It has been an interesting start to summer for our #physicaltherapy profession.  Appropriately released on the longest day of the year, we have learned that a significant number of corporate PT companies representing about 4,000 clinics who are in the Alliance for Physical Therapy Quality and Innovation (APTQI) have immediately rescinded any policies that support paying any APTA membership dues. Their beef? APTA’s push for vast changes in coding to CMS known as Alternative Payment System (APS).  There are a lot of issues on this, let me parse through them.

APS is not new. Beginning in the spring of 2012, a conceptual payment model was introduced to members.  Feedback was sought and much feedback was given. Here is the response that PTBA wrote just over 3 years ago (full disclosure, I am a cofounder and board member of this non profit that exists to represent private physical therapy practice’s business interests).  I personally am adamantly opposed to APS for all the reasons that the post presents including the reasons that generated this post in response to PTBA post.  But let me be even more clear-APS is not an alternative payment system-it is an alternative coding scheme (ACS) and should be re-initialed as such. There is nothing in the model about payment reform-it is a scheme change-like going from a pro set offense in football back to a Wing T formation.  In their position paper that was available till this morning at link  (now says it is down-score one for APTQI’s action), there were 3 eval codes and 9 intervention codes along a matrix of severity and intensity. A chief APS complaint by APTQI as well as PTBA is that APTA has not been transparent in changes to the model (there was talk of moving it from 9 to 6 codes but it wasn’t published on their website) or open to changes based on feedback. In 2013, APTA’s own internal forum on APS feedback was shut down and at the time, more folks responded to the PTBA post than APTA’s. The burden of documentation and lack of intuitiveness on 9 codes which would create confusion are my other main objections to APS. This in turn would create a dependency on APTA going forward and their non dues revenue coding courses to straighten the masses out-we already have enough confusion and burden with G codes, superimposed rules, PQRS, plans of care, 8 minute rules, cap, and MPPR.

To be fair, coding changes led by APTA in conjunction with research guided changes in practices over a lengthy period of time have resulted in significant positive changes to current AMA CPT codes for PT’s.  APTA deserves the credit on this as we have gone from hot packs and ultrasound being reimbursed at greater rates to justifiably manual therapy and exercise being the most rewarded.  Those coding changes followed significant number of practice surveys-they were well vetted.  Re-arranging codes with some new code introduction based on current practice is far different than a mass coding change that APS represents and a consensus based, collaborative approach with groups like APTQI, PTBA, and others should be embraced not rejected. Collaboration is more than just having a few meetings with no follow up or changes to the model and APTA if it is true to collaboration will re-initiate discussions and demonstrate how input and feedback have changed the model.

There is also an on-going insinuation by APTA that being against APS means that you are resistant to any practice change and want to be in an “old” or “bad”” fee for services model.  In essence, you are practicing in your reconstruction aid outfit putting steam packs on patients in between quad sets and straight leg raises. The APS illusion is that it is somehow promoting a non fee for service system-when in actuality the only group that can make that drastic change is CMS themselves-APS is still fee for service.

Now, onto the APTQI’s action in rescinding policies about paying APTA membership.  I generally believe you make changes through membership and have been a long term supporter and dues paying member.  However, I also believe employers have the right to any policy they want on APTA dues for their PT’s and PTA’s.  My own company’s have gone from fully paying to requiring participation as a qualifier to now fully considering it as an option amongst other options for employees as they see other organizations perhaps more relevant to their career. APTA’s letters in response to APTQI appear to condemn APTQI’s action and accuse them of limiting their PT’s “growth”.  My analogy would be a little simpler-compare it to a cash paying patient in a PT clinic. If they see value, they will pay out of pocket-just like an employee who feels it is of value will likewise pay it with their own discretionary dollars.

The APTQ’s action clearly has sent a signal to APTA. From my view, they tried to work together and when that wasn’t successful they used a dissident strategy and I fully respect it and their decision. Based on what I can tell, in a very short period of time it has worked:

1. On #solvePT last night’s twitter transcript,(thanks Selena). We also learned from @policy4pt that we are still in the first stage.

2. On APTA’s CEO’s blog we learned the following:

“”while APTA has been moving forward, our data demonstrated a need to pause and evaluate how well the specific model that had been developed could be implemented in a meaningful  and accurate way.  To that end, we invited more dialogue and collaboration with the companies referring to themselves as the Alliance, and others.  We also wrote a follow up letter to that effect.””

This should be interpreted as “our limited testing told us that nobody really can be consistent with 9 codes on a severity/intensity index”.

3. The APTA’s position paper on APS is suddenly not found on the website.

4. We have been told that the Aug, 2013 APS website update will be updated.

So, from my standpoint, we ought to applaud APTQI’s efforts-they are working AND we also ought to applaud APTA-they are responding-and fast and appear to understand that at the end of the day, it is a member organization.

Thoughts?

@physicaltherapy

The thoughts on this blog post are my own opinion and do not represent any organization

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