New Medicare Policy Restricts Physical Medicine and Therapy Services for Patients

DALLAS, Nov. 11, 2004 - Medicare patients will be severely restricted in their ability to obtain physical medicine and therapy services while visiting their physicians’ offices, according to a policy change announced Nov. 3 in the 2005 Physician Fee schedule. The Centers for Medicare and Medicaid (CMS) moved forward with a policy change that prohibits a long-standing practice regarding physicians who offer therapy services and then bill them under what is known as "Therapy-Incident To” services. The policy change will tentatively take effect March 1, 2005. The rule does not affect patients covered by private insurance who receive rehabilitation or therapy services in physician offices. "Doctors will no longer have the option of utilizing certified athletic trainers (ATCs), rehabilitation nurses or kinesiologists to provide physical medicine and therapy services to their Medicare patients,” says Chuck Kimmel, ATC, president of the National Athletic Trainers’ Association (NATA). “With this action, CMS has assured that physical therapists will have a virtual monopoly on the delivery of therapy services to Medicare beneficiaries, both inside and outside the physician’s office. This CMS policy change will have a negative effect on a Medicare patient’s access to quality health care and may increase the cost of therapy services to both the patient and Medicare system,” according to Kimmel. This is the first time CMS has restricted the physician’s right to delegate the care of patients to qualified health care providers. Since Medicare’s inception in 1965, physicians have had the right to hire qualified health care professionals to treat patients under their own supervision. Many national and state societies, including the American Academy of Family Physicians, American Academy of Physical Medicine and Rehabilitation, American Orthopaedic Society for Sports Medicine and Florida Orthopedic Surgeons, joined the Coalition to Preserve Patient Access to Physical Medicine and Rehabilitation Services, to challenge CMS’s proposal to change this policy. The Coalition stated that the primary concern of physicians is the health and well being of the Medicare beneficiary; that the physician is best equipped to make these medical decisions; and any attempt by government entities or other organizations to change this is not in the best interest of the patient. While physicians who employ ATCs and other qualified individuals who are not physical therapists, will no longer be able to receive Medicare Part B reimbursement for therapy provided incident to a physician’s service, athletic trainers can still provide rehabilitation treatment to Medicare patients. This change does not prevent or hinder Medicare patients from accessing physicians or therapy/rehabilitation services in any facility simply because an athletic trainer is employed there. “It’s a reimbursement issue,” says Kimmel. With the dramatic increase in injuries that men and women 65+ today are experiencing, thanks to being more physically active than ever before, many physicians have been recruiting athletic trainers to provide injury assessment and rehabilitation to their patients. Almost every American professional and college sports team, and one third of all high schools, have an ATC on staff. “Physicians in all types of practices recognize the value of using certified athletic trainers because they provide superior patient education and treatment,” says Kimmel. “Athletic trainers will continue to practice alongside physicians because the market demands their services and physicians appreciate their work ethic. It is a shame that the federal government chooses to rely on questionable legal reasoning and make this policy change that will ultimately restrict Medicare beneficiary access to health care and therapy benefits." NATA believes that this CMS policy change is contrary to Congressional intent of the physician “Therapy-Incident To” rules. It believes, rather, that this is a narrow re-interpretation of a change brought about by the 1997 Balanced Budget Amendment that CMS has let stand for seven years. The original 1994 report that looked at potential violations of “Therapy-Incident To” billing rules was based on 1991 data, which is now obsolete because of the tremendous shift in health care policy, regulations, payments and aging population. About NATA: Certified athletic trainers (ATCs) are unique health care providers who specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses that occur to athletes and the physically active. The National Athletic Trainers' Association (NATA) represents and supports 30,000 members of the athletic training profession through education and research.

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