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  • APTA Comments on SNFs, IRFs, and Inpatient Payment – And on Medicare as a Whole

    'Tis the season: the time of year when the US Centers for Medicare and Medicaid Services (CMS) accepts public comment on next year's batch of proposed rules. This time around, CMS changed things up a little, asking that in addition to feedback on specific rules, commenters also weigh in on how the entire system could be more transparent, flexible, simple, and innovative. APTA obliged.

    APTA's overarching comments were provided in the association's responses to proposed rules for the 2018 prospective payment systems for acute care facilities, skilled nursing facilities (SNFs) prospective payment system, and inpatient rehabilitation facilities (IRFs) prospective payment system. While each comment letter addressed specific provisions of the individual rules, APTA included general comments advocating for changes to some Medicare policies related to the therapy cap, direct access provisions, and physical therapist (PT) use of telehealth, among other areas.

    Although CMS can't end the therapy cap—APTA is advocating for a bill in Congress proposing just that—the association does suggest that CMS address problems that arise when patient hospital stays are reclassified by auditors after the fact as "observation status" stays. That reclassification means that therapy cap limits, designed for use in outpatient settings, inappropriately kick in at hospital admission. APTA is encouraging CMS to develop an exception policy for these patients.

    APTA also pressed for CMS to look for ways to facilitate greater PT involvement in telehealth. As with the therapy cap, the actual addition of physical therapy to the list of telehealth services included for coverage is something that requires a change in law; however, ATPA believes that new alternative payment models increasingly being introduced by CMS open up opportunities for coverage.

    "As CMS continues to develop new and innovative models, we encourage the agency to maximize the ability of multiple types of providers, including physical therapists, to have the flexibility to use telehealth services to effectively manage patient care," APTA wrote in its comments.

    Direct access was another topic covered in APTA's letters, with the association arguing that "CMS should adopt a broad policy that eliminates physician referral requirements for physical therapy services to improve patients' access to … medically necessary care."

    APTA argued that "physician authorization requirements inadvertently create significant delays in the provision of physical therapy services to individuals who would benefit from treatment by a [PT]. These delays often lead to higher costs, decreased functional outcomes, and frustration to patients."

    All 3 comment letters are available on the APTA website as downloadable pdf files. Here's a quick recap of each.

    Inpatient Prospective Payment System (PPS) proposed rule comments (PT in Motion News summary here)
    The proposed rule would increase payments to acute care hospitals by 2.9%, but long-term care hospitals could see a 3.75% cut. APTA's letter supports a CMS proposal to include dual-eligibility status as a component in calculating penalties, as well as a plan to scrap the current "patient safety for selected indicators" measure in favor of a “patient safety and adverse events composite” measure by 2023, and changes to the priority level of certification requirements for critical access hospitals to reduce administrative burdens.

    IRF PPS proposed rule comments (PT in Motion News summary here)
    IRFs and SNFs would each see a 1% payment increase in FY 2018. CMS also proposes changes to some reporting requirements and value-based purchasing, among other areas. In comments to CMS, APTA stated its support for revamping the existing “pressure ulcer quality” measure and removing the "all-cause unplanned readmission" measures. Additionally, the association agreed with CMS on its plan to update the list of codes on the "presumptive compliance list," a list used to calculate a facility's compliance with the so-called "60% rule" that links payment to treatment of 1 or more of 13 conditions. Also backed by APTA: a proposal to implement survey-based experience-of-care measures.

    SNF PPS proposed rule comments (PT in Motion News summary here)
    The proposed SNF rule contains many of the same elements as the proposed rule for IRFs. APTA was consistent in its support for the quality measure, 60% rule, and patient survey changes proposed by CMS.

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