PT and PTA Reimbursements Are the Same
Jason Marketti made an excellent point last week when he responded to my post. He pointed out that in all but one state, reimbursement is the same for treatments provided by a PT or a PTA. On the surface, that makes sense. Our charges are treatment-based. If I perform gait training, I charge a gait. If Jason performs gait training, he also charges a gait. One gait treatment equals one gait charge.
But things are never so simple. In theory, PTs and PTAs are supposed to be providing equal treatments. That's kind of like saying all PTs provide similar treatments although we know this isn't the case. PTs and PTAs are taught the same treatment techniques. The application is a matter of skill and experience. Maybe a gait is a gait is a gait if the level of skill is the same. In that case, reimbursement for treatment rather than practitioner is appropriate. So what if someone is a clinical specialist? Is that the same treatment too?
Suppose we're talking an involved neurological patient who requires significant hands-on to walk. The gait training I provide would probably be different than that of someone who does less neuro than I do. My treatment would require more skill and be a result of experience. Compare that to a recent total-joint-replacement patient. The skill required for that treatment might simply be cuing for proper sequencing.
In this instance, I would provide a more skilled treatment. Almost anyone could walk with the total-joint patient. Because my treatment was more skilled, should it be reimbursed at a higher amount? Physicians do this all the time. Specialists are expensive. Even specialists who aren't board-certified are able to charge more. It would be easy enough to justify the charge if it was reserved for individuals who are clinical specialists and somehow demonstrate advanced skills. PTAs have their own recognition process and should be included as specialists.
Using skill to justify a different charge with an associated higher reimbursement makes sense. Simply having a DPT couldn't be justification. Doing that would equate a new graduate with an experienced therapist and negate the whole point of charging based on skill. Except for the world of direct access, having a DPT doesn't make much difference.
Imagine what our world would be like if this were in place. Therapists with certifications would be in higher demand. They would be valuable to employers because they can generate increased revenue. That might even equate to increased salaries. Interest in becoming a clinical specialist would also increase if it helped the employment picture. If employers were actually advertising for those skills, more people would want them.
Physical therapy, like every other profession, is hurting in the job market. Facilities have instituted cost-cutting measures that are directly affecting PTs. There are fewer jobs and salaries are flat. Raises aren't what they used to be. Job security has become a real concern. We, as a profession, need something to make us valuable to employers.
This would be an excellent adjunct to Vision 2020; the drive for specialization. The APTA has the resources to pressure insurers and employers in this direction. The PACs raise thousands and thousands of dollars to lobby lawmakers. Over time, it could happen and all PTs and PTAs would benefit. Maybe they'll get around to it after direct access, if they ever get direct access.
It seems like the energies and money of the APTA should be devoted to things that help the most therapists over the long haul. Maybe they'll revisit this issue when more of us are out of work, or not working enough or overqualified for jobs we won't be hired for.