Forget about P4P measures as a way to control growth and ensure quality in outpatient physical therapy. According to CSC reports, the caps and the exemption process controlled growth while simultaneously did not restrict beneficiary access to physical therapists (and OT’s and SLP).
Although the report which is based on 2006 data cannot identify POPTS, the reports show a decrease in spending for PT overall compared to prior years and is roughly 3 billion for the PT component (which represents about 75% of total outpatient therapy). I believe this report is a serious blow to the POPTS argument that utilization is increased. Outpatient providers of private practice (which includes POPTS) now account for roughly 27% of all claims with hospitals now at 2nd place at 20%. PTPP has roughly 42,000 providers which is 27% more than in 2004. Pure physician billing of PT via “incident to service” is much less than prior reports as the conversion to individual provider numbers more than offset that decrease. It is my opinion that the growth in PTPP is undoubtedly POPTS but as you might guess, we don’t have data to prove it.
Interestingly enough, CSC’s analysis is that beneficiaries who reached the cap in an outpatient setting generally were not sent to a hospital for further treatment. Did it ever occur to CSC that this is logistically very difficult to do and that undertreatment in some ways has unintended consequences?
Did it ever occur to CSC that the proliferation of PTPP in and of itself caused the decrease in spending? When you reduce the highest cost providers (that would be hospitals) and they are treated by an ever growing base of “capped” providers this would reduce cost! If they really want to save money, just forbid hospitals from seeing medicare outpatient rehab patients!!! (for the record, I am not advocating this-just extending their illogic).
I am not even bringing in quality, cost-effective, or efficiency arguments between hospitals and PTPP-just logistical and growth in PTPP settings. That’s another rant for another time.
I will follow this up with some points that are very different than the CSC conclusions. Including the simple argument that decreased in PT spending is not necessarily a good thing or something that should be a goal. It will always be a lot cheaper to do PT than to do surgery, imaging, and drugs.
Make no mistake. We will undoubtedly be stuck with caps and exceptions process for a LONG time.
