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ADVANCE Perspective: Physical Therapy & Rehab Medicine

APTA Takes Aim at SNF Productivity Controversy

Published October 8, 2015 3:54 PM by Brian Ferrie

The American Physical Therapy Association (APTA), Alexandria, Va., issued an Oct. 8 press release detailing how the organization has spoken out in The New York Times (NYT). This initiative was precipitated by recent reports that skilled nursing facilities (SNFs) are taking advantage of Medicare billing policies. The APTA states that these allegations underscore the need to replace volume-based payment systems with systems tied to value.

In a letter to the editor published today, APTA President Sharon L. Dunn, PT, PhD, OCS, responded to a September 30 NYT article titled, "Nursing Homes Bill for More Therapy Than Patients Need, US Says." That story focused on a report from the Office of the Inspector General (OIG) of the US Department of Health and Human Services alleging that Medicare payments have "greatly exceeded SNF costs for therapy for a decade."

According to the APTA press release, this OIG report and related media coverage are directly related to the pressures being placed on physical therapists, physical therapist assistants and other providers to meet productivity demands that can sometimes run counter to actual treatment needed.

"The provision of physical therapy services should be driven by patient need and the clinical judgment of the licensed physical therapist," Dunn writes in her letter. "Productivity goals that drive services toward economic incentives continue to be an issue that policymakers and professional associations have a joint responsibility to meet."

Much of the criticism of SNFs is centered on the use of ultrahigh therapy hours in billing practices, the APTA press release continued. CMS estimates this tactic provides facilities with an average of $66 a day in payments over costs. In the APTA letter to NYT, Dunn also describes APTA's collaborative efforts to address volume-based vs. value-based care, and how the association's "Integrity in Practice" campaign aims to provide PTs and PTAs with resources to support care based on patient need and clinical judgment.

"We are committed to making sure that the correct incentives are invoked in care delivery, in a manner that maintains our patients' trust," the letter states.

What are your thoughts about these developments and the issue of unethical billing practices? Share your comments below!

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The only surprise here is how long it has taken the APTA to get involved in this billing practice.  Ethical therapists maintain vigilance in an attempt to prevent over utilization while desperately trying to stay employed.  Some Rehab Dept. Managers are willing to "work with" their therapy staff and take a lower reimbursement level where other managers use other tactics such as moving the patient from therapist to therapist to get the RUG level.  The reimbursement system is flawed.  Self regulation will never work in a for profit based medical system.

Donna, PT - PTA, SNF October 8, 2015 9:59 PM
Puyallup WA

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