APTA Alternate Payment System
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| Reform Payment for OP PT Services | To improve quality of care
Recognize & promote clinical judgment of PT
Provide policymakers/payers w/ accurate payment system that ensures integrity of medically necessary services
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| Fee for Service vs. APS | FFS: procedural-based payment system
APS: per-session based payment system
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| APS Characterizes pt's based on | Condition severity
Intensity of Interventions
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| Characteristics of APS | Reflect professional clinical reasoning/judgment & devision making by PT
Improves provider compliance
Reduces admin burdens of current model of reimbursement
Enhances payer recognition of value of PT-directed care
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| Going to a new coding system would mean what to a PT? | PTs learn significant changes to codes
Elimination of numerous existing codes (decreased admin burden)
Could result in more appropriate valuation of PT services (better reflect pt's condition/clinical judgment of PT)
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| 3 Evaluation Codes & 9 Exam & Intervention Codes | Eval Codes based on level of complexity: Limited, Moderate, Significant
Exam & Intervention codes: based on severity of pt's condition + intensity of PT intervention: Limited, Moderate, Significant
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| Factors Used to Determine Severity | Pt safety, Age, Time since onset, MOI, Current condition, Current LOF, Progression, Probable outcome, Co-morbidity, Cognition, Physical environment, Psych support, Goals/Agreement, Time to achieve goals, Prognosis, Pt mood, Intervention, Risk of procedure
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| Codes: Pt case scenario | http://www.apta.org/APS/
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