Physical therapists from Oregon and around the country are hopeful that a coordinated lobbying effort in Washington, D.C. will begin to pay off with changes to Medicare reimbursement rates and other restrictions related to patient care.
For the second year in a row, the Private Practice Section of the American Physical Therapy Association organized a lobbying campaign of Congress on behalf of private practice physical therapists. In some cases, local practitioners are seeing fewer Medicare patients, and may be forced to stop seeing them altogether if reimbursement rates are cut any further.
“We were back there talking about the same issues. We are continually educating legislators and advocating for patients,” said Tannus Quatre, founder and principal at Vantage Clinical Solutions, a healthcare consulting firm based in Bend, who was part of the lobbying efforts last month and a year ago. He met on Capitol Hill with Oregon Rep. Kurt Schrader and staffers for Oregon Sens. Jeff Merkley and Ron Wyden and Reps. Earl Blumenauer and Greg Walden.
Quatre and his cohorts have two dates circled on their calendars: November 11, when Congress convenes for its lame-duck session before the end of the year; and March 31, 2015, when Congress must take action on the Medicare sustainable growth rate, the current formula for calculating payment rates for outpatient therapy services.
Repealing the sustainable growth rate is a primary concern for the association. “It's flawed. Every year Congress has to pass a one-year fix,” Quatre said.
Extensions to the sustainable growth rate expire March 31. Unless Congress intervenes, as it has done every year for nearly a decade, the formula would enact cuts of more than 20% in Medicare payment rates.
Quatre and the association would like to see the sustainable growth rate replaced with an annual payment rate increase of 0.5% over a multi-year transition period, during which time the the Centers for Medicare & Medicaid Services would evaluate alternative payment systems. Legislation has been introduced in the House of Representatives that would establish such a system.
“We want a period of payment stability so we can come up with alternative payment methods,” said Quatre, also a licensed physical therapist.
The second issue, related to the sustainable growth rate, is repealing the $1,900 cap imposed on physical therapy, occupational therapy and speech-language pathology services for Medicare beneficiaries.
“The important thing for the public to know is Medicare beneficiaries deserve to get good care,” Quatre said. “You've got qualified providers across the country, but there's a couple fundamental flaws that get in the way due to the reimbursement cap and the sustainable growth rate … because the payment model is so flawed.”
Reimbursement rates could be cut further
Physical therapists in the Portland area agree.
“Does it cost us more? Definitely,” said Keith Glasser, who has operated Optimal Results Physical Therapy in downtown Portland for 11 years. His biggest fear is that reimbursement rates will be cut further.
“We offer people incredible value for what they get,” Glasser said. “We're in the business to serve patients. Most private practitioners will tell you the same. We're not some giant corporation watching the bottom line. Our bottom line is people getting better.”
Kent Bond, a licensed physical therapist who runs Impact Physical Therapy of Hillsboro, is treating fewer Medicare patients simply because referrals have declined. It's a trickle-down effect of some primary care physicians choosing not to treat those patients in the first place.
Quatre suggests that systematic flaws, such as the sustainable growth rate, are to blame for those primary care physicians not seeing Medicare patients.
For Bond, who opened his private practice 10 years ago, the Medicare patients he does see require extra paperwork. He estimates that less than 10% of his 600 patient visits per month are on Medicare.
“I have to pay my physical therapists to document all this stuff but I don't get any increased reimbursements. We do more work for the same pay and possibly even less,” he said. On top of that, “the secondary insurances here in Oregon have their own individual requirements that are mind-boggling.”
But it's more than just paperwork. The current regulations create extra work for his front office staff to schedule Medicare patients to make sure that for reimbursement purposes, those appointments do not overlap, and that a physical therapist rather than an aide is available for uninterrupted care.
“I have bright, intelligent aides who work with me. They all have Bachelor of Science degrees, and you're telling me I can't have them work with Medicare patients and walk them from one machine to another or give them an ultrasound?” Bond asks. “An aide can bring them back to the room, and that's pretty much it.”
The sense of urgency for these Medicare issues does not apply to large local providers. ZoomCare, for instance, was not asked to participate in the recent lobbying effort and has not been active on the federal level, according to company spokesman Len Bergstein.
The association lobbying efforts also included three other issues. One is adding physical therapists to the list of providers who are allowed to retain substitute physicians in their practices to treat Medicare patients when the providers are absent because of illness, pregnancy, vacation, or other reasons. Currently, the Social Security statute only allows this arrangement, known as locum tenens, for practitioners identified as “physicians” under Medicare: doctors of medicine, osteopathy, dental surgery, podiatric medicine, optometry and chiropractic.
The final two issues are adding physical therapists to the list of providers who are allowed to opt-out of Medicare and collect out-of-pocket payments from those patients instead, and reforming a law that allows physicians to “self-refer” patients for physical therapy services provided within their own clinics.
Christopher Heun can be reached at [email protected]
