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  • Senate Approves SGR Repeal, Keeps Therapy Cap and Exceptions Process

    The US Senate voted Tuesday to approve a bill that repeals the flawed sustainable growth rate (SGR) and moves toward payment systems based on quality, but, despite a concerted, historic grassroots advocacy effort, does not end the Medicare outpatient therapy cap. The therapy cap repeal amendment was defeated by a 58-42 vote, coming up just short of the 60 votes needed for passage.

    Instead of a full repeal, the therapy cap exceptions process will extend until December 31, 2017.

    The vote on the SGR ends a flawed system for payment that would have resulted in 21% reductions in Medicare payments to providers. The bill approved by the Senate passed with an overwhelming 92-8 vote, and President Barack Obama has stated that he will sign it into law. The bill was approved by the House in late March.

    Among the most significant features of the bill are the ways it sets the stage for a transition to value-based health care services, and away from the fee-for-service model—a shift strongly supported by APTA.

    The effort to include an amendment to end the therapy cap was championed by Sen Ben Cardin (D-MD) along with Sen David Vitter (R-LA), and was the focus of an intensive effort by APTA, its members, supporters, and other organizations to urge senators to vote in favor. In the end, the amendment was 1 of only 6 allowed to be considered, and among those 6, garnered 1 of the highest number of votes in favor.

    "Ending the SGR is good news not just because it ends a flawed policy, but because it's helping to transform payment models," said Justin Moore, PT, DPT, APTA executive vice president of public affairs. "We are of course disappointed that the therapy cap repeal effort was not successful, but thanks to the hard work of APTA members and supporters, we were able to seize an historic moment and move this issue closer to the goal line than at any time in the 18-year history of the cap. We will capitalize on this energy, unity, and momentum, and will never stop working for the best interests of patients."

    APTA will provide further information and resources on the provisions passed in the SGR bill over the coming weeks and will continue to influence its implementation with the Centers for Medicare and Medicaid Services.

    Comments

    • Dear APTA,the fact is nothing is changed! at the end it is not important how many "yes" and how many "no's". At the end we achieved nothing again. Unless next extension you will call a success. P

      Posted by john on 4/15/2015 3:54 PM

    • As a PT w/ a private practice, I am not fully opposed to having a cap for PT. Not having a cap would create a free for all for the unscrupulous providers out there. I don't mind being held accountable for my work, but Medicare should have a much fairer auditing process in place. In 2013 I sent 5 charts for audit requesting treatments over the $3700 cap. Some of the comments made by the reviewers denying approval were outright lies, and who decides what is skilled and medically reasonable? That language can bend in any direction. After 3 levels of appeal I succeeded in obtaining approval for 4 of the 5 patients. Point is - let's work with CMS on a better, fairer auditing process. Also, getting rid of the MPPR would mean more to me than getting rid of the cap. Pay us for what we do!! I applaud APTA for all their dedication and hard work, hope you consider my thoughts. Thanks.

      Posted by Nancy Reynolds on 4/15/2015 5:34 PM

    • The story would be more complete if you would please list the 42 who voted against. Thanks

      Posted by Valerie on 4/15/2015 7:35 PM

    • 18 years! Unbelievable how pathetic our elected officials are. The system has been so broke for such a long time. Nobody is bold enough to deal with this. Count on the same extension in 2017! I will be hopefully retired by then!

      Posted by Christine Ely on 4/15/2015 11:17 PM

    • This is good news - that we can some effect in Washington - in favor of our patients and our own reimbursement. We did not win the war - only a big battle. The cap is arbitrary and unjust for those honest clinicians who are working to restore function in our debilitated or dysfunctional patients. Should we not get paid for what we do? Are the second or third treatments in any given session less valuable than the first? The presence of MMPR suggests just that. From a private practice owner or from any financial perspective - treatments stay quality despite lowering reimbursements. However, eliminating the MMPR AND the cap would truly recognize our treatments -- with the expectation of good outcomes. The war - appropriate reimbursement for what we do = restore function in effective manner. Further the appeals process is tedious, unjust, and creates a conflict with the Federal paperwork reduction act (?). The process needs to go away as well as -- these are the battles we need to win to win the war. Congrats to APTA and great efforts for those who have also participated in the legislative process - lets keep momentum going with these issues!

      Posted by Rob on 4/16/2015 12:58 AM

    • severe storm ahead private practitioners until 2017; hospitals, once again, are saved from the storm.... As a private practitioner, I don't know how thick our skin can get.

      Posted by Oscar Pozzoli on 4/16/2015 7:25 AM

    • I am encouraged that our voice is being heard !!let's continue to work for your goals . John Daniel

      Posted by Dr.John Daniel . EdD, MA, PT on 4/16/2015 8:21 AM

    • Agree with N Reynolds. Let's focus on MPPR which has literally killed our margins. When this was enacted, I don't recall our operational expenses decreasing after the first 15 minutes of treatment. My practice is focused on providing quality care to our geriatric clients but MPPR has all but eliminated our ability to remain viable.

      Posted by Greg on 4/16/2015 8:41 AM

    • "The story would be more complete if you would please list the 42 who voted against." Valerie, You can find a list of how Senators voted here: https://www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=114&session=1&vote=00142

      Posted by Joe P on 4/16/2015 9:19 AM

    • I agree with the above statement that we desperately need to get rid of MPPR over the therapy cap! It blows my mind that I can see a PA for a cold and be billed close to a $100 for 10 minutes of there time, but when I spend a full 30 minutes with my patients get $40. Our services are extremely under valued for the level of education we have! This is making encourage young people to enter our profession a challenge, as we spend most of there income to pay back education and struggle otherwise.

      Posted by Amber Astafan on 4/16/2015 10:35 AM

    • Why is everyone always so up in arms about the cap? Every time it has come up, it gets extended. Yes, it wasn't taken care of per se, but when it comes up again 2 yrs from now, it will be extended again. I see mention of a 3,700 cap. The only cap I am aware of is 1,940. What is capped at 3,700? I deal with rotator cuff repairs and total knees and have people out of here in under 1,940 probably 95% of the time.

      Posted by jeff on 4/16/2015 1:09 PM

    • I would appreciate seeing a list of the Senators and how they voted. Thanks.

      Posted by G D Madden on 4/16/2015 2:36 PM

    • And of course, we would like to see the cap amount for PT and Speech separated, as it should have been all along!

      Posted by Carol Hermsen on 4/16/2015 7:33 PM

    • As a PT in private practice, I couldn't agree more with Nancy Relnold's post on 4/15/15.

      Posted by Mike Newby on 4/16/2015 8:40 PM

    • Completely and utterly disappointed!! how about removing ST from PT?

      Posted by Zachary Johnson -> CGWbDI on 4/16/2015 10:00 PM

    • ST and PT are together because someone forgot to put a comma in the initial legislature. Why has this not been fixed? Utterly ridiculous.

      Posted by Suzanne Foxx on 4/17/2015 12:19 PM

    • This is not really a win until cap repealed. We need to focus on the insurance companies destroying the therapy field with 50 dollar co pays per visit. Pre-authorizations that only allow minimal visits. If we don't focus on that, Medicare will not be far behind with the use of the G code modifiers in a continued decimation of health care providers and patients who need help.

      Posted by Kathy Burgdorf on 4/17/2015 1:17 PM

    • Grouped by Home State Alabama: Sessions (R-AL), Nay Shelby (R-AL), Nay Alaska: Murkowski (R-AK), Yea Sullivan (R-AK), Nay Arizona: Flake (R-AZ), Nay McCain (R-AZ), Nay Arkansas: Boozman (R-AR), Nay Cotton (R-AR), Nay California: Boxer (D-CA), Yea Feinstein (D-CA), Yea Colorado: Bennet (D-CO), Yea Gardner (R-CO), Nay Connecticut: Blumenthal (D-CT), Yea Murphy (D-CT), Yea Delaware: Carper (D-DE), Yea Coons (D-DE), Yea Florida: Nelson (D-FL), Yea Rubio (R-FL), Nay Georgia: Isakson (R-GA), Nay Perdue (R-GA), Nay Hawaii: Hirono (D-HI), Yea Schatz (D-HI), Yea Idaho: Crapo (R-ID), Nay Risch (R-ID), Nay Illinois: Durbin (D-IL), Yea Kirk (R-IL), Yea Indiana: Coats (R-IN), Nay Donnelly (D-IN), Yea Iowa: Ernst (R-IA), Nay Grassley (R-IA), Nay Kansas: Moran (R-KS), Yea Roberts (R-KS), Nay Kentucky: McConnell (R-KY), Nay Paul (R-KY), Yea Louisiana: Cassidy (R-LA), Yea Vitter (R-LA), Yea Maine: Collins (R-ME), Yea King (I-ME), Yea Maryland: Cardin (D-MD), Yea Mikulski (D-MD), Yea Massachusetts: Markey (D-MA), Yea Warren (D-MA), Yea Michigan: Peters (D-MI), Yea Stabenow (D-MI), Yea Minnesota: Franken (D-MN), Yea Klobuchar (D-MN), Yea Mississippi: Cochran (R-MS), Nay Wicker (R-MS), Nay Missouri: Blunt (R-MO), Nay McCaskill (D-MO), Yea Montana: Daines (R-MT), Nay Tester (D-MT), Yea Nebraska: Fischer (R-NE), Nay Sasse (R-NE), Nay Nevada: Heller (R-NV), Nay Reid (D-NV), Yea New Hampshire: Ayotte (R-NH), Yea Shaheen (D-NH), Yea New Jersey: Booker (D-NJ), Yea Menendez (D-NJ), Yea New Mexico: Heinrich (D-NM), Yea Udall (D-NM), Yea New York: Gillibrand (D-NY), Yea Schumer (D-NY), Yea North Carolina: Burr (R-NC), Yea Tillis (R-NC), Nay North Dakota: Heitkamp (D-ND), Yea Hoeven (R-ND), Yea Ohio: Brown (D-OH), Yea Portman (R-OH), Yea Oklahoma: Inhofe (R-OK), Nay Lankford (R-OK), Nay Oregon: Merkley (D-OR), Yea Wyden (D-OR), Yea Pennsylvania: Casey (D-PA), Yea Toomey (R-PA), Nay Rhode Island: Reed (D-RI), Yea Whitehouse (D-RI), Yea South Carolina: Graham (R-SC), Yea Scott (R-SC), Nay South Dakota: Rounds (R-SD), Yea Thune (R-SD), Nay Tennessee: Alexander (R-TN), Nay Corker (R-TN), Nay Texas: Cornyn (R-TX), Nay Cruz (R-TX), Nay Utah: Hatch (R-UT), Nay Lee (R-UT), Nay Vermont: Leahy (D-VT), Yea Sanders (I-VT), Yea Virginia: Kaine (D-VA), Yea Warner (D-VA), Yea Washington: Cantwell (D-WA), Yea Murray (D-WA), Yea West Virginia: Capito (R-WV), Nay Manchin (D-WV), Nay Wisconsin: Baldwin (D-WI), Yea Johnson (R-WI), Nay Wyoming: Barrasso (R-WY), Nay Enzi (R-WY), Nay Vote Summary By Senator Name By Vote Position By Home State

      Posted by Debby on 4/18/2015 11:48 AM

    • Here's how the voting went on this ammendment: http://www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=114&session=1&vote=00142

      Posted by Andrew Jones on 4/18/2015 2:09 PM

    • Glad to see North Dakota voting in favor. I completely agree with the words from Nancy Reynolds and Amber Astrafan regarding MPPR and cost of education vs quality reimbusment.

      Posted by Dr. Ryan Lorenz PT, DPT on 4/24/2015 7:48 PM

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