Can "severity-intensity" be the conceptual basis of an alternative payment model for therapy services provided under Medicare?

Currently, physical therapists are confined in CPT to using only 2 "evaluation" codes and a larger array of codes for specific procedures. [...] the majority of the more "intense" procedures (eg, a cervical manipulation coded in CPT as "manual therapy") must meet specif...

Full description

Saved in:
Bibliographic Details
Published in:Physical therapy 2011-10, Vol.91 (10), p.1564-1569
Main Authors: Guccione, Andrew A, Harwood, Kenneth J, Goldstein, Marc S, Miller, Sarah C
Format: Article
Language:English
Subjects:
Adults
Aged
Clinical medicine
Codes
Cost estimates
Decision making
Disability Evaluation
Disabled Persons - rehabilitation
Health aspects
Hospitals
Humans
Liability insurance
Manipulative therapy
Medicare
Medicare - economics
Medicare Part B - economics
Older people
Physical therapists
Physical therapy
Physical Therapy Modalities - economics
Prospective Payment System - economics
Prospective payment systems
Quality of Life
Relative Value Scales
Therapeutics, Physiological
United States
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Currently, physical therapists are confined in CPT to using only 2 "evaluation" codes and a larger array of codes for specific procedures. [...] the majority of the more "intense" procedures (eg, a cervical manipulation coded in CPT as "manual therapy") must meet specific "time" requirements (ie, 15 minutes of "service" for a procedure that typically has a brief duration) in order to be considered medically necessary and meet the threshold for payment. [...] we believe our approach to developing a system that decreases unwarranted variation in clinical practice by promoting service delivery that is concordant with evidence-based expectations about treatment for similar patients and increases provider accountability for performance could be initiated in the near future.
ISSN:0031-9023
1538-6724
DOI:10.2522/ptj.20110042