Hands-On News Sets the Record Straight on Physical Therapy Practice Billing

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Limited access to billing codes creates false appearances in physical therapy billing, leading to accusations of over-utilization and waste.

"Physical Therapists are in the forefront of helping people restore their lives."

A recent New York Times article uses financial data provided by Medicare to make negative inferences about physical therapy and physical therapy providers. Creswell and Gebeloff who authored the article specifically state: “One thing is certain: Physical therapy has become a Medicare gold mine”. The article can be found here: http://www.nytimes.com/2014/04/28/business/one-therapist-4-million-in-2012-medicare-billing.html?_r=0

The real problem is the lack of data to make a correct analysis of billing procedures. The article goes on to show that the lack of billing codes gives the erroneous impression of over-billing, when, in fact, the problem lies in the lack of information properly represent the diversity of treatments and treatment providers.

The article features Mr. Bakry, a Brooklyn based physical therapist who got paid over $4 Million by Medicare in 2012, yet it fails to make a thorough analysis of the overall Medicare data leading to misrepresentation of the real scene.

One of the points omitted by the article is that when physical therapist assistants treat Medicare patients, any billing they produce has to be billed under the provider number of the supervising physical therapist since physical therapist assistants cannot obtain their own provider number yet they can treat Medicare patients. In a New York Times interview Mr. Bakry stated that: “The care provided by all those therapists and assistants went under his Medicare billing number because he owned the practice.” Current law extends locum tenens only to doctors of medicine, osteopathy, dental surgery, podiatric medicine, optometry, and chiropractic. Because locum tenens arrangements are not currently granted to PTs in private practice, they are forced to risk gaps in patient care should they be absent, or must avoid such absences altogether. Reps Ben Ray Lujan (D-NM) and Gus Billirakis (R-FL), recently introduced legislation that seeks to expand the locum tenens arrangements to include PTs. According to the American Physical Therapy Association “This arrangement would allow a physical therapist to bring in another licensed physical therapist to treat Medicare patients and bill Medicare through the practice provider number when he or she is temporarily absent due to illness, pregnancy, vacation, or continuing medical education.”

The New York Times article further discusses the use of the same type of billing codes throughout most Medicare patients and makes the inference that patients do not receive individualized programs. Yet further analysis of the data points to the fact that many different types of treatments are been represented by the same billing procedure codes. Dr. Rizopoulos, a physical therapist from Queens NY, provides the example of patients who receive outpatient orthopedic physical therapy. “Almost 100% of these patients will receive some sort of exercise. Each of them will receive different types of exercises such a stretching, strengthening, isometric, isokinetic etc. No matter the type of exercise, the billing code available to use is always 97110 which represents therapeutic exercise. This creates a false impression that all patients received the same exact exercise which is not true.”

The article further failed to mention that a much larger number of medical professionals, other than physical therapists, who deal with similar type of patients have received millions of dollars from the Federal program. Over twenty-five orthopedists, twenty-three neurologists and over two hundred rheumatologists received payments exceeding $1 million. Only five physical therapists received more than one million dollars.

While payments to physical therapy due to utilization maybe on the rise this might be a good thing. A research study of over 400,000 Medicare patients published by Gellhorn in Spine Journal showed that the later the Medicare recipient received physical therapy the greater the odds of needing injections, surgery and more physician visits. Therefore, early access to physical therapy significantly reduces costly and more risky care.

Physical therapists have direct access in most states and patients can see them without seeing another physician. This can potentially save millions of dollars to most insurance carriers but not to Medicare. This is because Medicare does not extend the same direct access privileges to physical therapists. The lack of direct access to physical therapy for Medicare patients causes delay to care and a potential increase in the per episode cost.

Dr. Jeff Hathaway, President of the Physical Therapy Business Alliance released the following statement: "This NY Times article misrepresents the PT profession as a 'gold mine' by failing to point out that PT services are only about 1% of all Medicare expenditures. The PT profession is not a gold mine nor a waste of taxpayer dollars as they infer. Rather recent research is demonstrating that PT's who are caring for the Medicare patients ethically are actually saving the Medicare system significant dollars (20% or more). In addition, the private practice Physical Therapists depicted in this article (which also include Physician owned PT practices), make up only about 30% of the total Medicare PT expenditure - the 70% balance is paid to hospitals, rehab agencies, skilled nursing, home care etc... The proper perspective and current research paints a much more accurate picture of the value PT's bring to Medicare recipients versus the one portrayed in this article."

In response to the New York Times article Dr. Dimitrios Kostopoulos, past Co-Chair of the Alliance of Independent Physical Therapists and Board member of the Hellenic Medical Society of New York stated that, “It is irresponsible journalism to use numbers of a single provider without an in depth analysis to accuse an entire profession, especially when this profession has been in the forefront of helping people restore their lives.” Creswell and Gebeloff, authors of the article in the New York Times were invited to comment yet they never returned our e-mails.

Physical therapists have many more challenges surrounding the Medicare system. Limitations on the annual amount of care that can be provided to a Medicare patient, administrative delays in enrollment, revalidation and other procedures are important issues that today’s physical therapists have to deal with and navigate within a troubled health care system.

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Dan Bulger

Elan Etstein
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