Can 'Severity-Intensity' Be the Conceptual Basis of an Alternative Payment Model for Therapy Services Provided Under Medicare?

摘要

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.