I am excited to begin a monthly blog post for the Alliance for Physical Therapy Quality and Innovation (APTQI, or the Alliance). As some of you know, our Alliance came together around the topic of payment reform back in 2013. We wanted to ensure that our profession was best positioned for the changing healthcare environment we all live in. Our group followed the proposed payment reform plans and advocated for transparency of the process and a focus on rewarding quality clinical outcomes.
Since the beginning, the Alliance has advocated for payment reform measures that are rooted in evidence-based practice and are supported by outcomes data that proves the incredible value we give our patients. The biggest challenge we face in healthcare reform is how undervalued PT is to the rest of the medical field. The APTA and AOTA are currently working on the valuation of 10 of our primary codes that CMS has deemed “misvalued.” By misvalued, they mean over-valued. It is another potential hit to a profession that has taken too many over the last decade. If you add up MPPR, PQRS and FLR, we have significantly increased our cost to provide care and have taken a 12-15% payment reduction in the process. The problem is how CMS and payers are valuing physical therapy.
What if our profession was able to PROVE that $1.00 spent on physical therapy would save $1.25 in the total healthcare spend? We could change the dialogue that has happened over the last several years about the increasing amount spent on physical therapy. What dialogue is that? One of the reasons we have been a target for payment cuts is we have increased from 1.5% of the total Medicare spend to almost 2.5%. Physical therapy is still a very small amount of the spend, if you ask me, but the percentage increase is concerning to some.
Our future value is to show that physical therapy should be the provider of choice for musculoskeletal pain and dysfunction. We should be the “first in” provider that is utilized prior to surgery, imaging and other more invasive and expensive procedures and interventions. Additionally, physical therapy has been noted as a preferred approach for treating chronic pain disorders vs. the use of opioids. The Centers for Disease Control stated in its Guidelines for Prescribing Opioids for Chronic Pain in the United States – 2016, “The contextual evidence review found that many non-pharmacologic therapies, including physical therapy, weight loss for knee osteoarthritis, psychological therapies such as CBT (cognitive behavioral therapy), and certain interventional procedures can ameliorate chronic pain. The guidelines state, “There is high-quality evidence that exercise therapy (a prominent modality in physical therapy) for hip or knee osteoarthritis reduces pain and improves function immediately after treatment and that the improvements are sustained for at least 2-6 months. Previous guidelines have strongly recommended aerobic, aquatic, and/or resistance exercises for patients with osteoarthritis of the knee or hip. Exercise therapy also can help reduce pain and improve function in low back pain and can improve global well-being and physical function in fibromyalgia.”
The Alliance is currently developing a framework to provide clear data to demonstrate the value of physical therapy at the early stages of care to decrease the total cost of care. We are excited to be working collaboratively with more than a dozen different providers and some of the most respected names in our industry. John Childs, a member of the Alliance’s workgroup on innovative models states, “We know from several studies across numerous claims databases that a patient seeing a physical therapist early in the course of care has positive implications on outcomes and costs downstream, including lower utilization of drugs, advanced imaging, and surgery. In fact, the total cost of care for back pain is 50% lower when physical therapy is utilized early.” Providing additional data across the entire healthcare spend will be a key to advancing the early physical therapy intervention model. The current BCPI or CJR model for total hip and knee replacements are examples of how CMS is already looking towards total cost per episode vs. per provider.
The Alliance currently represents over 5,400 physical therapy clinics and nearly 20,000 therapists nationwide. We represent therapists in all 50 states and have a variety of practice settings including traditional outpatient, home health, sub acute rehab facilities, inpatient rehab hospitals and acute care hospitals. Our group attends all of the national APTA conferences, the AMA CPT Editorial Panel meetings, meets with CMS and congressional leadership to stay on the forefront of payment reform and policy in our profession. We have strong relationships with the APTA, AOTA and NATA in addition to other key professional organizations. For more information about the Alliance or to join our cause, please visit APTQI.com.