• The American Physical Therapy Association (APTA) supports the Promoting Integrity in Medicare Act of 2019 (H.R.2143), which would exclude physical therapy services from the In-o¬ffice ancillary services (IOAS) exception under the physician self-referral prohibition, commonly referred to as the Stark law. H.R. 2143 was introduced by Rep Jackie Speier on April 9, 2019.

    The Stark law was enacted originally in the Omnibus Budget Reconciliation Act (OMBRA) of 1989 to stop referral-for-profit arrangements, curb unnecessary patient referrals, and reduce over utilization of the Medicare system.

    The Stark law provisions relating to self-referral generally prohibit physicians from referring Medicare patients to entities in which they have a financial interest. This is to ensure that medical decisions are made in the best interest of the patient on the basis of quality, diagnostic capability, turnaround time, and cost, without consideration of any financial gain that could be realized by the treating physician through self-referral. The IOAS exception to the Stark law was created to allow physicians to self-refer and bill the Medicare program for typical same-day services, such as x-rays, while the patient was in the physician o-ffice. Unfortunately, this exception was inappropriately expanded to include many services and procedures that are either not same-day services or are too advanced to be completed during the patient's initial visit.

    Physical therapy is one such service that currently falls under the IOAS exception. Unfortunately, the IOAS exception has substantially diluted the self-referral law and its policy objectives, making it simple for physicians to avoid the law's prohibitions by structuring arrangements that meet the technical requirements, but circumvent the intent of the exception.

    However, H.R. 2143 removes the health care services most susceptible to over utilization and misaligned incentives from the IOAS exception, while preserving the ability of robust, integrated, and collaborative multi-specialty group practices to offer these services. Furthermore, the proposed bill strengthens the existing rural health exception.

    APTA has launched Integrity in Practice, a comprehensive campaign to promote high quality of care. It does so by helping physical therapists navigate complex regulations and payment systems and by making tools and resources available for physical therapists to encourage and promote evidence-based practice; ethics; professionalism; prevention of fraud, abuse, and waste; and more. The goals of the campaign are:

    • Demonstrate leadership in the health care profession in the effort to eliminate fraud and abuse and partner with like-minded stakeholders in the profession.
    • Educate physical therapists, physical therapist assistants, and students of physical therapy on how to avoid regulatory pitfalls and reduce risk of audits and returned payments as well as how to take proactive steps to prevent fraud and abuse so they can get back to the business of delivering value and quality in physical therapist practice.
    • Advocate on behalf of physical therapists and the profession to reduce or prevent further burdensome regulation and oversight, and preserve freedom to practice.
    • Provide solutions to the problems of fraud and abuse.
    • Protect the excellent reputation of physical therapist practice and shine a positive light on the profession.

    APTA is committed to protecting and preserving resources within the health care system through several Integrity in Practice initiatives, a few of which are highlighted below. To learn more about the Integrity in Practice campaign, please view this summary of activities (.pdf) or visit APTA's Center for Integrity in Practice.

    • Choosing Wisely: The Right Care at the Right Time

      APTA has partnered with the American Board of Internal Medicine (ABIM) Foundation's Choosing Wisely® campaign to provide specific, evidence-based recommendations that encourage both patients and physical therapists to make wise decisions about the most appropriate care. APTA was the first non-physician group to join more than 50 medical specialty societies that have produced a list of 5 things members of their profession and patients should question. APTA is providing this information to physical therapists and patients alike by partnering with Consumer Reports to create a free consumer-friendly summary of its recommendations. Consumer Reports already has reached more than 100 million consumers with Choosing Wisely information through its network of consumer communications partners.

    • Partnering to Prevent Fraud, Waste and Abuse

      APTA is working with the American Occupational Therapy Association, Inc. (AOTA) and the American Speech-Language-Hearing Association (ASHA) to analyze the conditions facing therapists to provide APTA members and others with information to ensure appropriate care based on ethical and professional standards. Together AOTA, APTA, and ASHA have published the above Consensus Statement on Clinical Judgment in Health Care Settings.

    • Educating Current and Future Physical Therapists

      APTA recognizes the need to educate both current licensed physical therapists and students of physical therapy on both the methods and reasons to prevent fraud, waste and abuse. APTA has published this primer to provide this information for practicing physical therapists and to educators instructing the next generation of practitioners.

  • Last Updated: 12/6/2019
    Contact: advocacy@apta.org