Relative value of PT vs PTA

There was a discussion in the last month on the Geriatrics Listserve about some insurance companies recently notifying providers that the reimbursement for treatments provided by PTA’s would be reduced compared to those by PT’s, and there has been mention that the difference in payments may come to Medicare eventually.

There are a lot of thoughts swirling around my mind about this. Everyone has a stake – rehab companies, insurance companies (thus shareholders)/ Medicare (thus society as a whole), PT’s, and PTA’s. The main question is, what is right?

As a business decision, it makes sense that rehab companies would not like this. A business would want to use more PTA’s than PT’s. If you pay x for a PTA and x+y for a PT, and get reimbursed $Q regardless of who does the treatment, you would want to minimize your labor costs by maximizing your PTA to PT ratio. Of course, that means more paperwork, more cases to manage and probably less patient treatment time for the PT, which is a whole different post.

At least some insurance companies like this obviously, and it would not be surprising if other insurance companies and even Medicare consider it. If they are paying $Q for a treatment regardless of who provides it and are looking at cutting their costs, it would make sense to pro-rate treatments based on who provides as the providers have been able to reap the benefits of paying the PTA’s less for what on the face of it seems like the exact same treatment and pocketing the difference.

Eval and re-eval are PT-only codes so I won’t address these, though the idea of an un-timed code for an evaluation has both its merit and its hazards.

For where I work, it comes down to the main treatment codes where there would most likely be a difference in approach for any given therapist: therex (97110), neuro-re-ed (97112), gait training (97116) and therapeutic activity (97530). I really respect the two PTA’s I supervise and work with. Should our company be paid the same or different if we provide the same treatment? Would or should our *treatment* differ? If one would argue (as the insurance companies seem to be) that the PT treatment is worth more, probably because of more training, then what about paying less for treatment provided by new grads, or paying more for those who have been practicing for 25 years (experience) or who have specializations (training)? If one would argue that our treatments should be paid the same, then what about the pay differential from our employer?

My thought at the moment is that the treatment is worth $Q, regardless of who provides. Yes, it will look different but so does treatment between a new grad and a seasoned PT. Why a PT should be paid $(x+y) over a PTA’s $x is the added responsibility as well as the extra knowledge. Not only do we evaluate, we also create and direct the plan of care, plan discharges, monitor progress, change plans of treatment, consult with other healthcare professionals, and deal with g-codes. I’m sure there are a lot of different opinions out there, and some PT’s I highly respect probably see it completely differently. I hope the issue is a non-starter with Medicare, but I don’t think it will go away – I’d love to get other points of view at PTpubNight, CSM, Twitter, or in the comments section.


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