…physical therapists have been good little boys and girls this year.  While some have mistakenly interpreted the recent extension to the extension on the exceptions process and the delay on the SGR “doc fix” as early Holiday gifts, we know better.  We were disappointed as to being the only healthcare practitioners to receive an early lump of coal in our stockings through an obscure MPRR implementation that cuts our reimbursement.  As crazy as it sounds, some PT’s are now happy that the final MPPR will not be as bad as initially drafted.  While we have compiled our list a little late, I would like to ask for the following:

-The Current Health Affairs journal in the hands of every legislator.  It contains 4 articles on the abuse of in office imaging equipment through self-referral.  In 2010, we have a Medpac report on how this impacts physical therapy and as you can only imagine abuse is rampant.

-A unique identifier in Medicare that distinguishes a physical therapist in independent practice from a PT who works in a physician office. Santa, docs aren’t stupid and “incident to service” is going by the wayside for medicare physical therapy billing.  Due to unintended consequences of bad strategy on POPTS, physician’s now get all of their PT’s their own billing number and the utilization data cannot be differentiated from private practice PT’s!  This one should be easy Santa-a lot easier than what we asked for last year-getting rid of antiquated signed plans of care and direct access.  But, please keep those on our list as well.

-Opt out of Medicare.  Santa, for some reason we are one of a handful of professionals that cannot opt out of medicare and simply take cash from willing medicare patients in a deregulated environment. This restriction poses big problems for many private practices who want to currently and will much more likely in the future do what many physicians have done and simply not take medicare due to oppressive regulations and poor reimbursement.  This would be a great gift Santa and you don’t even have to wrap it.

-A national policy by our professional association that is explicit as “The practice of physical therapy is provided exclusively by physical therapists acting within their own state’s scope of practice”.  You see Santa, this would then eliminate many positions that superimpose rules against our own state practice acts and only aid and abet national payment policy like Medicare which make us overeducated technicians with lots of student debt.   By the way, can you get us a meeting with nursing leaders who seem to have perfected expansion of practice versus our bent on adding more regulations and rules? While CMS has embraced physician extenders thru midlevel practitioners, they have given us things like the 8 minute rule and a definition for group therapy that continues to be heavily debated on listserves.  Yes, Santa, I know that not many people still use listserves but low technology serves us well.

-Filing complaints.  Santa, I know that filing complaints is not a “gift” but it really is in physical therapy.  You see Santa, PT’s are the most unbelievable grass roots folks who lobby, participate, and get in the trenches when things have to get done but we are too nice when it comes to getting beat up by insurance companies.  This was brought home recently when in a meeting with reps from our state’s insurance commission told us so.  The good news though Santa was that once we let PT’s know how to file a complaint, we got well over 40+ within 2 weeks who provided specific examples about the injustices brought thru “physical therapy benefit management firms”-the one’s who typically authorize 6 then 2 then 1 then 1 visits because they get paid on number of authorizations and only seek to deny, deny, deny.  Let’s hope that we can tap into more patient and practice advocacy and turn the tide agains the absurdity of those firms who are now contracted with almost every national insurance company.  As PT’s we need to know Santa that filing complaints with our state’s insurance commissioner on our behalf or providing the mechanism to patients won’t cause payors to revenge on us  or our practices.

Thanks Santa and have a great Holiday.

larry@physicaltherapist.com

Before I send to North Pole, please add your wishes to this list.