APTA: Vision 2020

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markelmarcel

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I think it would be beneficial for all of us here to discuss various aspects of Vision 2020, as it's going to directly affect us in the near future.

This morning I was reading up on the "Core Values" of professionalism in PT.

They've listed 7, in no particular order:

1. Accountability
The active acceptance of the responsibility for the diverse roles, obligations, and actions of the physical therapist including self-regulation and other behaviors that positively influence paitent/client outcomes, the profession and the health needs of society.

2. Altruism
Altruism is the primary regard for or devotion to the interest of patients/clients, thus assuming the fiduciary responsibility of placing the needs of the patient/client ahead of the physical therapist's self-interest.

3. Compassion/Caring
Compassion is the desire to identify with or sense something of another's experience; a precursor of caring. Caring is the concern, empathy, and consideration for the needs and values of others.

4. Excellence
Excellence is physical therapy practice that consistently uses current knowledge and theory while understanding personal limits, integrates judgment and the patient/client perspective, embraces advancement, challenges mediocrity, and works toward development of new knowledge.

5. Integrity
Steadfast adherence to high ethical principles or professional standards; truthfulness, fairness, doing what you say you will do, and "speaking forth" about why you do what you do.

6. Professional Duty
Professional duty is the commitment to meeting one's obligations to provide effective physical therapy services to individual patients/clients, to serve the profession, and to positively influence the health of society.

7. Social Responsibility
Social responsibility is the promotion of a mutual trust between the profession and the larger public that necessitates responding to societal needs for health nad wellness.



Thoughts on the Core Values? And any other topic dealing with Vision 2020?

I'd really like to get a good converation going to benefit all of us intellectually and also for those who will be going to interviews and will undoubtedly be asked questions regarding this vision!

Let the discussion begin!! :)

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APTA Vision Statement for Physical Therapy 2020

Physical therapy, by 2020, will be provided by physical therapists who are doctors of physical therapy and who may be board-certified specialists. Consumers will have direct access to physical therapists in all environments for patient/client management, prevention, and wellness services. Physical therapists will be practitioners of choice in patients'/clients' health networks and will hold all privileges of autonomous practice. Physical therapists may be assisted by physical therapist assistants who are educated and licensed to provide physical therapist directed and supervised components of interventions.
Guided by integrity, life-long learning, and a commitment to comprehensive and accessible health programs for all people, physical therapists and physical therapist assistants will render evidence-based services throughout the continuum of care and improve quality of life for society. They will provide culturally sensitive care distinguished by trust, respect, and an appreciation for individual differences. While fully availing themselves of new technologies, as well as basic and clinical research, physical therapists will continue to provide direct patient/client care. They will maintain active responsibility for the growth of the physical therapy profession and the health of the people it serves.
 
By: SHARON H. FITZGERALD
http://www.medicalnewsinc.com/physical-therapy-goals-for-2020-well-on-way-to-fruition-cms-85



Any optometrist will tell you that 20/20 vision means great eyesight, but when it comes to physical therapy, 2020 refers to a different goal.

Vision 2020, adopted by the American Physical Therapy Association (APTA) in 2000, sets out six broad goals for the profession to achieve by the year 2020, and with 13 years to go, the progress has been significant.

"We felt that 20 years was an appropriate horizon. We already had a mission, but we needed a vision of where we believe the association and the profession need to go," recalled Stephen M Levine, PT, DPT, MSHA, speaker of the APTA's House of Delegates, the highest policy-making body of the profession. "We recognized that we never as a profession had come to a consensus so that we could galvanize around a single point."


That single point is Vision 2020, which outlines six specific goals of the physical therapy profession:
  1. Autonomous practice, meaning physical therapists hold all privileges of other medical practices and may be assisted by PT assistants who are educated and licensed to provide physical therapist-directed and supervised care.
  2. Direct access, allowing physical therapists to legally treat patients without a referral from a medical doctor.
  3. Doctor of physical therapy, recognizing that the knowledge and training required in today's healthcare environment requires doctoral-level studies.
  4. Evidence-based practice, recognizing that changing standards require life-long study.
  5. Practitioner of choice, placing PT-patient relationships on par with other provider-patient relationships.
  6. Professionalism, setting out core values for the industry.
For two of those objectives, progress is measurable and dramatic: In 44 states, physical therapists now may see a patient without a physician referral, and about 88 percent of university physical therapy programs are doctoral programs. "It's very hard now to find a program that is not a doctoral program," Levine pointed out. "So someone who's interested now in a career in physical therapy would go four years as an undergraduate, and then a doctoral program." That's usually an additional three years.

Yet, Levine said APTA recognizes that "a transition" is required. "We did not believe that it was appropriate to wave a magic wand like other professions did — for instance, podiatrists used to be chiropodists and with a stroke of the wand all of a sudden they went from chiropodists to doctors of podiatric medicine," he noted. "We decided after doing a lot of research not to go in that direction, we had to ensure that the educational programs were there, that the universities accelerated their education to that level." Levine said APTA believed the goal was achievable by 2020. "In fact, the market has far exceeded that," he noted.

Levine pointed to himself as an example of a physical therapist "transitioning" with the profession. He graduated with a bachelor's degree in physical therapy in 1984 and later earned a master's in health administration. "But I went back to school to get my clinical doctorate, because I believe absolutely there are things that are taught now, for instance in the areas of radiology and pharmacology, that were not part of physical therapist education back in the 1980s. To have that structured, didactic knowledge, I felt it was critical to go back," he admitted.

While all but six states now allow a PT to see a patient without a medical referral, Levine acknowledged that third-party payers are slower to adopt the concept.

"Insurance companies many times still believe the physician is the gatekeeper. Although you can legally provide care in those states, oftentimes the third-party payers will not pay for that care," Levine said. "So the APTA is very, very focused on working with third-party payers to try to get them to understand that the requirement for physician referral provides no medical necessity issues. In fact, it actually causes the insurance company greater costs because it's requiring the patient to go see a physician and incur a visit to that physician and a fee for that visit when there's no evidence that shows that that visit provides anything necessary for the physical therapist to appropriately evaluate and manage the patient."

Levine pointed to the professionalism principle of the Vision as critical to the career of physical therapy. "Just because a group of people are deemed ‘professionals' by society doesn't mean they have, maintain or promote all of the qualities of professionalism," he said. "We have an entire set of core values for professionalism that deal with various tenets that we, in fact, believe identify true professionalism." Those core values include accountability, altruism, compassion and caring, excellence, integrity, professional duty and social responsibility. "There is a whole conceptual framework of professionalism that I believe is embedded in the entire vision. I would love to see all professional groups really focus toward aspects of professionalism as we've defined them," he said.

Levine acknowledged that "it's a little bit hard to measure some of these and easier to measure others" when it comes to Vision 2020's six goals, but he added, "I'll tell you without a doubt that, in my opinion as both a member of the board of directors and speaker of the House, the Vision is probably the single-most significant thing that we've accomplished in the last decade to really galvanize all of our activities and our goals and objectives to achieving what you see written in the Vision statement. I think it's been extremely effective. I believe that we will reach the tenets of Vision 2020 before that year, and then we'll be moving on to the vision for physical therapy in 2040."

Levine sold his private physical-therapy practice nearly three years, and now is a partner in the Rehabilitation Consulting & Resource Institute in Plantation, Fla. The Institute works with therapists in practice management and reimbursement and with the federal government in areas of fraud and abuse, over-utilization and medical necessity.
 
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This is what I've been looking for ever since I got my interview invites.

My opinion, I like the way Vsion 2020 is progressing and the way the profession is headed. The big deal is that the insurance companies is the key to getting direct access out there to patients. Patients still need a physicians referral for most to go to a PT because of insurance. If not, then direct access will not progress because most aren't willing to pay out of pocket to see a PT directly.

Another thing is, that IF insurance does start paying, there needs to be some type of campaign to inform the general public that you now can got directly to a PT more body movement issues and injuries. Most of the average joes in the world will go straight to a doctor for an ankle sprain. With the DPT and the training we get, we should be able to diagnose, treat and prevent also. After all, remember, we need to do what is best for the consumer. So....would it make sense for a patient to go to an MD when they know they can come straight to a PT, but won't do it because of insurance coverage

What else is there that we can converse on keep them coming. What I said may be wrong, so please educate me if I am wrong so I won't look dumb on my interviews.
 
Also, if insurance companies agree to pay for direct care visits to PTs, how does that play out money wise? Will people have to pay more for their insurance? Will there be a co-pay, much like a regular doctor visit, emergency room visit, etc?

How does this effect our health care system?
 
Its better to pay just one co-pay, instead of two co-pays, if they have to get a referal everytime. I dont think rates should increase either, insurance companies need to know that physical therapy is powerful and necessary treatment to get workers back on the job. I've never been to a chiro but are there co-pays for chiros?

If they do have direct access to PT, I say there shouldn't be a co-pay unless we can diagnose, treat the injury. The insurance company will just pay for the eval so PTs don't lose money for that time slot the patient takes and the PT would still have to refer them to an MD if they can't diagnose or treat. So it really defeats the purpose of having direct access to a PT.
 
What about autonomy? Do you think PTs can give meds, or at least to recommend NSAIDS.

In my opinion, to recommend taking tylenol should be fine. I dont think we should be able to prescribe anything, because that is a lot more training needed for that.
 
I've never been to a chiro but are there co-pays for chiros?

Yes, there are co-pays... I don't think every plan has one, but I do... I get 10 visits per calendar year for a $15 copay. Also, some chiros will try to bill themselves out as "rehab"... which, I think there is already a co-pay for... (out-patient, I believe).

If they do have direct access to PT, I say there shouldn't be a co-pay unless we can diagnose, treat the injury. The insurance company will just pay for the eval so PTs don't lose money for that time slot the patient takes and the PT would still have to refer them to an MD if they can't diagnose or treat. So it really defeats the purpose of having direct access to a PT.
The only thing a co-pay does is lessen the cost of the bill on the patient. For example, since I just said about the chiropractor, when I go to my chiro, I pay $15 instead of $40, thanks to my co-pay.

I doubt that PT's would ever be fully covered by insurance, because not even a family doctor visit is under some plans... I don't know a lot about insurance companies, other than they are a pain in the ass ;)
 
The only thing a co-pay does is lessen the cost of the bill on the patient. For example, since I just said about the chiropractor, when I go to my chiro, I pay $15 instead of $40, thanks to my co-pay.

Gotcha...I am definitely misinformed about insurance stuff.
 
Gotcha...I am definitely misinformed about insurance stuff.

I'm pretty sure everyone is, because it's so darn confusing!!

And yes, I think we should be able to recommend over-the-counter things... Heck, I'm a Spinning instructor and I advise some of my students when they have complaints... Glucosomine (sp?), calcium supplement, multi-vitamin, fish oil, etc.

That's just more common sense to me. Now prescribing something that requires a prescription? No. I'm not an MD or a Pharmacist.

Now, granted I'm sure that Mr. Jones who has a knee replacement is going to be referred to PT, so his meds would already be perscribed by his doctor.

For the most part, with direct access, my opinion is that the vast amount of people will not have severe problems. I think it'll be more or less "bumps and brusies" types of things.

Now that gets me to thinking about people who are always convinced something is wrong with them... having direct access to a PT could be problematic for those people who are just complainers. Yes, better safe than sorry, but seeing as PT's usually have busy schedules to begin with, they can't be wasting their time on those who don't really have an issue... Especially since PT's are the only ones able to diagnose... you can't just send trouble-maker over to your PTA and ask them to figure out if the person's complaint is legit. The PT is going to have to take time out for that, and then that takes time away from those who actually have legitimate problems/need therapy.
 
Now that gets me to thinking about people who are always convinced something is wrong with them... having direct access to a PT could be problematic for those people who are just complainers. Yes, better safe than sorry, but seeing as PT's usually have busy schedules to begin with, they can't be wasting their time on those who don't really have an issue... Especially since PT's are the only ones able to diagnose... you can't just send trouble-maker over to your PTA and ask them to figure out if the person's complaint is legit. The PT is going to have to take time out for that, and then that takes time away from those who actually have legitimate problems/need therapy.

Hmmm...I never thought about that until you brought it up. Hypochondriacs would be a problem, then they may blame a PT if their problems persist, etc. True about the bumps and bruises, but then the public needs to be informed so they are aware of the scope of PT, so not everyone will be coming to a PT.

Will malpractice insurance increase?
 
Do you agree with the move from MPT to DPT? There are some people on here that don't agree with it (specifically the cost of a DPT vs. MPT). But there are some that do agree with it.

My opinion: I agree with the move. If APTA wants autonomy and more responsibilities we need more training.

Another thing. Do you think we should be able to order x-rays, etc. I know PTs in the military can. This is more of insurance reimbursing it isn't it. Which is also part of my plan on repaying loans, working for the Navy as a PT, or a VA hospital.

Does or will Obamacare affect PT in some ways? Im not too current on Obama's plan for healthcare, other than he wants it free.
 
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A PT that I shadowed with told me this- If someone came in asking for a job with his clinic he wouldn't care if they had a bachelor's, a masters or a doctorate, as long as they knew what they were doing.

I do think it's fair for PT's to get the DPT due to creditload. Anyone else who does this many credits post-bachelor's would be well on their way to a doctorate (thinking PhD wise) and it wasn't fair that PT's were doing all that coursework and only getting a MPT.

The only thing is, now DPT isn't going to have a "special meaning". It's not going to mean that you are more qualified than someone else. I do think it's interesting that the ENTRY LEVEL position is going to be a clinical doctorate... How are we to continue our education if we are already at the peak when we first start? (Not including certifications for specialization work).

But, all in all, I think it's a good move to make so that PTs can have more authority and whatnot.

As far as rights to schedule x-rays or even MRIs and cat-scans, I think that it should be a consideration. What good will it do if the person off the street comes in and you can tell they have some type of injury, but without an x-ray or any other test you can't be sure. Thus, you can't be sure, can't diagnose, can't treat.

So, the patient comes to the PT so they don't have to go through the MD and then we have to send them back to the MD anyway? And, then, if the MD so chooses, they could send "my" patient to another PT facility.

Someone had another thread on Obamacare and PT on here-- http://forums.studentdoctor.net/showthread.php?t=711571

This is also a good article I just found on Medicare B being very similar to what Obamacare and PT could be like:
http://www.sodahead.com/united-stat...-preview-of-life-under-obamacare/blog-275133/
 
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Someone had another thread on Obamacare and PT on here-- http://forums.studentdoctor.net/showthread.php?t=711571

This is also a good article I just found on Medicare B being very similar to what Obamacare and PT could be like:
http://www.sodahead.com/united-stat...-preview-of-life-under-obamacare/blog-275133/

My eyes hurt so much. This is so confusing. I think I got a little bit from it. At least Obamacare is going to study direct access. If it will be beneficial or not.
 
My eyes hurt so much. This is so confusing. I think I got a little bit from it. At least Obamacare is going to study direct access. If it will be beneficial or not.

Yeah after I read through all that stuff, I was like... holy crap... Am I screwing myself over? I got out of education because there were no jobs, I'd like to go into healthcare because there ARE jobs... and this is just downright scary.


PS- I'm trying to compile a word document of PT interview questions, when I finish it, do you want a copy?

Since, apparently we are the only 2 people that seem to want to educate ourselves on our future, haha. ;) (Or at least the only 2 who want to talk about it)
 
this is just downright scary.


PS- I'm trying to compile a word document of PT interview questions, when I finish it, do you want a copy?

I know, especially about the loans. And oh yes, I would like a copy of those questions please.
 
I come here because I am not only afraid but to be totally honest, uneducated about how the PT field will change due to Obamacare. According to the PTs I work with it essentially will be a bad thing. If anyone could attempt to shed some light on this issue I would greatly appreciate it! I'm wondering if going to PT school and accruing debt of about 120 K is a semi-sane idea with this health care reform.
 
I'm reading through all this and it's all so confusing making my head spin/eyes hurt but at the same time it's not. I support the transition of MPT to DPT or some kind of change in general. We need changes to move forward and if they turn out bad, hopefully we can take it and be able to use it to make it better.

I try not to think about loans for now since for me, I feel like it's important to get into school/do what you want and finish strong in those 3 years. I don't want the issue of money to control my whole life because that sucks. We'll find some way to pay it off, if not slowly but surely we will get rid of them :]

markelmarcel: Can I get a copy of the interview questions too if you don't mind? I tend to get nervous in interviews even though I know my stuff I blank out at times
 
I'm wondering if going to PT school and accruing debt of about 120 K is a semi-sane idea with this health care reform.

I was thinking about this last night actually. I look at it as, if I accrue 120K in debt and pay 1k a month thats only 10 yrs to pay back. I thought it would take longer than that. And honestly, Ive been living off 30k a year with my job now and once I graduate from PT program, I will probably make double that. So if I decide to live for 30K a year for 4 years after I graduate, I can pay off my loans in 4 years instead of 10. So the loans are really the least of our concerns. Yeah, yeah, I didn't add the interest rates on that, but you see what I mean. Say that you only accrue 90K in debt. Its all good.
 
Thanks Jbizzle, that calms my nerves tremendously! I guess living on 30 grand a year for 4 or so years after PT school is not so bad considering I've been living off like 10 grand since I've been in school (broke ass college student lol). I'm just worried that the new healthcare that is planned to go into effect is going to cause PTs to end up like Chiropractors, and that is NOT good. My uncle is a Chiropractor and 15 years ago was rolling in the cash. He has multiple practices and had several MDs working under him. However, his business has been crippled because insurance companies no longer cover chiropractic visits. He is only the verge of bankruptcy. I'm just concerned that the Obamacare will essentially deem PT unnecessary and cause patients to skip PT treatments due to high co-pays or not PT coverage at all. What do you guys think? Also, as far as the MPT to DPT transition, I am impartial to it. I like the sound of having my doctorate (slightly fickle, I know) but I think it might be a little superfluous since, at least to my knowledge, having the DPT doesn't give you an advantage over the MPT. Also, could I possibly get a copy of the questions you guys came up with for your interviews? I honestly just want to look at it and get a strong feel for what I should be thinking about. All of it is SO damn confusing and I get headaches just attempting to sort through all the garbage I find online.
 
I come here because I am not only afraid but to be totally honest, uneducated about how the PT field will change due to Obamacare. QUOTE]

Alright, now were talking. More people!

So from what I am getting from the articles, Medicare has caps on how much PT a patient can have in a given year, which is obviously not a good thing. The author of article says it all, it's not right that when a patient comes in and has medicare and the patient already used up most of what is allotted to her, what will Physical Therapist do in this situation. (may be a possible essay question on interview day)


Do private insurance companies (i.e. Blue cross/Blue shield, Aetna, etc.) also have these caps?
 
Jbizzle, the answer to your question is YES! The other insurance companies all have caps on how much they pay for a patients treatment and they can differ tremendously. After talking with one of the PTs I work with about this very subject today, I got that basically the Obamacare plan is going to lower what medicare pays for its patients PT treatments. This is bad news because all other insurance companies base their cap off of Medicare. So if medicare lowers its payment, the other insurance companies follow suit, which means the same amount of work for PTs and less money coming in. I think what may happen is PTs will be forced to see more patients at once, reducing the quality of treatment for patients.
 
As an american citizen (but I was born in the philippines), I know that america was born with hard working individuals. Carpenters, day laborers, and to this day we still need these laborers for our country to survive.

Insurance companies, politicians, etc need to understand that PT is necessary for a person to heal and to be able to function normally again so THEY CAN GET BACK TO WORK. And from my experience, I saw plenty of patients in PT due to workers comp, which is where the laborers come in. The truckers who sit for 10 hours a day, the construction workers with bad hips, knees, elbows.
 
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Jbizzle, the answer to your question is YES! The other insurance companies all have caps on how much they pay for a patients treatment and they can differ tremendously. After talking with one of the PTs I work with about this very subject today, I got that basically the Obamacare plan is going to lower what medicare pays for its patients PT treatments. This is bad news because all other insurance companies base their cap off of Medicare. So if medicare lowers its payment, the other insurance companies follow suit, which means the same amount of work for PTs and less money coming in. I think what may happen is PTs will be forced to see more patients at once, reducing the quality of treatment for patients.

Well then that definitely will suck and sheds a lot of light on this issue. THANK YOU!!!!

BTW, bringing this up on interviews will be good. They may ask what the current issues are in PT.
 
http://www.beckershospitalreview.co...011-medicare-physician-fee-schedulerules.html

"Automatic pay cut raised to 29 percent in 2011. CMS proposes a negative 6.1% update for 2011 under the sustainable growth rate formula, bringing the automatic cut from 21.3 percent this year to 29 percent. This involves a proposed 0.921 “rescaling factor”/ budget neutrality adjustment. In its most recent action on this matter, Congress delayed the pay cut to Dec. 1, 2010."

"Less pay for outpatient therapy services. CMS proposes to establish a multiple procedure payment reduction policy for certain outpatient therapy services reimbursed under Medicare Part B, applying a 50 percent payment reduction to the practice expense component of the second and subsequent therapy services for certain multiple therapy services furnished to a single patient in a single day."

http://www.nytimes.com/2009/05/13/us/politics/13health.html

"the financial condition of the two largest federal benefit programs, Medicare and Social Security, had deteriorated, in part because of the recession.

As a result, the administration said, the Medicare fund that pays hospital bills for older Americans is expected to run out of money in 2017, two years sooner than projected last year. The Social Security trust fund will be exhausted in 2037, four years earlier than predicted, it said."

I've heard the estimation to be around a 20 percent decrease in overall reimbursement from Medicare Part B services. Since this is what is paying for outpatient services, this looks to have a significant impact on private-practice PT clinics. One thing that can be extrapolated from this is that the trend has been decreasing payments to providers. So one very big current issue is that in 2017 there might be no money left to pay you for therapy services. If there is you might be getting paid a whole lot less than PTs are now for doing the same service. Since PT is considered an ancillary service presently, when services looked to be cut due to necessity it could be first on the chopping block.

While it's good to know the issues of PT for your interview. I'd say it's a thousand times more important to know the issues before you decide to put yourself into a position of $120k+ debt.
 
This is so horribly complicated. I sincerely hope Republicans gain the majority again this coming election so they get repeal Obamacare ASAP. It's scary to think about. I know my family in Canada has even said universal health care sounds nice, but it doesn't work.
 
also based upon what ICD-9 code you classify the patients Physical Therapy diagnosis you will receive cap exemption on medicare patients allowing them to be seen as much as the PT/physician deem necessary. What this means is you may determine to diagnose under one of these exemptions in order to treat the patient beyond the cap which will provide more care and more reimbursement.

http://www.parkphysicaltherapy.com/newsletter.html

here is a list of these codes- ex: if your medicare patient has LBP due to OA, you place them under OA which is cap exempt while LBP is not.
 
And from my experience, I saw plenty of patients in PT due to workers comp, which is where the laborers come in. The truckers who sit for 10 hours a day, the construction workers with bad hips, knees, elbows.

A majority of the patients that I came into contact were also worker's comp people and some of them were having major problems with their worker's comp benefits... running out of "money" before their treatment was up, leaving the PT scrambling for ways to fudge the system to get the person to be able to stay longer to get fully healed. What. a. mess.

don't panic, supply and demand determines the well being of any profession. Outpatient PT may require more pta's and aides working with patients so DPT's can see more as time goes on- this has happened in medicine as well (PA's, DNP's, nurses). Regardless where there is need the grass is green.

I've heard that the market is now flooded with nurses, but I don't know any numbers or details, other than my aunt is a LPN, has been for many, many years, and she said she is in jeopardy of losing her job, as others are at the hospital in my town. Lots of debt and not enough money to keep people around.



Also- What I've compiled so far as potential interview questions can be found on my skydrive-- http://cid-3ed9b297c84d2ef9.office.live.com/browse.aspx/.Public; file is called "Practice PT Questions"
 
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"Automatic pay cut raised to 29 percent in 2011. CMS proposes a negative 6.1% update for 2011 under the sustainable growth rate formula, bringing the automatic cut from 21.3 percent this year to 29 percent. This involves a proposed 0.921 "rescaling factor"/ budget neutrality adjustment. In its most recent action on this matter, Congress delayed the pay cut to Dec. 1, 2010."

"Less pay for outpatient therapy services. CMS proposes to establish a multiple procedure payment reduction policy for certain outpatient therapy services reimbursed under Medicare Part B, applying a 50 percent payment reduction to the practice expense component of the second and subsequent therapy services for certain multiple therapy services furnished to a single patient in a single day."


Can someone put this in simpler terms? I think I understand, but I want to be sure... Ok, I don't really get it... An automatic pay cut for what? For who?

And am I to understand that "subsequent therapy services for certain multiple..... to a single patient in a single day." Is that meaning if a patient comes for physical and occupational therapy in the same day whoever they go to second, third, etc would get less money because they were in a previous therapy situation?

This is ludacris.
 
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I've heard that the market is now flooded with nurses, but I don't know any numbers or details, other than my aunt is a LPN, has been for many, many years, and she said she is in jeopardy of losing her job, as others are at the hospital in my town. Lots of debt and not enough money to keep people around.

Here in Tallahassee, FL, my sister is an RN and hospitals are always calling her to work some PRN away from the main hospital she works at. So it does depend on location as well. I do know that they have stopped the importing of RNs from the Philippines, as well as PTs (especially with that cheating scandal)

Anyway, mtm34 thanks for that info. I learn more and more evryday. This would be another ethical question for an essay: If a patient used up all their coverage but still needs care how would you handle that situation. So there would be loopholes a PT can take, but would that be ethical?
 
surely, within limits though. If you get a pt with a plantar fasciitis it would be a stretch but for the appropriate client it is very reasonable and ethical- you are not billing for services that aren't being done and you'll be helping someone who needs those visits. My clinical instructor was very angry at himself for not coding a medicare patient under one of these codes when they could of most definitely benefited from more therapy. Just like anything you pick and choose.

As far nursing goes it just isn't comparable to PT anymore, nursing is a 2 year degree and a DPT takes 7. There is no way to 'flood' the market with PT's just like there is no way to flood the market with MD's or PharmDs ect. The way to counterbalance demand is to increase assistance thus production.
 
How does PT fare when Medicare goes bankrupt? With a geriatric population on a fixed income in an environment of increasing costs of living, how are they going to pay for services? Has there been any action by government officials to make this program sustainable? If so why is it still projected after our Affordable Care Act that this program will go away before 2020? In the outpatient environment, copays have been increasing significantly. When people can't pay for services it decreases the demand.

As for overflooding the market, take this response from the physical therapist Donna Miller,,,

"As a physical therapist, I've always loved my career but with changes in recent years, I'm also glad I'm in the latter days of my career rather than just starting out. The education required is becoming progressively more expensive and time required for your education is progressively growing while the reimbursement per patient is progressively heading downward. The market will also be flooded in a few short years and there is progressive loss of market share to occupations with less education and training such as massage therapists, personal trainers, athletic trainers, Pilates trainers, yoga teachers, etc. Do you see a problem looming and a "bubble" developing here? Paperwork demands are growing as well. Medicare is proposing a 17 page form be filled out on EVERY PATIENT. I spend every weeknight and weekend finishing notes, writing reports, etc. While 5 years ago, I strongly recommended it as a career, I am no longer doing so because of the changes."

http://money.cnn.com/magazines/moneymag/bestjobs/2009/snapshots/7.html

I think she missed Chiropractors as well. Is the 6/7+ years of education plus educational costs going to provide the competitive advantage to charge two or three times as much as these other providers? Or is the price to obtain such an education overinflated for what the market will allow prices to be set at? How do you feel owing over 100k and making 30k as an honest, evidence-based DPT?
 
There is no way to 'flood' the market with PT's just like there is no way to flood the market with MD's or PharmDs ect. The way to counterbalance demand is to increase assistance thus production.


So, is it APTA (or whoever)'s idea that by making the entry level position a DPT that the market would not become saturated, because we are making the schooling more competitive like MD's?

I used to be all for the DPT... I thought it was great, but now... seeing that an entry-level position is a clinical doctorate kind of makes me wonder how continuing education will be handled. Plus, I'll have this clinical doctorate and still have to get an additional doctorate (PhD) if I want to research/teach? How do I get into a PhD program without a master's? Will a school allow DPT's to enter PhD programs if they only have a DPT and no Master's??

As for overflooding the market, take this response from the physical therapist Donna Miller,,,

"As a physical therapist, I've always loved my career but with changes in recent years, I'm also glad I'm in the latter days of my career rather than just starting out. The education required is becoming progressively more expensive and time required for your education is progressively growing while the reimbursement per patient is progressively heading downward. The market will also be flooded in a few short years and there is progressive loss of market share to occupations with less education and training such as massage therapists, personal trainers, athletic trainers, Pilates trainers, yoga teachers, etc. Do you see a problem looming and a "bubble" developing here? Paperwork demands are growing as well. Medicare is proposing a 17 page form be filled out on EVERY PATIENT. I spend every weeknight and weekend finishing notes, writing reports, etc. While 5 years ago, I strongly recommended it as a career, I am no longer doing so because of the changes."

http://money.cnn.com/magazines/moneymag/bestjobs/2009/snapshots/7.html

There are LOTS of other options besides therapy. I, for one, will admit that I go to a chiropractor because it's cheaper, and it helps. Yoga has also helped me tremendously. The only difference is, with a physical therapist you are getting a legit person who knows what they are doing. The fitness market is so overrun with anyone who "feels" like teaching something that it's a toss up whether you get someone who has sound knowledge in what they are teaching (yoga teachers who are REAL undergo at least 200 hours of training, and lots of times way more than that, to fully understand all aspects of yoga) or if it's someone that just pretends like they know what they are doing because "the burn feels so good".
 
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You can still go for a Phd with a DPT. There are PTs doing this. I think the DPT has created a lot of confusion regarding what it is. If you haven't figured out yet, there is much contention regarding it's existence within the PT profession. There are good arguments for it as well as against it.

At the present time, the DPT offers almost zero clinical benefit in practice over a BsPT or MPT. That is the reality. It has zero reflection on what PTs get paid. As the costs to obtain the degree have increased, the pay has been decreasing due to lack of funds in Medicare. Like I've stated previously, I believe it's only a matter of time before the axe falls and PT providers will be getting less, not more, than they are now despite the increasing educational requirements. Private insurers have historically have used medicare as a guideline for what they will reimburse. So cuts in Medicare will most likely effect what private insurers pay. With everyone required to purchase health insurance, insurance will further dictate what PTs get paid.
 
You can still go for a Phd with a DPT. There are PTs doing this. I think the DPT has created a lot of confusion regarding what it is. If you haven't figured out yet, there is much contention regarding it's existence within the PT profession. There are good arguments for it as well as against it.

At the present time, the DPT offers almost zero clinical benefit in practice over a BsPT or MPT. That is the reality. It has zero reflection on what PTs get paid. As the costs to obtain the degree have increased, the pay has been decreasing due to lack of funds in Medicare. Like I've stated previously, I believe it's only a matter of time before the axe falls and PT providers will be getting less, not more, than they are now despite the increasing educational requirements. Private insurers have historically have used medicare as a guideline for what they will reimburse. So cuts in Medicare will most likely effect what private insurers pay. With everyone required to purchase health insurance, insurance will further dictate what PTs get paid.

Oh, I know that DPT's can get PhD's... I'm just wondering, can they get into a PhD program without a master's program... Just a side-thought.

Anyway-- I agree with your entire comment. The DPT is no better than a BsPT or an MPT. A PT that I shadowed with told me that if someone came in for a job he wouldn't care what degree they had (BS, MS or DPT) because he'd want to know what their prior experience was... I think it's unfair that that the time spent into schooling has increased, but, as you said, experience wise the DPT is no better than the BsPT.

To me, I feel like out-patient practices are going to be be at a bigger risk with this whole health care mess... They make their money based on what patients come into them alone. What about PTs that work in hospitals? How will medicare and insurance effect those PTs that work in hospital settings? Are we going to see the same reprecussions, but at different levels? I don't know whether to think that working for a hospital would be "safer" than working in an out-patient clinic.

I mean, we all know that PTs are definitely needed... it's just, how much are we going to be worth?

Totally scary...
 
The median salary for a PT in the US is in the mid 70s, there is an expected 30% increase in the need for PT's and that demand will not be met due to the increase in education. You can be sure that figure is going no where but up. PT is extremely valuable- the option to keep people out of the OR is a HUGE money saver, look up how much different surgeries cost and you'll see that PT is a very cheap and SAFE alternative. PTs can manage the whole patient including all the comorbitities that come along with them which is why the future for PT is so bright.
 
I know the value and effectiveness of PT. The question is does congress and third-party payors. Their behavior being to decrease reimbursement, increasing copays, and implementing arbitrary therapy caps suggests to me they don't. Demand for services is limited to the ability to pay for those services, unless you want to work for free. If medicare ceases to exist and the trends of increasing copays/decreasing third-party payment from private payers continues, what is the true demand for PT services?

What determines true demand is who shows up for therapy regardless of how many people could use it due to demographics. The bls hasn't taken these trends into account and is looking at the current model and demographics. Look to the chiropractic model where they are currently recieving 20 or so dollars from insurance. The honest ones make around 30k or so. The business model is unsustainable and they have the highest student loan default rate of all health providers. Would it be the same for PT?

Here is a blog post from the veteran PT Ian Ross a while back.

"In my state, Medicare is the major player. Therefore, the future health of PT, as it is currently structured, is directly linked to the health of Federal budgets, and by extension, to that of the Federal Government itself. The prognosis for economic recovery looks pretty poor, no matter what Mr. Obama does. His policy of borrowing more to spend more to rise out of a pit formed by borrowing too much seems patently unreasonable. The suggestion that LOWER payments to beneficiaries will improved medical care makes my personal balance sheets look dangerously unsustainable. What the suggestion portends to folks starting out with 120K of educational debt must be frightening.

A reasonable economic diagnosis, given that the Federal budget deficit is approaching 20% of GDP, among other things, is analogous, in terms we health care folks understand, to septic multi-system shock, with a very, very poor prognosis for meaningful recovery.
Because the PT profession's very soul is functionally intertwined with Medicare, due to decisions made in the mid 1960's to embrace that payor's largess, it may well be that professional apoptosis is fully underway. Medicare made PT viable in its current guise. Dr. Saulk and his Polio vaccine ended our profession's prior model; instead of doing the hard work to define and justify an independently sustainable model in that period of professional termoil, we took the easy route and built our current edifice on a foundation of free-flowing government funds. Those funds are gone. It's time, now, to, if possible, fashion our profession so that it can, in its future, stand in spite, and not because, of its funding sources. The DPT isn't the big fight: survival is. Re-branding may be mere window dressing.

We have to define ourselves to be necessary, rather than to be reimbursable. Our value to society and role in society must be defined in such a way that others are compelled to spend resources on our skills. Unless we do so, we will disappear from the marketplace. We have yet to define ourselves as necessary: we are still an optional luxury existing and defined principally to consume government funds (Medicare). And, by the way, if we price ourselves too high (DPT, anyone??; I know that train's already left the station.) it won't matter a whit how necessary we think we are. Polio's gone; so too the PT of that era. Medicare's now gone, and with it should PT as we've known it go.

What will the future hold, we ask? Something different than today: smaller maybe; more brains and less brawn; more telling how and why than doing to and doing for; more expertise about and less counting reps; more giving permission to and less doing for; more advice and less telling; more hands off than hands on. It's going to be rough, very rough, in, at least, the short run. There'll likely be no inheritance in my kid's future, but, will there be PT? We'll see. People still fall out of trees and crash their cars, have movement dysfunctions and structural failures. We can help. Will they pay? We'll see. Tim Richardson's on the right track. "

http://movingforwardapta.blogspot.com/2009/03/is-obama-health-plan-good-business.html
 
^very very scary. WTF! What can we do? Who here knows what APTA is doing with this? Is there anything we can do?

Since I want to become a PT very badly, I've decided to take becoming a PT one step at a time. I tell myself I have to get accepted first. However, I start thinking about the loans I will accrue. After readin some post, I get bummed out a bit about the numbers and take some time to realize that the debt is not as bad (as I noted earlier) as I thought and can be paid off and be able to live reasonably. So my focus turns back to getting accepted first. Then I start thinking about the future of PT. I read post like this that scare me to even pursue PT. And now I'm stuck, because instead of focusing on taking it one step at a time to get accepted first, I'm here thinking about the decision of becoming a PT, before I even get accepted.

Is there anything I (we) can do?
 
Ok nevermind, my focus has shifted back. I will worry about getting accepted first and then IF I get accepted, that's when I'll start worrying if I still want to pursue this.
 
We have to define ourselves to be necessary, rather than to be reimbursable. Our value to society and role in society must be defined in such a way that others are compelled to spend resources on our skills. Unless we do so, we will disappear from the marketplace. We have yet to define ourselves as necessary: we are still an optional luxury existing and defined principally to consume government funds (Medicare).

PTs understand that we are necessary, and to a large degree I think that doctors and the healthcare field in general see a need for PTs. However, like the author also says- does the government/Medicare see us as necessary? As a profession we have to be necessary. We have to prove why we are the best route, why we know the most and why we need money. Is that my job personally? No, it's not. I think that is APTA and any other PT Association out there's job. There are people that run these education programs and run the profession and they need to start fighting. APTA seems like they are attempting to get some footing on the situation, but the point is- our economy sucks, our country has no money and healthcare is going down the tubes. PTs are going to be affected just like everyone else.


Since I want to become a PT very badly, I've decided to take becoming a PT one step at a time. I tell myself I have to get accepted first. However, I start thinking about the loans I will accrue. After readin some post, I get bummed out a bit about the numbers and take some time to realize that the debt is not as bad (as I noted earlier) as I thought and can be paid off and be able to live reasonably. So my focus turns back to getting accepted first. Then I start thinking about the future of PT. I read post like this that scare me to even pursue PT. And now I'm stuck, because instead of focusing on taking it one step at a time to get accepted first, I'm here thinking about the decision of becoming a PT, before I even get accepted.

Is there anything I (we) can do?

I get really nervous too... I decided that I wanted out of education because there weren't any jobs (in the area I am willing to live in/travel to) and I chose PT because of my increased interest in the health and fitness field and the fact that I love socializing and helping people. I am a people person. My best friend and I took a trip to NYC a couple of years ago and she was astounded by how many "friends" I made simply by randomly talking to people. I love people. I love helping. I also still love teaching. PT is a form a teaching. I am teaching a person how to walk again, how to strengthen, etc. That is a big, well for lack of a better phrase, turn-on for me to the profession.

Some of the healthcare talk and everything is just down right frightening. I also find myself thinking, oh no is this going to put me in the exact same situation I am now? A degree that I can't find a job with?

It's not that the demand is not going to be there. The demand WILL be there. It is a fact of if the money will be there to PAY the PTs.

What I'm wondering is, are we going to see the role of PTAs and Aides increase in the coming years? Less PTs doing physical interaction with patients due to mounting paperwork and more interaction via the PTAs and Aides?

Sometimes, I feel like you jbizzle... Maybe I should just stay in my mediocre day job that I enjoy, but doesn't pay terribly well... Because at least it's a pay check and I'm not 70K in debt, yet! I just feel that I owe it to myself to pursue something more... I feel like I'm smarter than a desk job, and that I have the ability to help people. Maybe in a few years there will be different options for PTs that aren't available right now... I just hope we aren't all stuck in tons of debt for nothing.
 
Just trying to explain the bigger picture. You can't simply go by articles for the "best job in america" or bls statistics which many times are influenced by interest groups (aka schools that are trying to recruit you).

I bet we see the role of PTAs and Aides increase significantly in order to dilute the service. Paperwork will probably rise as well, especially if government involvement keeps getting bigger.
 
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hmmmm this is a really interesting thread...really makes you think. i had to almost laugh at the irony of my own life experiences in regards to the post about PT not being "necessary" but rather a "luxury". in my own family, my parents have supported and even encouraged me to go for PT, yet don't want to take my sister who feels she may have pulled her groin, to see one. my boyfriend suffers from horrible back pain and went to a few PTs before deciding they weren't showing him anything he couldn't look up online or figure out how to do on his own.

i agree that the medical field itself sees us as valuable but that doesn't mean we are NECESSARY. i think that there will always be jobs but will there be jobs that we want is the real question. i don't know. i currently work in an inpatient facility in a large hospital and that seems like it will not be affected-then again, the majority of out patients rely on Medicare so what will happen if it runs out?

i am glad that we have this thread going. i really love PT and can't see myself doing something else but that doesn't mean we have to lay down and let our profession be destroyed. it's people like all of you that are commenting and reading this thread that can make a difference as is demonstrated by your initiative to educate yourselves on what is going on in the field. i don't know what the future of physical therapy will be, but it is discussions like this that make me hopeful and make me want to be a part of it.
 
i currently work in an inpatient facility in a large hospital and that seems like it will not be affected-then again, the majority of out patients rely on Medicare so what will happen if it runs out?

Even though things look bad, I just can't forsee the government not being able to save Medicare AT ALL... I don't know that what they do 'save' will be good, but I can't believe it will cease to exist.

I went to an open house and asked the program director about the healthcare reform... I got a beat-around-the-bush answer, but was told that as an active member of APTA she felt very confident that the organization is very good at fighting for and standing up for PTs. Also, at this particular school during your last year you actually have a health care course where you get to learn about what is currently going on with the PT profession, how to speak to legislators, etc. I thought that was pretty impressive, and feel better about that school better preparing me for the real world.
 
my parents have supported and even encouraged me to go for PT, yet don't want to take my sister who feels she may have pulled her groin, to see one. my boyfriend suffers from horrible back pain and went to a few PTs before deciding they weren't showing him anything he couldn't look up online or figure out how to do on his own.

This is just one example of why we are viewed as "unneccesary" by a certain percentage of both the general populace as well as by other health care providers. As a prospective therapist yourself, how can you say you value your future profession when you don't even feel that it is worth you or you relative's time to take her to be evaluated by a physical therapist?

Also, there are A LOT of crummy physical therapists out there, and it seems like your boyfriend has managed to find not just one, but two. If the therapist isn't taking the time to explain to him the findings of the physical exam, the physical therapy diagnosis, his prognosis, and the evidence which supports the best physical therapy intervention, he is wasting his time, and the therapists he has seen are doing a disservice not only to him, but to their own profession. This type of story drives me CRAZY! Eventually, the profession will need to draw a line in the sand - PTs can either get on the quality care, evidenced based bus, or get the hell off. Too many are to overcome by apathy and are content to just keep treating their patients with the same crappy interventions that have been gettign the same crappy results without putting in the work and self-reflection to improve themselves and their clinical acumen.

jess818 - take your sister to see a therapist. Preferably a good one. You may learn something more about a profession you supposedly care about and will someday need to advocate for. Also, if he isn't already pissed off from the previous poor care he received, have you boyfriend go see a better PT. Here's a link to find a therapist who is a board certified specialist in his area:


http://www.apta.org/AM/Template.cfm.../aptaapps/speccertdirectory/selectccsform.cfm
 
Eventually, the profession will need to draw a line in the sand - PTs can either get on the quality care, evidenced based bus, or get the hell off. Too many are to overcome by apathy and are content to just keep treating their patients with the same crappy interventions that have been gettign the same crappy results without putting in the work and self-reflection to improve themselves and their clinical acumen.

Unfortunately, this happens in EVERY profession. You have people who care about their job, and people who do not. It's unfortunate, but it is to be expected. Some people forget why they decided to do what they do and they become apathetic.

We need to remember we are young and excited about the future, and we also need to remember to "remember" how we felt when we first started and not let years of service bog us down, like it has to others.
 
jesspt-thank you very much for the link. I didnt meanmto sound like i don't respect pts. That is definitely not the case and I have had the pleasure to see some AWESOME therapists.
I COMPLETELY agree with you about needing to be more evidence based and that was my boyfriend's biggest problem with the pts we saw. I went with him to the first treatment and not only did she not even introduce herself to us, but she explained NOTHING, hooked him up to an ultrasound and gave him some exercises to do at home (all of which you addressed in your other post about good pts).

Hopefully more evidence based practices will be embraced :xf:
 
Jesspt--

What's your stand on where the profession is going with all that is swirling about health care reform/Medicare/etc?

If you don't mind me asking, have you been in the field for awhile now, or still relatively young? ;)

I love hearing opinions from PTs that are currently in the profession.
 
Jesspt--

What's your stand on where the profession is going with all that is swirling about health care reform/Medicare/etc?

If you don't mind me asking, have you been in the field for awhile now, or still relatively young? ;)

I love hearing opinions from PTs that are currently in the profession.

Certainly there is obvious uncertainty with what type of change Medicare will undergo. I assume that Congress will do whatever they deem necessary to keep that monster afloat, which likely means decreasing reimbursement to health care providers, and probably increased regulation. I think we can also expect an increase in retrospective case audits from CMS due to the fact that the return on investment is quite good, with CMS getting back a larger amount of money than they have to spend performing the audit. So, long story short, as with many government entitlement programs, we will see the program trying to pay out less, with an increased number of hoops to jump through.

In regards to other health care reform, I an uncertain as to how that will effect PT. I anticipate a decline in reimbursement on average. My hope is to actually see a larger percentage of cash for service patients, which should move PT closer to a free market. Patients will be more discerning when choosing a PT when they are paying out their hard-earned cash every visit. This should help separate the evidenced-based practitioner who provides good customer service from the "PT factory" that has been described in other posts.

In regards to my experience level, I have been practicing 12 years.
 
Certainly there is obvious uncertainty with what type of change Medicare will undergo. I assume that Congress will do whatever they deem necessary to keep that monster afloat, which likely means decreasing reimbursement to health care providers, and probably increased regulation. I think we can also expect an increase in retrospective case audits from CMS due to the fact that the return on investment is quite good, with CMS getting back a larger amount of money than they have to spend performing the audit. So, long story short, as with many government entitlement programs, we will see the program trying to pay out less, with an increased number of hoops to jump through.

In regards to other health care reform, I an uncertain as to how that will effect PT. I anticipate a decline in reimbursement on average. My hope is to actually see a larger percentage of cash for service patients, which should move PT closer to a free market. Patients will be more discerning when choosing a PT when they are paying out their hard-earned cash every visit. This should help separate the evidenced-based practitioner who provides good customer service from the "PT factory" that has been described in other posts.

In regards to my experience level, I have been practicing 12 years.

Let's hope so. Thanks for the continued insight, you have been invaluable to me (and some others) on this forum.

I find it frustrating that I have finally decided on a new career path, one that I feel is truly the "right" way for me to go, and now I feel like it has the potential to be a repeat of my undergrad degree. Graduate and not be able to get a good paying job. Stressful, but I can't not continue on... Money isn't everything, but you do need money to survive.

I was pleasantly surprised that one of the programs I applied to, offers a lot of research opportunities for their students to work with faculty as well as a series of courses they call "Principles of Practice" with the second to last component being "Health Care Delivery, Management and Policy". I feel this has the potential to really be helpful as its given the 2nd to last semester, right before we'll be ready to graduate and get jobs.
 
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