How Will The Patient Protection and Affordable Care Act Affect Physical Therapy
Health care. Affordable health care. The Patient Protection and Affordable Care Act. The issue of providing health care to Americans has been a constant on the American political landscape for decades. And the issue only seems to have become "all the rage" because of the great deal of outrage that surrounds it. As physical therapists, you have your own opinions about the Act, about what's good and what's bad about it, both as an insured person and as a health care professional. And you have concerns. Questions. Primary among those, at least from a professional standpoint, are whether the PPACA will impact the profession and, if so, in what way(s)?
As October is National Physical Therapy month and it has been 18 months since passage of the PPACA, now would be an appropriate time to look at the effect of the legislation on our area of specialization. In response to specific questions from the Institute of Medicine about how physical therapy fits into PPACA and health reform, the American Physical Therapy Association replied:
Physical therapists are qualified to provide rehabilitative services, a defined category of essential health benefits by the Secretary of Health and Human Services.... Essential rehabilitation services are also those that are necessary for the establishment of a safe and effective maintenance program for the patient.... Rehabilitative services should be provided by qualified health care professionals currently authorized under federal law...such as physical therapists.
The APTA is attempting to establish physical therapy as being an essential service under the Act, ensuring those services are specifically covered. But that only addresses part of the Act's potential impact.
In fact, the PPACA has already effected our profession. More Americans than ever are or will become insured, thereby increasing the number of potential patients requiring post-acute, rehabilitation or habilitative care. What remains unknown is which types of treatment we provide those new patients will be covered under the act.
Thus far, physical therapy is not defined as a primary care option under the Affordable Care Act. There is, however, no question that physical therapists engage in rehabilitative as well as habilitative services. The Act has the effect of covering those services. What we need to remember, though, is that the rehabilitative essential benefit designation under the Act also includes devices related to physical therapy (e.g., prosthetics). You must establish the medical need for any device you recommend so that the cost to your patient is covered.
There is also a growing belief that payment for or reimbursement of costs associated with rehabilitative or habilitative physical therapy will turn on whether you have established that the treatment you provide makes a real, rather than perceived difference. Evidence-based therapy requires that you show the actual effect on patient outcomes. The APTA is working towards creating a "National Outcomes Database" that will provide data sufficient to demonstrate the efficacy of the the treatment physical therapists provide. Evidence-based therapy is seen by many to be critical to how we will get paid in the future.
And getting paid is what is part of what it's all about, no? Concerns remain that the Act will not provide sufficient coverage for what we do and that we may need to consider creating Accountable Care Organizations (ACOs). ACOs are now seen as perhaps the best way for physical therapy to be deemed primary care under the Act, significantly increasing insurance coverage.
All in all, the jury is still out on the overall impact of the PPACA on physical therapists. Stay tuned.