Barriers to updating medicare
According to the Alliance for Physical Therapy Quality and Innovation (APTQI), however, many past studies supporting this assertion examined non-Medicare beneficiaries.
That’s why the APTQI teamed up with The Moran Company (TMC) to evaluate different initial treatment interventions for low back pain—and their associated costs—for Medicare patients, specifically: “Using nationally representative Medicare claims datasets across multiple sites of service,” the study “provide[d] tabulations of total Medicare A/B spending on average for groups of beneficiaries with an incident lumbago (low back pain) diagnosis who received physical therapy first, injections first or surgeries first.” The results showed that “beneficiaries who are newly diagnosed with low back pain (as defined by the diagnosis code for lumbago) and receive physical therapy (PT) as a first line treatment option have lower total Medicare A/B costs on average in the period surrounding diagnosis and in the year following than do lumbago beneficiaries who receive injections or low back pain related surgeries as the initial treatment intervention.” In other words, receiving physical therapy first is both better for Medicare beneficiaries and the Medicare program.
The MEDCAC provides CMS with an external review of medical literature, technology assessments, public testimony, and other data and information on the benefits, harms, and appropriateness of therapies under review.
As of 2005, per the Medicare Benefit Policy Manual (Publication 100-02), Medicare beneficiaries may seek physical therapy services without seeing a physician or obtaining a referral. Well, we know it wouldn’t be Medicare if it was truly that straightforward. We’ll dive into all of Medicare’s nitty-gritty direct access details in a moment, but before that, let’s discuss why it’s so important for Medicare patients to have direct access to physical therapy in the first place.
In fact, about 3.6 million Americans each year miss or delay preventive or primary care appointments because they don’t have the means to own a car or they lack access to affordable public transit.By directly addressing barriers to care, Medicaid health plans help beneficiaries beneficiaries and state Medicaid programs avoid costly, serious health complications in the future. Consider this – a new study shows that Medicaid health plans’ care coordination initiatives helped reduce the rate of hospital readmissions for kids with type 1 diabetes.That’s a great outcome, and it’s one of the many reasons why Medicaid health plans continue to lead in delivering the right type of care at the right time.Medicare uses the term “referring provider” because they’ve yet to update that portion of the claim form.So, while it’s not exactly relevant—nor does it affect existing regulations regarding direct access—it’s the current Medicare requirement.