2011 Rule Includes Significant Cuts for PTs - APTA link

[lee9786]

November 2: 2011 Medicare Physician Fee Schedule Final Rule Released

Today the Centers for Medicare and Medicaid Services (CMS) released the 2,023 page final rule on Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2011. The rule included a number of provisions that have a significant impact on physical therapists. These provisions include:

• Application of a multiple procedure payment reduction policy (MPPR) for therapy services under Medicare Part B.
• Implementation of the $1870 therapy cap without an exceptions process;
• The projected cut in the sustainable growth rate /conversion factor;
• Expiration of the geographical practice cost index (GPCI) floor;
• Discussion of options for therapy payment alternatives;
• Quality reporting under the physician quality reporting initiative (PQRI).

http://www.apta.org/AM/Template.cfm...ggedPageDisplay.cfm&TPLID=342&ContentID=48513


Could a PT provide some insight on what kind of cuts and how much?

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[jbizzle]

Could a PT provide some insight on what kind of cuts and how much?

Please, please, please someone, jesspt, whoever, please clear up what will happen. Maybe I'm getting accepted to PT prgrams this year because the applicant pool is not as strong because of all this medicare issues driving the stronger applicants away. This is so ironic, now that I have finally been accepted after years of praying to get in a program, now I seriously have to think about this.

Forgive my ignorance, is this final or does it have to pass something. Or is this something that doesn't have to go through congress and whatever they say goes.

 

[lee9786]

http://www.medicalnewstoday.com/articles/206522.php
"Medicare beneficiaries will continue to see cuts in rehabilitation services next year as new policies released today under the 2011 Medicare Physician Fee Schedule Final Rule create further challenges for providers who care for the nation's most vulnerable citizens, says the American Physical Therapy Association (APTA).

A new multiple procedure payment reduction (MPPR) policy aimed specifically at outpatient therapy services will reduce payment 7%-9% above the approximately 30% across the board reduction contained in the final rule. Also, payment for outpatient therapy services will be limited to $1,870 in 2011 for physical therapy and speech-language pathology services combined, further restricting beneficiaries' access to vital rehabilitation services for stroke, hip replacements, and chronic conditions.

"The situation for Medicare beneficiaries is getting progressively worse with these short-sighted policies that attempt to control costs without regard to the complex needs of this population," said APTA President R. Scott Ward, PT, PhD. "It is time to move away from policies that arbitrarily cut or limit services and move toward policies that ensure optimal function and recovery for each senior. The MPPR policy is ill-conceived and flawed. Such policies run counter to the Administration's stated goals and undercut its motives for health care reform."

On January 1, 2011, physical therapists in certain states could expect to see overall payment reductions of nearly 40%. APTA believes this could lead to some physical therapists closing their practices, which would further decrease access to care - especially for beneficiaries in rural areas. APTA is extremely disappointed with this unjustified payment cut and questions the Administration's desire to cut costs in any form possible without regard for patients' well being and the providers who serve the nation's seniors and individuals with disabilities. As such, APTA will aggressively explore all legal, regulatory, and legislative options to negate the MPPR policy."

Ouch

 

[DancerFutureDPT]

so glad I'm getting into more and more debt each day. How promising Hopefully it'll get worked out

I'm going to ask my APTA rep faculty member about this tomorrow.

 

[johncronejr]

Dancer please let us know what they say.

 

[goyo1010]

this is ludicrous! those freaking bureaucrats don't know anything about what patients need when their pockets are stuffed. and the effect on physical therapists?! payment reductions of 40%?!? wtf

 

[markelmarcel]

This is not good, folks.

 

[meliffy18]

This is really disheartening. Now I'm not sure if I am making the right decision or not. 40% cuts are HUGE and they will probably get progressively worse. Our "health care" system is a joke!

PLEASE, if any PTs out there have any insight, let us know.

 

[mtm34]

The MPPR cuts are to scheduled physician fees overall meaning that MD's will be cut as well, the AMA estimates about 25%... this will be repealed on November 15th- The APTA is not very strong but you better believe the AMA is. Basically they will demand a 13 month hold on the bill and hopefully by next year this is figured out correctly. Centers for Medicare Services wants to say that the lost reimbursement will be made up through the new people added in the healthcare bill which is erroneous and makes no sense. Regardless all will be well in a couple of weeks. Don't jump ship.

 

[jbizzle]

I just PMed a current PT on SDN and he/she PMed back stating that I shouldn't worry about this since this was already in the works for a while now, and that it's not a dig cut that some are iimagining.

I still want to know more information about it though.

 

[DancerFutureDPT]

Dancer please let us know what they say.

The faculty member said she'll get back to me this weekend when she has more time to really explain what it means. Fingers crossed that it will be repealed like the other poster said on Nov 15.

 

[PT Dad]

Folks, the only way to implement Obamacare is to ration care and the way to do that is by cutting reimbursement schedules. Is this the change you voted for?

 

[jbizzle]

Is this the change you voted for?

Or we could have kept digging ourselves into a grave if we stayed with the status quo. Was this the only change I was hoping for???

With that said, however, It sure sounded nice then. Plus, there were more changes to be made, not just about healthcare anyway.

 

[PT2014]

Stop the BLEEDING! Take the loss. Get OBAMA OUT NOW!

 

[DancerFutureDPT]

ok let's not turn this into a political debate over obama vs. republicans.

I think we can all agree that Obamacare has both good and bad points, regardless of which side we fall on ourselves.

And I saw this article from an MD's perspective http://money.cnn.com/2010/11/05/new...eed:+rss/money_topstories+(Top+Stories)...I'm hoping all the final rules are lumped together since the AMA will probably be able to shut it down....if they can pull it off and the PT portion goes along for the ride, that'd be great.

 

[jbizzle]

I wanted the troops home, and the econmy to be fixed, I didn't want healthcare reform (just so happened obama wanted all three). So is this their idea of fixing the economy, by sacrificing healthcare, geez! I hate politics anyway, why am I talking about this.

I hope AMA can kick butt.

 

[markelmarcel]

ok let's not turn this into a political debate over obama vs. republicans.

AGREED 100%. This is a conversation on how this affects PTs, not a conversation on politics. Regardless of who voted for who, we are faced with this issue and we would like to discuss the possible implications. It does no good to have a pissing match on politics.

 

[PT2014]

Hard to talk about reimbursement cuts, healthcare reform, and Medicare without talking about politics....

 

[jbizzle]

There was this armadillo that I accidentally ran over last night. I didn't know they moved so fast. A grilled cheese sammich and tomato soup sounds good right now.

So, im reading that this is just for next year and by 2013 it will be less of a cut. Like 5% i think. Do you guys think PT reimbursements will ever be in the green (you know, like an increase to what PTs are currently seeing now; as in this morning, before the cuts will ever happen)

You know what im saying? Like when I first started driving in 2003, I was so mad that gas was $1.82. And then they actually rose to like $4 and I found myself saying that the $1.82 I was paying was better than this. Do you think the cuts will keep coming, and that when we look back, we will start saying stuff like my fuel anaolgy. I'd rather have 25% cut, instead of 75% cut.

If I am asked "Where do I see healthcare 20 years from now" in an interview, what am I going to say? (No seriously, what am I going to say)

 

[NATO]

I only read small sections of the article, so correct me if I'm wrong, but these cuts only affect PTs that work in outpatient therapy clinics, correct?

 

[jbizzle]

I only read small sections of the article, so correct me if I'm wrong, but these cuts only affect PTs that work in outpatient therapy clinics, correct?

Thats what it sounds like to me.

 

[lee9786]

I believe outpatient clinics at the hospital also bill under Medicare part B, which is what is being affected here. Someone correct me if I'm wrong.

It looks to me like this is the writing on the wall. What has either party done to resolve the well-known fiscal issues with Medicare over the past decade? Their answers look to be decreasing reimbursement to providers. At least we can see where their priorities are among practitioners.

 

[DancerFutureDPT]

I believe outpatient clinics at the hospital also bill under Medicare part B, which is what is being affected here. Someone correct me if I'm wrong.

I'm not sure...when I was working in the front office back in March during the whole Medicare $1870 cap before Congress extended the exceptions allowance, we were told that if our patients hit their max, they had to go to outpatient therapy at a hospital as opposed to a private clinic...that makes it seem like hospital provisions may be different when it comes to billing. But, I'm not sure. I'm also not sure if the rules are the same this time around.

 

[lee9786]

I think hospitals are still clear of the cap, but I think they will see decrease in reimbursement in the outpatient setting because they use part B.

 

[jesspt]

Lee - you are correct. Outpatient facilities that are physically within a hospital are exempt from the cap. Free standing outpatient facilities are not. Regardless, the decrease in reimbursement will effect all facilities.

 

[markelmarcel]

Lee - you are correct. Outpatient facilities that are physically within a hospital are exempt from the cap. Free standing outpatient facilities are not. Regardless, the decrease in reimbursement will effect all facilities.

How are in-patient PTs reimbursed currently?

 

[lee9786]

How are in-patient PTs reimbursed currently?

Part A I think

 

[jbizzle]

How are in-patient PTs reimbursed currently?

Like in-patient rehab or acute care

 

[markelmarcel]

Like in-patient rehab or acute care

Are in-patient vs acute care reimbursed separately? Or if it's within a hospital is it considered the same thing?

 

[jesspt]

Inpatient rehab is reimbursed via Medicare part A.

 

[markelmarcel]

Thanks, jesspt.

Instead of being excited about my interview to get into a program, I'm starting to get ill thinking about if this is the right choice or not.

I would love to be a PT, that is not questionable. What is questionable is, will I be further in debt than I am now from my first degree I'm not using, and be in the same position (unable to find a decent job)?

Literally sick.

 

[DPT8387]

Thanks, jesspt.

Instead of being excited about my interview to get into a program, I'm starting to get ill thinking about if this is the right choice or not.

I would love to be a PT, that is not questionable. What is questionable is, will I be further in debt than I am now from my first degree I'm not using, and be in the same position (unable to find a decent job)?

Literally sick.

I think the biggest issue here is that people would consider not going into PT just because of this. I am in a massive amount of debt from undergrad alone, but PT is my passion and it is all I have ever wanted to do- I would be crazy to let fear of the unknown make me doubt pursuing this. Thats exactly what this is-- unknown. We can talk about what effects this will have on us but freaking out when we have yet to see the results is doing no one any good. I have researched this a lot and talked a lot about it with the PTs I work with and while they are worried, they are also excited to take on a new challenge and are committed to figuring out how best to treat their patients. All we can do is back the APTA and continue to provide superior care.

 

[markelmarcel]

I think the biggest issue here is that people would consider not going into PT just because of this. I am in a massive amount of debt from undergrad alone, but PT is my passion and it is all I have ever wanted to do- I would be crazy to let fear of the unknown make me doubt pursuing this. Thats exactly what this is-- unknown. We can talk about what effects this will have on us but freaking out when we have yet to see the results is doing no one any good. I have researched this a lot and talked a lot about it with the PTs I work with and while they are worried, they are also excited to take on a new challenge and are committed to figuring out how best to treat their patients. All we can do is back the APTA and continue to provide superior care.

This is mostly how I feel. I guess I put more pressure on myself because all of my friends are married/getting married and have full-time jobs and I'm just finally going to be starting school.

Also, I like to think that I would love to teach at a university someday, specifically anatomy. I think a DPT ontop of whatever PhD work I would decide to do, would make me a good candidate

 

[jbizzle]

Instead of being excited about my interview to get into a program, I'm starting to get ill thinking about if this is the right choice or not.

I would love to be a PT, that is not questionable. What is questionable is, will I be further in debt than I am now from my first degree I'm not using, and be in the same position (unable to find a decent job)?

Literally sick.

Same as this and to add that people are leaving PT programs are makingme concerned as well.

 

[jesspt]

Same as this and to add that people are leaving PT programs are making me concerned as well.

Bizz, Mark -

Alright. Both of you. Knock it off. I don't usually reply to this type of post, but here I go.

All of healthcare is going to undergo some changes. Are you going to abandon healthcare all together? PT has seen adversity before (the Balanced Budget Act under the Clinton administration), and lived to tell a fairly prosperous tale.

You've both obviously considered PT for quite some time, and put thought into whether it is something you really want to pursue. You have apparently both decided that pursuing PT is worth considerable expense, financial and personal. You are on a path. Why change?

In regards to people leaving programs - you're talking about two people on this forum, one who decided to quite pursuing PT after shadowing PTs - you both speak positively about your shadowing experience. The other is considering leaving a PT program because A) he's homesick, and B) he's performing poorly academically. And this is what you base your concerns on? Doesn't make sense to me.

My advice (and believe me, you can take it or leave it):
1. Accept a spot in the cheapest program that will accept you
2. Study your ass off.
3. Seek out clinical experts as clinical instructors during your student internships
4. Become engaged in your chosen profession
5. Become an advocate for your patients and your profession
6. Live a comfortable, but not overly affluent life doing something that you will love.

 

[johncronejr]

Bizz, Mark -

Alright. Both of you. Knock it off. I don't usually reply to this type of post, but here I go.

All of healthcare is going to undergo some changes. Are you going to abandon healthcare all together? PT has seen adversity before (the Balanced Budget Act under the Clinton administration), and lived to tell a fairly prosperous tale.

You've both obviously considered PT for quite some time, and put thought into whether it is something you really want to pursue. You have apparently both decided that pursuing PT is worth considerable expense, financial and personal. You are on a path. Why change?

In regards to people leaving programs - you're talking about two people on this forum, one who decided to quite pursuing PT after shadowing PTs - you both speak positively about your shadowing experience. The other is considering leaving a PT program because A) he's homesick, and B) he's performing poorly academically. And this is what you base your concerns on? Doesn't make sense to me.

My advice (and believe me, you can take it or leave it):
1. Accept a spot in the cheapest program that will accept you
2. Study your ass off.
3. Seek out clinical experts as clinical instructors during your student internships
4. Become engaged in your chosen profession
5. Become an advocate for your patients and your profession
6. Live a comfortable, but not overly affluent life doing something that you will love.

Hear, Hear! That will be enough reason and logic out of you!

Great post Jess. I am 45 and fixing to enter PT as a second career. I certainly don't like hearing about the government making any cuts, but I figure they can't cut it too much or else they run the risk of peopel abandoning the practice in droves. I believe that I will still be able to live comfortably and I know that I will still enjoy the career.

 

[jbizzle]

DAYUM!!!!!!!!!!! Thanks for Talking some sense into me!!!!

IDK? I just thought I'd be more excited about being accepted is my issue with my recent comments. Idk, I wanted to get into a program so bad and always replayed scenes in my mind as to what I would do if I got that first acceptance letter and it didn't play out like I thought it would. I thought I would tell everyone at my job to kiss my ass, or the opposite which was to just keep them guessing as to why I quit all of sudden. I ran through the numerous scenarios so many times. As to what song would be playing in the background when I reveal that I finally got accepted (since everyone I know, knows how much I've wanted this) to wearing a bow tie and a T-shirt to work. But when it finally came it was weird. Something I've wanted so badly (I mean badly-I was so lost when I got rejected the first time I almost went into depression) It didn't have the excitement that I thought would give me due to what we have posted above.

Anyway, I've been thinking and All of this shouldn't stop me from doing what makes me happy. Let's face it, everyone has to work to get paid. And unless you win the lottery, you might as well do something you will be happy doing. So with all the issues in PT at the moment. At least I know I will do something I am happy doing.

 

[lee9786]

Bizz, Mark -

Alright. Both of you. Knock it off. I don't usually reply to this type of post, but here I go.

All of healthcare is going to undergo some changes. Are you going to abandon healthcare all together? PT has seen adversity before (the Balanced Budget Act under the Clinton administration), and lived to tell a fairly prosperous tale.

You've both obviously considered PT for quite some time, and put thought into whether it is something you really want to pursue. You have apparently both decided that pursuing PT is worth considerable expense, financial and personal. You are on a path. Why change?

In regards to people leaving programs - you're talking about two people on this forum, one who decided to quite pursuing PT after shadowing PTs - you both speak positively about your shadowing experience. The other is considering leaving a PT program because A) he's homesick, and B) he's performing poorly academically. And this is what you base your concerns on? Doesn't make sense to me.

My advice (and believe me, you can take it or leave it):
1. Accept a spot in the cheapest program that will accept you
2. Study your ass off.
3. Seek out clinical experts as clinical instructors during your student internships
4. Become engaged in your chosen profession
5. Become an advocate for your patients and your profession
6. Live a comfortable, but not overly affluent life doing something that you will love.

I tell you it's comforting hearing from a PT that's somewhat optimistic. I've come to a conclusion that PT is in a bubble right now, and about ready to pop. The bubble being inflated by Medicare and slowly deflating since the balance budget act. Since there is no real long-term solution to sustaining Medicare, it will have to discontinue. So any long-term business model should be independent of Medicare. I see myself doing a ton of volunteer work to help out these senior citizens, because our government won't be there for them. I think that's the way things are heading. Someone told me the decision to pursue this comes from the heart not the head. You have to throw rationale thought out the window. I've come to agree with that.

 

[lee9786]

I wonder sometimes if the PTAs were to advance their education to the BS level and disassociate with the APTA, if they'd be able to legislate their way into taking the traditional role of the PTs in acute care and nursing home settings due to being a lower cost provider. I had a talk with a PT yesterday on the growing influence of the PTA. They largely have the mindset that they have the same skills as the PT and can provide the same service at a lower cost. Could this paraprofessional riding coattails on PTs for years supplant their supervisors? From what I hear more and more PTAs are becoming directors of clinics every year. Disturbing trend. While PTs struggle, PTAs are thriving.

Check out this comment and link below. Interesting

"I have been a PTA for 8yrs, but have been in the field for over 20yrs. I started out as an aide and move on to be an office coordinator and then went back to school to be a PTA. I have worked with many great PT's and some awful ones that are extremely intimidated by my knowledge as a PTA. I know my stuff and I am always increasing my medical knowledge with education. I feel we do need to be respected more and they need to increase the educational degree to a bachelor for the new incoming PTA's. However, I think some PT's should not think just because they have a master's or Doctorate degree in PT that you are smarter. We are not trying to take sny thing away from the PT's, but We learn alot as a PTA's in college just so we can be the same level as the PT's. We learn every thing that PT's learn except evals and screens.I believe we are a great asset to PT's and the rehab world so I have been told. So PTA's we need to form a social meeting once a year to get together in different states to support one another and make it better for PTA's."

http://www.indeed.com/forum/job/physical-therapy-assistant/It-is-time-change/t161946

 

[FLsurferDPT]

.

 

[markelmarcel]

Jesspt, I appreciate your post. I obviously am not going to quit, I am just concerned that I will be put in a similar situation as I was with my first degree. Yes, I love people. Yes I love helping people. And most importantly, I am downright absolutely fascinated with the way the human body works and responds to different stresses.

But, all the love in the world isn't going to matter if I'm not making enough money to be able to pay on student loans/live comfortably.

That's the concern.

Will I not pursue this because of that? No... I mean, I already said, sorry $30K of undergrad debt, elementary education is not for me! Hello $10K of debt as I fullfil my pre-req classes... And looking at probably about 70K for the schools I'm applying to for the degree.

There's a lot of other concerns too... Like, maybe I'll break my leg! Or lose an arm! Or the apocolypse will happen!

I think it's reasonable when this thread is negatively toned on the potential changes that it worries those of us that are going through the application process. We want to remain excited about the career we've chosen, not be scared.

I don't want to be niave either, but where are the success stories?!


Also, I had responded already to the fear of the unknown not making me stop pursuing what I want to do and also to re-post:

I guess I put more pressure on myself because all of my friends are married/getting married and have full-time jobs and I'm just finally going to be starting school.

Also, I like to think that I would love to teach at a university someday, specifically anatomy. I think a DPT ontop of whatever PhD work I would decide to do, would make me a good candidate

 

[jesspt]

Actually I do have a B average in my classes so I'm not performing poorly academically. Also, there are not just two people leaving. A lot of PT students and pre-PT's don't necessarily use this forum and so two people doesn't give you an accurate representation of how many people are actually leaving. My program alone, 5 people left last years class and 3 already this year. I think, like Lee's post states, that PTA has become a better route to practice physical therapy for the PTA programs are only 2 years, usually inexpensive due to being an instate community college and in my opinion aren't over inundated with information to make them more like "doctors". I thought physical therapy was the perfect career at the Bachelors level. Ever since what, 1999 where there were bachelors to 2010 with everything being a doctorate it doesn't make sense. People get themselves into a TON of debt for a 7 year doctorate degree that no way pays well when comparing it to other 7 year degrees (pharmacist, vet, podiatrist, PA which is not 7 years). Also, it frustrates me all the info you learn and probably don't use most of the information due to restrictions. You gotta do what you love but you won't love doing something if you have 100K of debt on your mind every day going to work. If you love physical therapy, become a PTA. That's what I wish I had done after high school before going into 4 years of college and now a year of grad school.

My appologies for making an assumption. But, from your previous post, it was not an unfounded one.

Also, i'm not doing that great in PT school because I've gotten really nervous on my practicals and I haven't been feeling too good because i'm in a place four states away and don't have family/friends/support here and the people in my class or professors haven't really been much support

I hope that you find the career you are looking for. Best of luck.

 

[FLsurferDPT]

.

 

[VA757]

Bizz, Mark -

Alright. Both of you. Knock it off. I don't usually reply to this type of post, but here I go.

All of healthcare is going to undergo some changes. Are you going to abandon healthcare all together? PT has seen adversity before (the Balanced Budget Act under the Clinton administration), and lived to tell a fairly prosperous tale.

You've both obviously considered PT for quite some time, and put thought into whether it is something you really want to pursue. You have apparently both decided that pursuing PT is worth considerable expense, financial and personal. You are on a path. Why change?

In regards to people leaving programs - you're talking about two people on this forum, one who decided to quite pursuing PT after shadowing PTs - you both speak positively about your shadowing experience. The other is considering leaving a PT program because A) he's homesick, and B) he's performing poorly academically. And this is what you base your concerns on? Doesn't make sense to me.

My advice (and believe me, you can take it or leave it):
1. Accept a spot in the cheapest program that will accept you
2. Study your ass off.
3. Seek out clinical experts as clinical instructors during your student internships
4. Become engaged in your chosen profession
5. Become an advocate for your patients and your profession
6. Live a comfortable, but not overly affluent life doing something that you will love.

I have been reading this thread and I have to say it has been informative and valuable. jbizzle, markelmarcel….I’m in the same boat you are both in. I have questioned if it is worth the investment of going into PT. The fear I have is the investment turning into a financial liability down the road.

I worked as a PT tech after undergrad then went into the corporate sector. After several years in the corporate sector and sitting at a desk in front of a computer, it is definitely not for me. PT is where my heart is…..and has been. There is not much else out there I want to do for a career. I’m not going to let these issues make me throw in the towel on the dream.

I think the best thing at this point is for us to keep educating ourselves on the big topics that are going on in healthcare and PT. Jesspt thanks for your input in the last post. I may ask you more questions down the road.

 

[meliffy18]

I wonder sometimes if the PTAs were to advance their education to the BS level and disassociate with the APTA, if they'd be able to legislate their way into taking the traditional role of the PTs in acute care and nursing home settings due to being a lower cost provider. I had a talk with a PT yesterday on the growing influence of the PTA. They largely have the mindset that they have the same skills as the PT and can provide the same service at a lower cost. Could this paraprofessional riding coattails on PTs for years supplant their supervisors? From what I hear more and more PTAs are becoming directors of clinics every year. Disturbing trend. While PTs struggle, PTAs are thriving.

This is exactly why I am wondering if I should just become a PTA for now and see what happens down the road in regard to PT? I will be starting my prereqs in Jan but now I'm wondering if I really need to throw down $70K in 2012 for a DPT if the demand will not be as high as it is for a PTA years from now? What to do, what to do...