WASHINGTON — Physicians should continue to control access to outpatient physical therapy for Medicare beneficiaries, according to the Medicare Payment Advisory Commission.
In a report to Congress, MedPAC recommended that Medicare keep in place its current policy of using physicians as gatekeepers to accessing physical therapy.
Under current law, Medicare beneficiaries must be referred by a physician to receive physical therapy services; the physician must review a written plan of care every 30 days.
The Medicare Modernization Act required MedPAC to examine the idea of allowing Medicare beneficiaries to have direct access to these services.
But MedPAC commissioners were reluctant to recommend removing the restrictions because so many Medicare beneficiaries have multiple and chronic health conditions.
“Without these physician requirements, the medical appropriateness of starting or continuing physical therapy services would be more uncertain,” the MedPAC commissioners said in their report.
“Under Medicare, physical therapists are not allowed to order the diagnostic services that may be critical to identifying the patient's underlying medical conditions.”
And current requirements do not appear to impair access for most beneficiaries. In 2003, 85% of beneficiaries reported no problem in getting physical therapy services, commission consultant Carol Carter said at a MedPAC meeting last November.
These restrictions are also the only way that Medicare can curb unnecessary utilization, she added.
But MedPAC recommended that additional steps should be taken to make the current restrictions more effective.
For example, MedPAC advised that there should be increased provider education about Medicare coverage rules both for physicians making the referrals and for physical therapists.
The Office of Inspector General has repeatedly recommended that Medicare claims contractors, the facilities where physical therapists practice, and the professional associations step up their efforts in increasing provider knowledge about Medicare's coverage rules, Ms. Carter said.
In addition, the MedPAC report pointed out that that better, more reliable data are needed in order to understand more about the efficacy of physical therapy for older patients.
This evidence could then be used to establish practice guidelines to educate physical therapists and physicians about what physical therapy service provisions are likely to be effective for Medicare beneficiaries.