APTA Joins Federal Policy Makers in Efforts to Reform Outpatient Therapy

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Asks congress to reject policies that do not promote real reform of the benefit.

ALEXANDRIA, VA, June 14, 2013 — Today, the American Physical Therapy Association (APTA) continued to support congressional efforts to seek reform in the outpatient therapy Medicare benefit and called on policy makers to reject several misguided recommendations released by the Medicare Payment Advisory Commission (MedPAC) in its recent report to Congress.

While APTA applauds MedPAC for its recognition that a hard therapy cap without an exceptions process would be "inconsistent with the goal of ensuring appropriate access to important services for Medicare beneficiaries," the association remains concerned that several of the report's recommendations do little to further real reform of this vital benefit and put patient care at risk.

"APTA remains committed to working with Congress, the Centers for Medicare and Medicaid Services, MedPAC, and other policy makers to address this needed area of reform and to continue to demonstrate the value of physical therapy services to Medicare beneficiaries and the Medicare program," said Paul Rockar Jr, PT, DPT, MS, president of APTA. "Physical therapy has the potential to reduce spending across the program, improve quality of life for beneficiaries, and advance health care reform initiatives."

During the MedPAC deliberations many commissioners correctly identified the importance of therapy services, noting that they reduce hospital admissions, prevent readmissions, save health care costs, and improve quality of life. Despite this recognition, the commission ultimately endorsed recommendations that do little to reform the therapy benefit, but add regulatory burdens that will restrict patient access.

Specifically, MedPAC included 2 troublesome recommendations in its June 2013 report to Congress:

  • Reducing the level of the therapy caps from $1900 to $1270
  • Application of a multiple procedure payment reduction (MPPR) of 50% to the practice expense component of therapy services for services provided on the same day.

Created in 1997 as part of the Balanced Budget Act, the therapy caps are an arbitrary limit on outpatient services without regard to clinical appropriateness of care. MedPAC indicated that a large number, approximately one-third, of Medicare beneficiaries would exceed a $1270 cap. The caps discriminate against the most vulnerable of Medicare beneficiaries, such as those who experience stroke, neuromuscular diseases, hip fracture, Parkinson disease, diabetes, arthritis or osteoporosis. Also, beneficiaries who experience more than 1 episode of illness or injury in a 12-month period are particularly at risk of exceeding the caps.

"Lowering the level of the therapy caps is akin to doubling down on a bad policy – a policy that Congress has acted to delay 10 times to prevent putting thousands of Medicare beneficiaries at risk," said Rockar.

Furthermore, MedPAC's recommendation to increase the MPPR on payment for outpatient therapy services to 50% does not promote reform principles currently embraced by Congress as it moves forward with efforts to repeal the sustainable growth rate and support innovative new models of payment. The 50% MPPR, which Congress implemented in the American Taxpayer Relief Act of 2012, has resulted in arbitrary payment cuts across the board. In 2013, as a consequence of these lower reimbursements, outpatient therapy providers are not being adequately compensated for the resources needed to provide medically necessary and vitally important therapy services.

As the voice for physical therapy, APTA has been engaged with policy makers on the Hill and with federal agencies for 2 years regarding proposals to reform the outpatient therapy benefit, including initiatives to improve quality of care and gather information about patient functional status to inform future payment reform. This is in line with MedPAC's recommendation to collect functional status information using streamlined, standardized assessment tools. The association has also been working closely with decision makers to advance a new payment methodology for these services and is currently engaged with an American Medical Association Current Procedural Terminology workgroup tasked to develop a proposal on a new coding system for outpatient therapy services.

For more information please visit www.apta.org/Advocacy.

The American Physical Therapy Association (APTA) represents more than 85,000 physical therapists, physical therapist assistants, and students of physical therapy nationwide. Learn more about conditions physical therapists can treat and find a physical therapist in your area at www.MoveForwardPT.com. Consumers are encouraged to follow us on Twitter (@moveforwardpt) and Facebook.

CSM 2016