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Toni Talks about PT Today

The DPT May Affect Reimbursement

Published October 12, 2010 1:03 PM by Toni Patt

Last week I had a chance to visit with someone very knowledgeable about the PT world. We talked about the many changes in the profession over the years as well as what was yet to come. I enjoy talking to her because she has an unusual take on things. She caught me completely off guard when she said she expects insurances to stop reimbursing for treatments performed by PTs.

That makes a sick sort of sense. Insurances and other third-party payers are always looking for excuses to not pay. My unit is constantly getting denials over things like name spelled wrong, wrong gender, something left blank and wrong ICD code. All of those sound easy enough to fix and shouldn't be a problem. Insurance companies use them as excuses not to pay. Medicare is another payer likely to jump on that band wagon. It seems like every year Medicare pays for less and wants more paperwork for what it does reimburse.

The argument would be simple to make. The APTA is claiming the DPT is the new standard for therapists. I've yet to hear a formal statement comparing the PT to the DPT. I remember reading that individuals with PTs would be grandfathered in so they could continue to practice. I've also read statements from the APTA that a transitional DPT isn't required to continue to practice but is encouraged. That's a mixed message. It both endorses the PT and implies the DPT is better at the same time.

Payers aren't going to pay more for a treatment by a DPT, direct access or not. I can easily see them paying less or refusing to pay for treatments by PTs or requiring some sort of supervisory DPT role. A requirement like that will anger many people. It would also put many facilities at a disadvantage. Not everyone has a DPT on staff. No one has the time for whatever busy work complying with such a condition would require. All in all, this is not a good thing.

What would the PTs and MSPTs do if that were to come into effect? Even if grandfathered, they won't be able to work if payers refuse to reimburse for their work. The only ones not affected would be those who work at self-pay facilities and those that treat the uninsured. Those with certifications might fair a little better since a specialist certification is evidence of advanced practice skills. An exception might be made for those PTs.

Certainly such a decision could result in a large increase in enrollment to transitional DPT programs. Currently I don't think those programs are having problems with class size. But they would be hard pressed to accommodate a mass of applications. Acceptance would be no guarantee. Most of those programs are two to three years in length, which could translate into a couple years without work in the worst-case scenario.

I hope my friend is wrong and it doesn't come to that. Only reimbursing for DPTs would change the structure of how PT is delivered. It would also put many PTs in danger of being out of work and open a huge can of worms no one could control. Except for limiting reimbursement it makes no sense to do such a thing. The problem is payers aren't known for looking beyond the bottom line. If someone with a spreadsheet and the right credentials says it will save money, payers might just do it.


I had mentioned in an earlier blog about a progressive reimbursement based on educational level.  Perhaps this is will come to fruit after all.  Unfortunately all we can do is speculate at this point and first see what happens with the new MDS.  

Dean, don't forget insurance companies also end up paying for treatments by aides and not a licensed therapist.  I am sure insurance companies would not pay a cent if they knew how some clinics operate.  It is sad to some extent.  CNA's have a license to care for patients but an aide does not have to have a license to use US, TENS, etc, (even OT's in some states have to go through a rigorous training to operate these) yet reimbursement for an aides work is higher than a CNA's.  

Jason Marketti October 14, 2010 11:03 PM

If that were the case, why are insurers paying for treatments provided by PTAs?

Sounds like more "pinwheel eyes" to quote from one of your previous posts.

Dean Metz October 13, 2010 12:01 PM

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