PT Direct Access Looms as Threat to O&P

Prescription rights for physical therapists may be joining other woes for the O&P industry included in Medicare reform legislation currently being considered by the Senate.

Sen. Blanche Lincoln (D-AR) introduced amendment No. 959, which would create a three-year, five-state demonstration project to assess the benefits of giving Medicare beneficiaries direct access to physical therapy services without a physician's prescription, the National Association for the Advancement of Orthotics & Prosthetics (NAAOP) warned June 20. This amendment would permit physical therapists to prescribe and provide orthotic and prosthetic services as well as a number of other healthcare services.

The amendment also includes a provision defining a "qualified physical therapist" as one who is state-licensed, NAAOP noted.

The American Orthotic & Prosthetic Association (AOPA) adamantly opposes this effort, according to Walt Gorski, AOPA's director of legislative affairs. "AOPA has a number of serious concerns," he said. "There are a number of unintended consequences that could come from this legislation. For one, it would adversely affect the quality of orthotic and prosthetic devices since Physical therapists have not received proper training to prescribe, provide, evaluate, fabricate, and fit orthotic and prosthetic devices for Medicare beneficiaries."

Gorski continued, "Secondly, this legislation would create an enormous loophole in the Stark Law, the physician ownership and referral statute. The Stark Law only governs referral practices of physicians and facilities in which they have ownership-it doesn't apply to physical therapists. Physical therapists could thus provide referrals to themselves leading to fraud, abuse and overutilization of health care services. This would clearly increase Medicare expenditures, Gorski added.

"Additionally, it would create a situation in which physical therapists are being paid twice for providing orthotic and prosthetic services, since they use the CPT coding system. However, O&P practitioners can only under the HCPCS coding system, which includes all facets of O&P service, plus 90 days of follow-up. Physical therapists can bill under both codes, so Medicare would be paying twice for the same service and device provision."

The amendment also would circumvent the BIPA legislation, passed by Congress in 2000, which included provisions for determining who is qualified to provide certain orthotics and prosthetics, Gorski pointed out, adding, "Under BIPA, qualified physical therapists could provide these services if the Negotiated Rulemaking Committee determines they have received the proper education and training. The Negotiated Rulemaking Committee is working right now to determine this issue. "However, the legislation currently being considered would circumvent BIPA and the Negotiated Rulemaking process by ensuring that, as long as physical therapists are state-licensed, they would meet the requirements of the BIPA provisions."

Commenting on the term "direct access," Gorski said that he thinks this term is the physical therapists' way of framing the issue. "Their objective is to obtain prescriptive rights in the Medicare program," he said. "This proposed demonstration project is just one more step along the way of achieving prescriptive rights.

"AOPA has reached out to its friends on Capitol Hill," Gorski continued. "We feel we have raised enough objections so that people are thinking twice about this provision. However, we are continuing our efforts because, even if this does not become an amendment to the Senate Medicare package, we believe this is so high on the physical therapists' legislative agenda that it will come back, whether in conference [as the Senate and House iron out difference in their respective Medicare reform packages-expected to occur in July] or at some future date."

Fore more information, contact AOPA: info@aopanet.org ; and NAAOP: naaop@oandp.com .

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PT Direct Access Looms as Threat to O&P

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