• News New Blog Banner

  • MedPAC Votes on Alternative to SGR

    Yesterday, the Medicare Payment Advisory Commission (MedPAC) voted 15-2 on 4 recommendations that would move Medicare reimbursement from the sustainable growth rate (SGR), the flawed payment formula that updates the Medicare physician fee schedule on an annual basis. Without congressional action by December 31, the SGR will trigger a 29.5% reduction in payment to all providers, including physical therapists, who bill under the Medicare physician fee schedule.  

    The recommendations are:  

    1. Repeal the SGR and replace it with a freeze on primary care and a 5.9% reduction per year for non-primary care for the next 3 years, followed by a freeze for the next 7 years. The cost of this change is $200 billion over 10 years.
    2. Congress should direct the Department of Health and Human Services (HHS) to collect data, including service volume and work time, from a variety of sources to establish more accurate work and practice expense values.
    3. Using data collected under draft recommendation 2, Congress should direct HHS to identify overpriced fee schedule services and reduce RVUs accordingly. This should be budget neutral within the fee schedule. 
    4. Under the 10-year update path in recommendation 1, the secretary should increase the shared savings opportunity for physicians and health care professionals who join or lead 2-sided risk ACOs. They should compute spending benchmarks for the 2- sided ACOs using 2011 fee schedule rates.

    Most of the Commissioners were willing to vote in favor of the recommendations because MedPAC Chairman Glenn Hackbarth emphasized that the commission would go back and review payment adequacy in the future

    During the public comment session, a number of physician and other health care professional organizations commented in strong opposition to the recommendations.


    • I hope the APTA spoke against the 5.9% reduction in payment. We are out here trying to hang on and keep seeing our patients and cannot afford to stay in business if there are any greater decreases in payment whether from Medicare or others. Medicare requires that we be face-to-face with patients to charge for the time/service. There is a lot of time for note and report writing that is on our time and then to decrease payment any more seems unfathomable! We cannot sustain the level of care that we do and is required and also pay our bills! I know there are places that are committing fraud by billing for services that are not provided face-to-face and the therapists do their notes while the patient is being "treated!" I have heard this report from many of my patients who "went to that other place" before seeing us. APTA needs to stand up for the ethical and good practitioners and keep us getting paid and if we could cover out costs it would be really great! Joan-Alice Taylor #67931

      Posted by Joan-Alice Taylor on 10/11/2011 1:33 PM

    • Can APTA comment on how this will effect PT? Are PTs going to grouped as specialists? At the reimbursement and legislative forum in Austin two weeks ago, it was suggested that APTA might have been successful in separating PTs from other groups because of the proactive efforts to contain costs suggested by APTA. Is this still a possibility? Are PTs considered part of "primary care" or are we grouped with "specialists?"

      Posted by Herbert Silver on 10/11/2011 7:22 PM

    • I hope the current Medipac proposal was opposed by the APTA and will continued to be opposed. The APTA will join other healthcare associations to opposed this proposal.This group would make alternative proposal to effect real change in health care one that would be driven by quality outcomes and reflect the actual expense of the provider to delivery the care. The current Medipac proposal is typical of flabby thinking "if it ain't working pretend it is , maybe it will fix itself. The medipac committee believes that by manipulating the words that it change the truth, that the proposal is a regurgitation of the same flawed ideas that are at the heart of the failed SGR; mandated decreasing reimbursement, that does not reflect the actual cost to delivery the care, perpetuates the healthcare model that is driven solely by reimbursement with out regards to quality, increased our national debt, decreased the number of providers that will accept MC, decreased access to less expensive health care for our senior population . One should ask if the solution is the same why should be a expect a different result? I would like to see a health model proposal; That is driven by quality care, based on outcomes, reward early intervention, prevention programs, provides increased access to health care for the seniors population,increases the number of providers that accept MC, takes into account the actual cost incurred by the provider to deliver the care.

      Posted by James Fuller on 10/13/2011 3:33 PM

    • A meeting with Congressman Sam Farr and 4 physical therapists and one physician took place on October 20th. We discussed the effects of the 30% decrease in Medicare reimbursement. He also gave us some valuable insight on what to do. He has put a bill through the House that passed to attached to the bill from the Super Committee only to have the bill defeated in the Senate. He strongly suggests contacting your Congressperson and Senators Feinstein and Boxer to get this through the Senate. Do it today, January 1st is going to be here sooner than you think.

      Posted by Bud Ferrante on 10/20/2011 3:02 PM

    Leave a comment
    Name *
    Email *