah, blah. Remember the knife

cuts

> > both ways. For the respondents to this post and others in a similar vein I

have

> > a few questions: Do you collect objective, standardized, risk adjusted

outcomes

> > as well as patient satisfaction data? Justify your " quality of care " with

data,

> > if you can't the rest is just hot air. Time does not equal quality or

ethics.

> >

> > What about the OP clinics where the PT is there on a Monday doing

evaluations

> > and PTA co-visits for the week not to return till the following Monday to do

it

> > all over again. Who is making the program changes, progressions,

modifications

> > when the PT is not on site for the remainder of the week? On the other hand

the

> > OP clinic with a full time PT/owner, onsite 50 hours/week, with an aide or

two.

> > This PT is in constant contact with knowledge of what each patient's status

and

> > makes program changes daily.

> >

> > My heart goes out to the younger PT's that have huge student loans with

> > expectations of big salaries. My heart also goes out to the facilities whose

> > individual PT productivity doesn't " cover their nut " , " you want me to see

>10

> > visits/day and do an eval but what about the ethical one on one care? " Time

does

> > not equal quality or ethics. The tipping point that our profession will be a

> > loss leader when health care contracts are signed is close at hand.

> >

> > Meanwhile, EP and ATC's do " functional testing " for cash with less training

> > quoting PT research to justify their conclusions. What do we do, " hey they

> > can't do that " . Yet these groups also get referrals from physicians for post

op

> > " rehab " at your local gym. Why? Simple answer, many of us are too passive

with

> > our interventions. What do we do as PTs? Complain and cry foul but are

> > unwilling to consider alternative practice settings or adding these skills

to

> > our tool box.

> >

> > Quoting Norm from the old TV show CHEERS. " its a dog eat dog world out their

and

> > I'm wearing milk bone shorts " . We are wearing the shorts and giving away

more

> > milk bones. When are we going to turn around and take on the dogs?

> >

> > The leaders of our profession have put us into the " one on one treatment "

box

> > which is completely unsustainable. Now its a mantra tied to quality and

ethics.

> > Time does not equal quality or ethics. State boards are there to police the

> > fraud, overutilization, and improper care issues so let them.

> >

> > As a profession we need to raise our productivity, and consider alternative

> > practice settings to meet the needs of the consumer and market place, or

lower

> > our expectations of pay and benefits. There are other groups out there more

> > than willing to step in for PT. Profit is not a bad thing but is hard to

> > justify the hours and stress for 6%.

> >

> > , I would ask that you withhold my name and email from this post. As a

> > fellow private practice clinician/owner in the killing fields day in and day

out

> > for the past 20 years I feel that I am jousting with windmills some days. If

you

> > can not withhold I understand, then do not post. We are far too passive as a

> > profession.

> >

> >