Written By: Daniel Walters, PT, DPT, GCS

On November 1, 2024, Medicare released its highly anticipated final rule for 2025, bringing significant changes that will affect physical therapy practices nationwide. Two major adjustments in this rule—the shift from direct to general supervision of PTAs in outpatient settings and the relaxation of requirements for physician certification on therapy plans of care—promise to impact how private practices staff their clinics and manage documentation. These changes reflect a trend toward increased autonomy for physical therapy professionals and reduced administrative burdens, which could benefit both clinics and patients. Let’s explore what these changes mean for the future of physical therapy practice management.

The Shift to General Supervision of PTAs

Until now, Medicare required direct supervision of physical therapist assistants (PTAs) in outpatient settings. This meant that a licensed physical therapist (PT) had to be physically present and immediately available to intervene while a PTA was treating patients. Under the new 2025 rule, this requirement shifts to general supervision, which means the PT only needs to be available by telecommunication, allowing PTAs much more autonomy in outpatient settings.

Implications for Clinic Staffing and Operations: This shift will likely change how clinics staff and manage their teams. With PTAs now able to work more independently, private practices may consider adjusting their staffing models to include a higher ratio of PTAs to PTs. This could be a cost-effective strategy, as PTAs generally have lower salaries than PTs. Additionally, with fewer PTs needed on-site for supervision, clinics could potentially extend their hours, offer more flexible scheduling, or increase patient caseloads without adding significant labor costs.

Potential Concerns and Quality Control: While this shift offers increased flexibility, it also raises questions about maintaining high-quality patient care and ensuring that PTAs feel confident working with greater independence. Clinics may need to enhance training and education for PTAs and communication channels between PTs and PTAs to ensure that care plans are being followed accurately. Establishing robust protocols and frequent check-ins, even if remote, could help practices ensure quality and maintain continuity of care.

Removal of the Physician Certification Requirement for Therapy Plans of Care

Previously, Medicare required that a physician sign off on therapy plans of care within 30 days of the initial evaluation for claims to be processed. This requirement often created delays, as therapists had to secure physician signatures despite having direct access to patients in some states. Now, under the 2025 rule, PTs are still required to send the plan of care within 30 days, but a physician’s signature is no longer necessary for reimbursement. This change provides an exemption that can save clinics valuable time and streamline the administrative workload.

Reduced Administrative Burden and Improved Workflow: For private practices, this exemption is a game-changer. In the past, securing physician signatures could delay treatment or interrupt billing cycles, leading to financial challenges and frustrated patients. With this new rule, therapists can complete and submit treatment plans without depending on a physician’s approval, making the process faster and more efficient. This adjustment will also allow PTs in states with direct access to operate more independently, enhancing the autonomy of physical therapy as a profession and reducing the perception of PTs as adjuncts to physicians.

Financial Benefits for Clinics and Increased Patient Access: Without the added requirement of a physician’s signature, private practices can speed up the revenue cycle and ensure faster payment. This can be especially impactful for smaller clinics that may not have the resources to manage complex documentation requirements. Additionally, patients in direct-access states may benefit from reduced waiting times, as therapists can start care promptly without waiting on administrative hurdles. In turn, this could make physical therapy a more attractive option for patients seeking efficient, effective care.

Preparing for a New Era of Outpatient Physical Therapy

These Medicare changes for 2025 suggest that physical therapy as a profession is moving toward greater independence and reduced oversight from other healthcare providers. With PTAs having more autonomy and PTs freed from some administrative constraints, clinics can potentially increase efficiency, lower costs, and enhance the patient experience. However, to make the most of these new rules, clinic owners and managers will need to take proactive steps to adjust their staffing, documentation, and training processes.

Key Action Steps for Clinic Owners:

• Revise Staffing Models: Evaluate the optimal PT-to-PTA ratio in light of the general supervision rule, and consider how this may impact hours, caseload, and patient flow.
• Strengthen PTA Training and Communication: Since PTAs will have more independence, it’s critical to establish strong communication protocols between PTs and PTAs to maintain quality care. Regular check-ins, remote case reviews, and additional training could be valuable.
• Invest in PTA Skill Development: With PTAs taking on a more autonomous role, consider supporting advanced training and skill development to enhance their effectiveness and confidence. Encourage PTAs to pursue specialty certifications, such as orthopedic or neuromuscular specialties, and provide access to continuing education in advanced manual therapy techniques, clinical reasoning, and clinical decision-making. Building these skills will equip PTAs to handle a broader range of cases independently, improve patient outcomes, and elevate the overall quality of care within the clinic.
• Streamline Documentation Practices: With the physician signature no longer required, clinics should review and possibly update their documentation procedures to ensure timely submission and compliance without unnecessary steps.
• Educate Patients: Ensure that patients understand the new roles PTs and PTAs may play in their care journey, particularly with PTAs taking on a more autonomous role. Transparent communication can help reassure patients about the continuity and quality of their treatment.

By embracing these changes thoughtfully, private practices can set themselves up for continued success and create an environment where PTs, PTAs, and patients all benefit from a more streamlined and autonomous care model.

Additional context on the 2025 measures and reporting requirements can be found in CMS’s official documents on their site:

• CMS’s Medicare Physician Fee Schedule Final Rule (CY 2025)
• CMS Fact Sheet on Quality Payment Program Proposed Changes

Learn more about how Summit can help you implement these practices in your future trainings: Summit Group Learning or call 615-647-8486

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