Over the last 5 – 6 years, there has been an effort by Insurance companies and the Self-insured Association of Virginia to reduce workmen’s compensation costs. Initially the attempts were unsuccessful, until the legislature passed a bill to curtail surgical costs in 2013. Despite agreeing to the legislation, the insurance companies were unhappy and continued to pursue a full fee schedule based on payments from Medicare. While the Medicare based fee schedule did not pass, in 2015 the legislature passed a bill authorizing the development of a Fee schedule that reflects payment based on 2014 and 2015 payments to providers. This Fee schedule is set to take effect January 1, 2018.
After passing the bill, a committee met to develop the process for the fee schedule and they hired an actuarial group to compile data and develop the fee schedule. The state was broken into six geographical Regions based on zip code. Payment data was collected in each of these districts utilizing NCCI complaint insurance companies to collect the data. The company calculated an average of the payments to develop the fee schedule for each CPT code. This was released and open for public comment in January and February 2017 and the VPTA commented on and gave recommendations for changes to the Actuarial group. This went back to the Actuarial Company for review and adjustment based on comments. Changes to the proposed fee schedule were made and a public hearing was held on 5/23/2017.
As a result of comments, the Hospital systems and Physician Groups were given an exception and increased payment on certain CPT codes and procedures elevating many of their payments above the level of the Privately held or group practices and errors were corrected in the schedule to align payment with actual payment. Once the public comment period is over, the proposed fee schedule will be reviewed and forwarded to the Virginia Workers compensation commission for review and then become enacted January 1, 2018. The VPTA is actively monitoring and participating in the process to ensure a fair payment for services for Physical Therapist Services.
Tom Bohanon, PT, DPT, OCS
VPTA Government Affairs