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.
It would appear that the CPT Codes under review also include 97530, 97112, and 97001 (noted on page 96). Is there any thing we can do to avert any adverse changes in our (already low) Medicare fee schedule?
Thank you for your anticipated response.
Sincerely,
Randy Veroline
Posted by Randy Veroline
on 7/1/2011 9:43 PM
The proposed fee schedule cuts approaching 30% will cause unprecedented casualties throughout the medical community and to the healthcare economy. It will also leave medicare recipients struggling to find quality medical services as more and more practitioners opt out of medicare contracts. Our outpatient physical therapy practice sees a population that is currently 25-30% medicare recipients. If the fee schedule cuts are imposed, we will likely have to lay off one full time PT and one full time office assistant while trying to manage the same volume of patients. Needless to say, everyone, patients included will lose. My question: why is the government so concerned with cutting the fee schedules to medical practitioners when the real money is spent on hospitalization costs and prescription drug benefits? This is just not right!
Posted by Matthew Spiegelman, MPT, CSCS
on 7/3/2011 1:14 PM
These proposed 30% cuts are only going to hurt patients and their care. During the last few years, i have seen more and more patients that are misdiagnosed by physicians. I see that physicians are spending less and less time with their patients (i.e. 30% less care). Physicians are NOT going to take a pay CUT! They will only spend 30% less time with their patients. I feel like PT's may become more of a PCP for their patients, since we get more time with them. The cut in payments to MD's (and PT's)will only hurt the patients....not the providers. Go look at Senator Kathy Gifford. She could tell you how important PT's are....and that capping rehabilitation services should be abolished.
Posted by P. Navarrete
on 7/5/2011 10:30 AM
The government does not understand that quality care for vulnerable patients isn't something squeezed into a square accounting box. We provide services that can be measured, but warmth and attention that can't.
Posted by Chris Co
on 7/5/2011 9:14 PM
I provide the only source of outpatient P.T. in a small town in GA where the local hospital closed and the nearest alternative hospital or oppt is 25 miles away. Pts can't afford to travel elsewhere for services. The proposed cuts would likely cause my practice to reach the tipping point of closing.
Posted by Donna Benton
on 9/24/2011 5:05 PM
When apat going to start working for PT's ? out patients cap is been there for 5 years what have you done ? Now physical therapy is combine with physicians fee schedule. Where is apta voice. If apta wants more members they have to start working for us, not just get together and have a few drinks
Posted by noman
on 10/21/2011 1:07 AM
As an owner of an HHC, I am wondering at what point lower compensation will mean lower compensations for PT's. The economics are staggering. Right now a PT goes for 3 -4 years of training at 150K expense. If you make 50-60k per year, you will not repay your loans. Fewer bright students will go into PT into the future. This is juxtaposed with a growing population of seniors particularly needing services. My feeling is that eventually the economic lesson that is rehabilitation services save on rehospitalizations and put individuals back to work will have to be learned again and again.
Posted by Benjamin Gilbert MSPT
on 11/16/2011 9:45 PM