Not surprising, NY Times latched on to the not so casual observation that about half of the top ten medicare claims for physical therapy have Brooklyn addresses. My prior post (What Medicare #physicaltherapy Data Doesn’t Tell You), gives background to the fundamental problems of the published medicare data so no need to rehash most of this but NY Times makes several statements-many completely unfounded and perposterous .
-Yes, it is very difficult to believe that the majority of the highest #physicaltherapy claims for medicare are in NY. The article points out that the PT in question is currently in the medicare program, has not been investigated, has very predictable and repetitive billing habits, and lengths of stay that are excessive. The PT does point out that the claims are for about 24 PT’s and multiple PTA’s (from a medicare billing perspective PTA’s are essentially the equivalent of PT’s). If the average PT receives in claims 250k per year with 75% of the patients being medicare (not out of line in some retirement parts), $4M per year is not out of line when you include PTA’s . Regardless, it is hard to understand given the therapy cap, exceptions process, and manual review for claims above roughly $3700 how this didn’t trigger an investigation. This brings me to the point I made in the blog post that the real failure is by CMS. If in fact, an investigation reveals fraud, then this case is not about representing the PT profession but about criminal activity.
-NY Times claims that “physical therapy has become a medicare gold mine. Medicare paid physical therapists working in offices $1.8 billion in 2012 alone, the 10th highest field among 74 specialties”. NY times clearly doesn’t do its homework as real analysis would show that PT is about 1% of the medicare expenditures. While it might be 10th of 74, the overwhelming few at the top consume the vast majority of dollars but let’s not let the facts get in the way of an image of PT’s panning for gold while walking grandmothers. NY Times also refuses to point out that this public database only accounts for physical therapists in private practice (PTPP which also includes PT’s working for MD’s offices) which is roughly 30% with hospitals, rehab agencies, SNF (part B), CORF, and HHA’s (part B) amounting to the balance and the majority. Isn’t it possible NY Times that the 30% public database doesn’t represent the entire picture?
-NY Times also points out that “physical therapists collected about $49,000 in Medicare payments in 2012, according to the data”. If a PT averages about $250k in collections per year, this is roughly 20% of a PT’s practice-a minority part of a PT’s practice and hardly a gold mine. Which is it NY Times?
-The most outrageous NY Times claim is “unscrupulous practitioners bill Medicare for unnecessary treatments or procedures they never perform-something that is often easier to do in physical therapy than in fields like oncology or cardiology”. I challenge NY Times to post the documentation, plan of care, technical requirements, G codes, and the string of superimposed rules and regulations for physical therapy claims and see how they stack up versus the requirements for oncology or cardiology. Physical therapists are over burdened by the CMS requirements in comparison to all 74 of the supposed specialty areas that NY Times has dug up.
Totally understand NY Times writing about the suspicious numbers primarily in NY but to extrapolate to an entire profession is completely out of line.
Thoughts?
@physicaltherapy
