The Magical Medicare Eight Minute Solution

If you were to take a tour through any number of physical therapy clinics or chiropractic offices in this country, you would be amazed to find a startling trend. Pull out any number of patient charts. Pull out their corresponding billing slips, or whatever financial information is submitted to the insurance company. Compare the two.

It is amazing how many treatments will take exactly 8 minutes. Soft tissue massage? 8 minutes. Treadmill running? 8 minutes there too. Strengthening exercises? Wow, imagine this, 8 minutes.

Is 8:00 the exciting new, super-special parameter for treatment these days? Or is there something else that drives all of this?

In the current system of Medicare-driven reimbursements, clinicians bill in 15 minute increments per modality or CPT code. The minimum amount of time that must be documented in order to bill for the full unit is 8:00. This is just slightly greater than half of the unit time, but it allows you to bill for the full unit.

There is 8:00 of documented accountability. Essentially, this is the least common denominator in terms of time to officially and legally bill for a modality without committing fraud.

So for those of you who might have thought that there was some magical reason for using 8:00 of soft tissue massage or treadmill or strengthening, think again. It’s not about the treatment at all.

It never ceases to amaze me how the parameters of exercise, or of modalities, or of virtually any billable unit in a clinic, revolves around this magical 8:00. You would think that perhaps it was some special exercise parameter that has higher levels of clinical efficacy. No, that parameter is decided not on the effect of the exercise, nor the effect on the patient, nor the outcome. It is driven by the minimum time that you need to perform a treatment intervention to allow you to bill for it.

Wait just one minute. You mean to tell me that the treatment itself really isn’t about the parameters that define a level of clinical efficacy? [insert sarcasm here]

In the reimbursement world as it exists right now, you could effectively bill for 4 units – one hour of clinical time – and theoretically perform a grand sum total of 32 minutes of actual “skilled intervention” (not that watching a patient perform exercises is a skilled intervention, but I will address that in an upcoming post). Now isn’t that a deal?

Our current system is devoid of proper incentives. Obviously, the financial incentives are askew. Quality is not the objective – productivity and units of care are the standard. No wonder we have problems in our system. It supports mediocrity at best. The system financially rewards the clinician who implements a greater number of units with no regard or accountability for the patient outcome - eight minutes at a time.

Photo credits: mag3737