WSJ researches possible exploitation of MC reimbursement

[Guest guest]

Today's (04/27/2010) Wall Street Journal has a front-page article discussing

an analysis of home health therapy visits and the reimbursement which

follows.

Prior to 2008, MC paid about $2,200 for the care of a patient who received

nine HH visits, and then another $2,200 if they received ten. In January

2008, they shifted to a progressive scheme with steps at 6-14-20 visits.

The Journal commented that the number of visits seemed to change to reflect

the change in reimbursement.

Comments by one interviewee indicated that ... " He emphasized that the

number of home therapy visits is driven not by the company but by doctors

orders. `The final decision as to how much care the patient needs

ultimately is authorized by the physician, not the home health care

provider.' "

Outrageous. So much for autonomous practice by physical therapists.

There was a brief redeeming quote: " ...Some rely on home therapists to

provide guidance on the number of visits a patient requires. " also,

" Generally, I leave it up to the therapist because that's what they're best

at... " say a medical director in Georgia. " Typically, a therapist will

visit and evaluate a patient at home, recommending how many weeks of therapy

the patient will need. ... It's pretty rare for me to disapprove of what

they do. "

Who's in charge of physical therapy? We're half way to Vision 2020. It's

time for therapists to stop being seen as agency staff and start being seen

as the practitioner to whom the patient is referred by the PCP or surgeon.

This article presents a great opportunity for physical therapy as a

profession to assert -- very publicly -- the correct way that we practice,

driven by the therapist's assessment of the patient and their needs, not by

reimbursement, a physician, or a corporate employer. I know that a full

page ad in the Journal is expensive, but let's differentiate ourselves in

the public's (and government's) eye from those who exploit the system, and

start looking like autonomous professionals, accountable for our own

actions.

Last week, I saw the president of the ARNP association interviewed on the #1

national cable morning program " Fox and Friends " to explain how they are

competent to serve the community. Maybe we should be doing something

similar.

Sincerely,

Dr. Dick Hillyer

Dr. W. Hillyer

Lee Therapist Group, LLC

Hillyer Consulting

Cape Coral, FL 33914