Government

Physiatrists oppose eliminating Medicare PT referral

The physicians say the legislation in the House and Senate could hurt patients. Physical therapists back the proposed law.

By Chris Silva — Posted June 18, 2009

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Lawmakers recently introduced legislation that would increase access to physical therapy services for Medicare beneficiaries by eliminating the need for a physician's referral or certification of the therapy plan of care in those states where direct access is authorized.

Under the Medicare Patient Access to Physical Therapists Act, introduced by Sens. Blanche Lincoln (D, Ark.), Lindsey Graham (R, S.C.) and Arlen Specter (D, Pa.), Medicare Part B beneficiaries who need outpatient physical therapy would have direct access to the services as permitted by state law. Forty-four states and the District of Columbia allow direct access to some, but not all, forms of physical therapy.

The senators introduced their bill April 30. Rep. Earl Pomeroy (D, N.D.) introduced the House version of the legislation March 31.

The legislation has the backing of physical therapists, but some physiatrists oppose it. Scott Ward, president of the American Physical Therapy Assn. said in a statement that physician referrals and plan certifications are burdensome requirements. Removing them "will allow Medicare beneficiaries to receive high-quality, cost-effective physical therapy services in a timely manner," he said.

But Sam Wu, MD, chair of the health policy and legislative committee for the American Academy of Physical Medicine and Rehabilitation, said the legislation could have an adverse effect on patients if it were to become law..

If Congress approves the bills, "then patients may not access their primary caregivers, who can give them more than just a musculoskeletal evaluation that a physical therapist would provide," Dr. Wu said. "A patient might think they are getting care, but there may be other illnesses that could be there."

Physicians are better equipped, for example, to detect kidney stones if they happen to show up in a patient who has back pain, or an aneurysm in someone with knee pain, Dr. Wu said. He also said the legislation could prompt unnecessary overutilization of physical therapists, a shift that would lead to higher Medicare costs.

Dr. Wu pointed to a December 2004 report from the Medicare Payment Advisory Commission, which concluded that the physician referral and plan certification requirements were in place to ensure the proper patient diagnosis and treatment. The commission also concluded the requirements did not appear to inhibit beneficiary access to services.

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