Medicare Considers Adopting New Policy that Would Restrict Who Physicians Can Hire to Provide Outpatient Therapy Services
Measure Could Increase Medical Costs and Restrict Access to Therapy for Many Patients.
DALLAS, Sept. 10 -- The Centers for Medicare and Medicaid Services (CMS), which governs Medicare, has traditionally allowed physicians to hire qualified trained individuals to treat patients under their direct supervision, and bill for their services as an “incident to” service. However, the CMS is now considering adopting a new policy that would restrict who physicians can hire to provide rehabilitation therapy services to their patients. In a proposed rule issued on August 5, the CMS has recommended that no providers other than physical therapists, occupational therapists and speech language therapists can offer “therapy-incident to” services in a physician’s office. Doctors would no longer have the option of employing certified athletic trainers (ATCs), rehabilitation nurses or kinesiologists to provide such services. The CMS is accepting public comments through September 24 before making its final decision. If approved, physical therapists would gain almost exclusive rights to Medicare reimbursement for outpatient therapy services. "This measure will greatly reduce the quality of health care for Medicare patients; increase the costs associated with ‘incident to’ services; and place an undue burden on the health care system,” says Chuck Kimmel, ATC, President, National Athletic Trainers’ Association (NATA). “It will also restrict access to necessary therapy services for many patients.” With the dramatic increase of injuries men and women 65+ today are experiencing, thanks to being more physically active than ever before, many physicians have been recruiting certified athletic trainers (ATCs) to provide injury assessment and rehabilitation to their patients. ATCs are highly-skilled health care professionals trained to prevent, evaluate, manage and rehabilitate injuries sustained by athletes and active individuals of all ages. Almost every American professional and college sports team, and one third of all high schools, have ATCs on staff. The attempt by CMS to identify a narrow group of health providers is unprecedented in the Medicare program. Since its inception in 1965, physicians have had the right to delegate the care of their patients to trained individuals whom they deem knowledgeable and trained in the protocols to be administered, based on their type of practice and medical subspecialty, plus the individualized needs of the patients. There have never been any restrictions placed upon the physician in terms of whom he or she can use to provide “incident to” services. Because physicians accept legal responsibility for the individuals under their supervision, Medicare and private payers have always relied upon their professional judgment to be able to determine who is, or is not, qualified to provide a particular service. Opponents to the proposed new Medicare policy can contact The Centers for Medicare and Medicaid Services (CMS) at www.cms.hhs.gov/regulations/ecomments (click "Send Electronic Comment" and then CMS-1429-P) or by writing to Centers for Medicare and Medicaid Services, Department of Health and Human Services, Attention: CMS-1429-P, P.O. Box 8012, Baltimore, MD 21244-8012. “This country is currently experiencing an increasing shortage of credentialed allied and other health care professionals, particularly in rural and outlying areas,” says Kimmel. “Ironically, this new Medicare proposal comes at a time when Congress is working to provide seniors with more, not fewer choices.” “ATCs are highly educated,” says Kimmel. “All have at least a bachelor’s degree and over seventy percent have a master’s degree or higher, which is comparable to physical therapists, occupational therapists, nurse practitioners, physician assistants, speech therapists and similar mid-level health care practitioners. If ATCs are qualified to prevent, evaluate, manage and rehabilitate injuries for the top athletes in this country, including many who competed at the Summer Olympic Games in Athens, then surely they are qualified to prevent, evaluate, manage and rehabilitate injuries for Medicare beneficiaries.” Medicare considers new policy