Payment Reform

By Terry C. Brown, PT, DPT

There is little that affects a private practitioner’s ability to deliver effective quality care more than payment. It remains the number one concern of our members and their ability to thrive. The payment environment we practice in puts all the discussion and concern regarding the America Physical Therapy Association’s (APTA) payment reform initiatives into context. Discussions on this topic are all over the place—from hopeful optimism to apocalyptic demise. Not surprising, as this is the lifeblood of our practices and the income for not only our families but also all who we employ.

The questions surrounding this effort far outweigh the answers. What will the new Current Procedural Terminology (CPT) codes look like? What will payment for new codes be? Will it be adequate for us to thrive? How do we plan for future growth of our practices? Will there be new administrative burdens attached to this effort? Is what we have now better than what we might be given? If we manage our practice as we always have, will it limit our future in private practice?

Perhaps we should start with what we do know:

• The present system of fee for service is a nightmare of manipulation and counting minutes in order to receive a constantly shrinking, barely sustainable fee.
• The administrative burdens continue to bog down therapists and limit our patient care time.
• The current system completely ignores any successful efforts to provide quality and cost effective services. Is this system working for you? Is it promoting your cost-effective quality service?

Is this system working for you? Is it promoting your cost-effective quality service?

Provider and payer alike are recognizing this system as broken. Reform is inevitable; it is happening all around us, in all of aspects of health care beyond physical therapy. The National Commission on Physician Payment Reform has called for a phasing out of fee-for-service within the next five years. Their article in the New England Journal of Medicine¹ reports a blueprint for a new physician’s fee schedule that recommends fee for service payment be eliminated because of its inherent inefficiencies and problematic financial incentives. It also recommends transition to an approach based on quality and value. Health and Human Services (HHS) recently outlined their goals as they strive to move to a value-based payment system, with efforts being apparent as soon as 2016.²

APTA has been proactively working on a new model of payment for physical therapists and has recently gained approval for new evaluation codes based on patients’ presentation and the work of the provider. Ongoing work is being done on treatment codes over the next several months. Much effort has gone into these new coding structures to support the developing payment models. Much work still needs to be done.

My fellow Private Practice Section (PPS) members, change is coming with or without our participation. Innovation of payment methodology and related reporting mechanisms are needed. This will require the knowledge of business leaders in our section working with APTA to be innovative in effecting real change, change that will benefit physical therapists that provide quality care with real outcomes. PPS members need to take the challenge to become engaged and direct change so that we are not negatively impacted by its outcome.

Notes

1. New England Journal of Medicine www.nejm.org/doi/full/10.1056/NEJMsb1302322. Accessed May 2015.

2. Health and Human Services www.hhs.gov/news/press/2015pres/03/20150325b.html