It is interesting to read various opinions on the opposition to RC-15–10. We covered this fairly extensively in the Stymied by Our Own Policies post. Since then the board of director’s of APTA have come out in opposition of this-something very surprising since there is exposure on the board to private practice. Also quite ironic in today’s ultra transparent world, there is no forum from APTA on discussion of these issues by its members and therefore we are forced to email sentiments to our respective delegations.
By way of reminder, this RC put forth by some great leadership within Private Practice Section basically proposes the seemingly logical suggestion that APTA should be in favor of PT’s practicing within their scope of practice. The restricted positions within APTA’s current documents maintains that PT’s are incapable of decision making and judgment with regards to support personnel and therefore are told thru positions (HOD 06–05–18–26 and HOD 06–01–12–15) that there can be no attempt to direct or supervise care through support personnel which is restrictive in the overwhelming majority of state practice acts and the model
practice act. Fortunately or unfortunately depending on your perspective, APTA has only convinced medicare to follow their PT license restricting positions. The net impact is that this policy with respect to medicare has put an arbitrary wage cap on physical therapist earnings in the range of 60k. Imagine getting future insurance contracts at 80% of medicare rates and having
to abide by the restrictive rules-this is a sure recipe for disaster and is reason enough for eliminating those oppressive and antiquated positions at APTA. This also runs contrary to the larger trend in evolving health professions of scope of practice expansion-something we should be learning from nurses.
The latest justification for those in opposition is that eliminating these positions would compel physician’s who have in office physical therapy to fire their licensed PT’s and simply hire techs. While it may be a good negotiation tactic to throw an occasional red herring into the mix to get an emotional charge this one is so far fetched that it may have originated from Nostradamus.
Physician’s who bill for physical therapy in their office do so through two mechanisms -“incident to service” or getting each PT their own provider number and re-assigning payments to the physician practice (the same way that the majority of private PT practices bill). While this latter technique doesn’t have as long term history as the former, it is clearly the major mechanism for
POPTS clinics and the CMS data on this is unarguable. Even if physician’s bill using “incident to” they still have to comply with the rules which basically state they are required to use licensed PT’s when seeing medicare patients-something that APTA and others worked hard at with CMS. This requirement by the way came in large part from substantial claims review by CMS which demonstrated amongst other things that PT was being provided by non-qualified personnel. There are other regulatory constraints to “incident to” billing which in essence have paved the way for it to probable extinction. The unexpected results of forcing MD’s to get licensed PT’s to see medicare patients (rather than ATC’s or other non licensed providers including PTA’s) coupled with the ability for MD’s to have PT’s get their own medicare number and re-assign to the practice has in large part fueled growth in POPTS (and of course the referral for profit motive!). But let’s not lose sight of the main point-regardless of where and how physical therapy is billed, medicare patients have to be seen by a PT.
There is no relationship between RC 15–10 and incident to billing. There is nobody advocating for taking PT’s out of the loop in medicare. There is nobody advocating that any physical therapy be done outside of a physical therapist acting within their scope of practice. It is a silly and illogical connection-almost as silly as PTA’s getting full vote at the component level of APTA.
If you are against RC 15–10 then at least be forthcoming with your rational and also admit that the positions narrow the scope of practice of a PT in most states and are against the model practice act which was put together by PT’s. Let’s leave completely unrelated issues out of it.
