Thank you so much for taking the time to share ALL that information! Although my passion is being a physical therapist, I do "play" in the online world. LOVED, LOVED Twitonomy! I was looking for something that could capture what my followers liked - retweets in particular. Now I know and I can tweet better! Thanks!

Once the cap is met, the patient pays out of pocket for services.

Once the cap is met, services are no longer a "benefit" and Medicare beneficiaries can choose to see whoever they want - par, non-par, opted out and even anyone who is cash based only (physical therapists do not have the opt out option). When the service is no longer a covered benefit, because of the therapy cap, the providers don't even have to follow Medicare rules and regulations because the relationship is now between the provider and the patient. The provider would follow state practice act.

The cap is in place for 2013... there isn't a Merry Christmas in this ruling.

The "data" being collected starting in 2013 on function and "complexity/severity" won't be helpful at all. It isn't standardized, deemed valid or reliable, nor is it acceptable to analyze it as group data. CMS also hasn't figured out that value isn't necessarily limited to episodic care.

I am happy to see the feds lost in the case, yes, but it's too late or it was planned to be this way so beneficiaries couldn't take advantage of the ruling due to the cap.

That idea evolved after Simon Sinek's publication of "Start with Why."

Yes, Sinek does a great job helping us to see the difference between the lack of passion in how and what and the power of passion in why.

You do have to remember, some of these ideas are new. The idea of a habit and how some decisions are made was new to me. I never thought about it that way.

Why do you do what you do, Jerry?

We do sell, every single day. The most sell happens during the initial physical therapy visit.

I will admit, I do have a difficult time selling myself in general outside of the 4 walls of the clinic. I think that is because via our local Chamber of Commerce, my skin crawls whenever I run into certain members: they are always, always focused on selling. We can't have that either. I mean, at the Christmas parade, I'll walk on the other side of the street to avoid the sales pitches.

I think my style would be more of enlightenment and education... how to know when a physical therapist is needed.

Excited to know you are delivering a message during PPS annual and helping others to learn the value of selling...

Jason, an email was sent to me that mentioned a new generic outcome tool called "CARE" being rollled out. I interpreted the email to indicate "CARE" would be used for outpatient B. (What I could find on CARE did not indicate CARE would be the outpatient tool.) CMS is again going down an erroneous path. The current CARE takes 30-60 minutes to complete! That is SO not practical.

medpac does need to think a bit about the regional variation statement. I believe CMS DOES have the data to analyze to truly determine the level of regional variation. CMS pays all claims. I'm of the belief beneficiaries could easily be categorized based on their level of medical spending (prescriptions included). I'd be willing to bet high spenders = those with greater frailty or severity. medpac isn't even trying to analyze what is available to them to actually look at regional variation. Categorize patients based on their overall spending high, average and low and THEN look at physical therapy costs. Who am I though?

medpac needs to be brought up to speed on procedural codes and ICD-0. I believe they would have a very difficult time defending their position of who physical therapists treat AND what physical therapists do. There is an old report that indicates the top 10 ICD-9 codes and also the top procedural codes utilized by physical therapists. That old report full of data definitely describes who physical therapists treat and how much more reliably.

They could take the data available to them and analyze the potential impact physical therapists do have with regard to downstream cost savings. Categorize patients as I mentioned earlier... then yank patients into 2 categories, physical therapy services utilized or not utilized... compare the costs.

I also agree with Jason... there are already quick and dirty Quality of Life tools that could be used with every Medicare beneficiary by every type of provider to assist with learning cost-effectiveness.

Very nice, David! I can definitely appreciate it (infographics take time)!Our society can't afford the train wreck any longer...

I'll hang in there an be an optimist. I don't think the right people or companies actually have this information in their hot little hands. I don't believe we've shared the story with the right individuals. Leaving change up to legislators and lobbyists is completely crazy because they can be bought. But... implementing a different strategy, sharing a targeted story and information that connects with the right individuals could lead to change - the momentum of these companies and individuals wanting a non-gatekeeper marketplace will drive change.

So, what we need is data on various diagnoses. Those with physical therapy intervention (actually provided by or supervised by a physical therapist, which will be a huge obstacle because of claims not clearly indicating a physical therapist was involved in the care) and those without physical therapy intervention. We need to figure out our "projected" value.

Meaning... for some Medicare beneficiaries, they may not achieve traditional "outcomes," BUT may have significantly less utilization of more costly services in the future.

In other words, a model also has to address a bigger picture than the "episode of care" and consider the downstream results...

That's a good point, Tim - a perspective that really drives home the value of a physical therapist. It'll be quite difficult to factor that component into a model.