How to efficiently deliver medically necessary PT services.

[Guest guest]

Larry,

Nothing trumps eliminating the physician signature requirement on the

POC to speed delivery and reduce barriers to medically necessary PT

services.

CMS controls overutilization of PT with physician oversight now but

commercial insurance companies have realized that physicans can't

control overutilization and besides, with POPTs flourishing, physicans

aren't to be trusted anyways.

CMS policymakers would, however, need to be reassured they could

control overutilization with administrative controls on PT (the way

the commericals do now, eg: unit limits, visit limits, etc.).

Medicare policymakers don't trust physical therapists any more than

they trust physicians.

The STATS group could offer a 'hard cap' on therapy services to

prevent overutilization and cost outliers. In exchange, CMS lifts the

requirement for the physician signature on the PT POC.

The current exceptions process should continue at around 16 visits -

it amounts to a risk transfer to the physical therapist that creates

an incentive to document need, progress and skilled care using

currently available tools, eg: OPTIMAL, AM-PAC & FOTO.

The hard cap could be set at some higher amount, perhaps 2-3 standard

deviations above the mean (2006 per episode mean & SD = $788 +/- 782)

The risk associated with the current exceptions process is appropriate

'schooling' for doctoring physical therapists to begin making tough

decisions in anticipation of using a needs-based assessment tool in 5

years.

Physical therapists should get used to generating this information

(need) independant of the physicians' referral.

Too many PTs still look to the 'script' as the document that describes

medical necessity for PT.

Let's improve outpatient therapy payment policy in the short-term by

eliminating the physician signature requirement on the POC.

Tim

--

Tim , PT

www.BulletproofPT.com

www.MedicalArtsRehab.com

clinic phone:

clinic address: 506 4th Avenue West, Palmetto, Florida 34221

'Get Better Physical Therapy'