This letter was sent to a contact at the APTA on September 21, 2009.
This letter is intended to initiate a discussion and propose a course of action that is in the best interests of Medicare physical therapy beneficiaries, the American healthcare system and physical therapists everywhere.
Why do Medicare auditors assess 'skilled therapy' as a criteria of payment? Because they lack an alternative measure of value.
Evidence based physical therapy, such as classification decision rules, have been shown to improve outcomes, decrease expensive testing, medication use and invasive procedures.
Can physical therapists avoid arbitrary, punitive Medicare audit denials by documenting the use of classification predictor variables and decision rules in the plan of care, daily notes and discharge?
Couldn't a commitment from Medicare to "immunize" physical therapists who document evidence based therapy from the 'skilled therapy' criteria of Medicare audits prompt a sea-change in clinician behavior to adopt evidence-based methods more quickly?
Medical doctors and legislators have sought a similar immunization, based on evidence based care, from the current administration as regards defensive medicine.
Why couldn't physical therapists, the only doctoring profession subject to time-based CPT codes, put forth similar argument as regards Medicare audits?
Thank you for your consideration,
Tim Richardson, PT