Nearly 100 physical therapy private practice owners were in Washington, DC, on Tuesday, July 23rd, to meet with legislators on key issues related to Medicare and healthcare reform.
One of the top issues that Congress may actually make some progress with this session is the Sustainable Growth Rate (SGR), also known as the “doc fix.” You may remember those frantic emails and letters we send at the end of the year to avert a cut of 20-25% in Medicare payment rates. Every year, they pass a fix at the last minute to prevent this healthcare “fiscal cliff,” and allow patients who need it access to physical therapy care beyond the 14-16 visit annual limit.
How did this crazy cycle get started? Well, when the last major change to the Medicare program was included in the Balanced Budget Act of 1997, Medicare spending was tied to a percentage of GDP. As the economy faltered, this calculation now meant that healthcare providers would accept dramatic payment cuts.
The American Physical Therapy Association has put forth an alternative payment system for physical therapy services that would promote value over volume, but during the time of transition, health care providers would like to see a period of stable, predictable payment and the end to annual surprises, like the New Year’s Day budget deal that resulted in a 6-7% cut in payment for 2013.
As you know, our practice is small, and trying to plan for these payment variations, along with the dramatic increase in reporting and regulatory requirements over the past few years has been very challenging. My meetings with the staff of Sens. Durbin and Kirk, Congresswoman Schakowsky and Congressman Quigley were productive, and it was reassuring that they seemed to understand the issues well. However, my biggest concern was that there is very little attention to the effects of mass consolidation on anti-competitive behavior and preserving independent practice as a healthcare choice for patients.
Because small providers will need options to plan for the survival of their practices, we have also asked that physical therapists be added to the list of providers who can opt-out of the Medicare program. If the future system is geared towards large, consolidated systems providing the care, but you as the patient would like to pay out of pocket to see your preferred physical therapist, the Medicare program currently would view that arrangement as illegal.* You could see your doctor or optometrist and pay out of pocket, but not your physical therapist.