On July 1, the Centers for Medicare & Medicaid Services (CMS) issued the proposed physician fee schedule rule that would update payment rates and other policies under the Medicare physician fee schedule for services furnished on or after January 1, 2012. If this rule becomes effective, physicians, physical therapists, and other health care professionals would receive a 29.5% cut in Medicare payments January 1, 2012, due to the flawed sustainable growth rate (SGR) formula. Over the last few years Congress has taken action to avert these cuts prior to their effective date. If the 29.5% cut is averted by Congress, the projected impact of other changes in the rule on outpatient physical therapy services in aggregate would be a positive 3% in 2012.
In addition to the payment updates, the rule also proposes to extend the multiple procedure payment reduction (MPPR) policy to the professional component of imaging services, resulting in significant reductions in payment for radiology and interventional radiology. CMS also indicates that over the next year it will review more closely whether specific CPT codes billed under the fee schedule are overvalued or undervalued, and specifically identifies manual therapy (97140) and group therapy (97150) as codes the agency would like to examine.
In the proposed rule, CMS announces its plans for continuation of the Physician Quality Reporting System (PQRS) in 2012, which will involve bonus payments of .5% of allowed charges for physicians and other health care professionals—including physical therapists—who who successfully participate. Twenty-six additional new measures were added to the program for individual claims and/or registry based reporting.
APTA will complete a comprehensive review and summary of the rule in the coming week. This summary will be posted at www.apta.org. CMS will accept comments on the proposed rule until August 30 and will respond to them in the final rule to be issued on or about November 1. APTA will submit extensive comments in response to this rule.