Medicare Compliance & Reimbursement

Here's why therapists still have hope for the future. Therapists hoping for direct access to rehab services for Medicare beneficiaries might have to take matters into their own hands.

The Medicare Payment Advisory Commission decided recently it will not advise Congress in January to change Medicare's requirement that beneficiaries receive a physician referral for physical therapy, citing lack of compelling information supporting such a change.

In response, the American Physical Therapy Association has suggested "a multi-site demonstration project that could provide the information MedPAC needs to accurately assess the impact of providing Medicare beneficiaries with direct access to physical therapists," says an APTA release.

The Senate had already approved such a demo project in an early version of the Medicare Modernization Act, notes APTA's Vice President of Government Affairs Dave Mason. "Given the fact that the Senate has approved the demo once, we hope we're starting from a fairly strong position," he tells MLR.

In the meantime, MedPAC's decision isn't cause for dismay, experts agree. The move doesn't mean direct access isn't part of the foreseeable future, asserts Ken Mailly with Mailly & Inglett Consulting in Wayne, NJ. It simply means direct access won't happen right now, he says.
 
And keep in mind that therapists have the advantage of having direct access for non-Medicare patients in most states, notes consultant and PT Lynn Steffes with Steffes & Associates in Milwaukee.

Providers should not simply wait for the federal government to make a change, Steffes urges. "The more we demonstrate that we're creating a cost savings, the more we'll be able to take those studies to the federal government," she says.

"We can deliver a demo project that has been done with a private payer, and that may strengthen our case more quickly" than waiting to convince Medicare to conduct its own demo, Steffes continues.
 
In other words, CMS might take note if providers currently involved in direct access with non-Medicare patients can prove the system is working for patients and achieving cost savings.

And therapists can often look to physicians to back up their argument that direct access is good for patients and providers alike, according to Steffes. "We believe physicians who work with competent therapists will welcome the opportunity to get patients from them," she says.

Physicians in Wisconsin are realizing that direct access isn't a threat to their business, she reports. To the contrary, docs are recognizing PT as a valuable referral source.