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  • MedPAC Votes on Outpatient Therapy Payment Reform Recommendations

    Yesterday, the Medicare Payment Advisory Commission (MedPAC) voted to adopt several recommendations on outpatient therapy payment reform. These recommendations will be included in a report to Congress that may be used to inform future policy related to outpatient therapy services. Congress has the discretion to determine whether or not to pass legislation that incorporates any of these recommendations. The Centers for Medicare and Medicaid Services also can choose to enact MedPAC's recommendations. APTA will continue to work diligently over the next couple of months with Congress to extend the exceptions process for therapy services in 2013 and to avoid any payment cuts. 

    Overall, MedPAC commissioners expressed appreciation of the value of outpatient therapy services for Medicare beneficiaries and recognized that a "hard cap" with no exceptions would be detrimental and severely impede access to medically necessary therapy services. Several commissioners also acknowledged that, if applied appropriately, therapy presents a beneficial alternative to more costly services, such as surgery and hospital admissions due to falls and other conditions.

    To avoid capping therapy services without an exceptions process, MedPAC recommends that Congress reduce the therapy cap for physical therapy/speech-language pathology combined to $1,270 in 2013 and occupational therapy to $1,270 in 2013, and permanently include hospital outpatient therapy departments under the cap. The cap amount would be updated each year by the Medicare Economic Index. MedPAC also calls for the secretary of the Department of Health and Human Services to implement an improved a manual review process for requests to exceed cap amounts. MedPAC's recommendation to improve the manual medical review process was based on what MedPAC staff described as "constructive feedback" from stakeholder groups, including APTA.

    Other recommendations include applying a multiple procedure payment reduction (MPPR) of 50% to the practice expense component of therapy services provided to the same patient on the same day and reducing the certification period for the outpatient therapy plan of care from 90 to 45 days. MedPAC also voted to direct HHS' secretary to prohibit the use of V codes as a principal diagnosis on outpatient claims.

    To improve management of the benefit in the long term, MedPAC recommends that CMS collect functional status information about beneficiaries using a streamlined, standardized assessment tool that reflects factors such as patient demographic information, diagnosis, medications, surgery, and functional limitations. This information could be used to measure the impact of therapy on functional status and provide a basis for future long-term reform of the payment system.

    In anticipation of the release of these recommendations, APTA has been aggressively engaged on Capitol Hill to ensure payment reforms do not detrimentally impact access, quality, or the financial viability of providers and facilities that play an essential role in the health care delivery system.

    For more information, read APTA's October 9 comments to MedPAC regarding its recommendation to implement a 50% MPPR policy and reduce the therapy cap amount. Additionally, APTA's comments submitted in September address MedPAC's various long- and short-term proposals to reform the Medicare therapy benefit.  


    • Really? Huge cut and more admin burden! !!! Great job guys. Another job poorly done. Hey here's an idea... How about we work to decrease costs by eliminating the admin burden on practices that meet a performance threshold? Lets be honest nobody's looking at all this data were collecting for PQRS, why and at what cost is collecting more data? Functional measure a must, the rest is waste!

      Posted by Dan Fleury on 11/3/2012 9:05 AM

    • the obama "death panels" are arriving as fast as hurricane sandy. the geriatric population will be given pills to control their joint pain rather than getting a new joint. remember---election day is only a couple of days away.

      Posted by robert on 11/3/2012 9:10 AM

    • Wow, this is the future of PT. Medicare is the last of payers to move in this direction. All of the insurance companies have already done things like MPPR years ago. We as a profession need to realize that this trend is not going in the other direction, EVER! Unless we decide to do something real and powerful about it, not just writing letters to Congressional groups or insurance commissioners.

      Posted by Billy on 11/3/2012 12:45 PM

    • wow

      Posted by Jonathan Casler -> ?FS]>M on 11/3/2012 12:46 PM

    • death panels were a republican idea adopted in a a bipartisan bid via congressional committees ... that the Right wing rejected all their own ideas had more to do with their own legislative agenda as described by Mitch McConnell ("defeating Obama in 2012 is our number one legislative agenda item"-- january 2009). Remember, Bush and the Republican Congress of 2005 brought you HMO for medicare seniors underwritten by 500 billion in guaranteed profits. You may object to having your reimbursement cut, God knows I do, but at least I will have clients. Under HMO empowered Medicare I have no access to those patients. The election is only days away and a strong Democratic turnout is essential to ensure that the policies that brought us Donut holes, Medicare Advantage, Iraq and tax cuts for billionaires, etc etc. do not return.

      Posted by Jonathan Holtz on 11/3/2012 10:43 PM

    • "Death panels" completely misrepresent the very reasonable idea of discussing end of life decisions in a rational and reasonable manner, BEFORE a crisis happens. Making such decisions early makes practical sense. Most of the health care dollars are spent in the last 6 months of life - with no obvious quality enhancement. Obama's idea makes very good sense. I agree with Dan, more assessments are a nightmare with no apparent PT application. If we spend all our time doing bizarre assessments, then who is going to help the patient get better?

      Posted by Jane Milliff on 11/4/2012 9:44 PM

    • What I have learned: The character of the comments physical therapists leave on this subject is directly related to whether they: A) work in affluent areas vs. impoverished and B) whether these PT's (all credential abled health care providers) are employeed and may be naive. vs. selff employed and informed! Time has passed and the health care operations of the late 80's through the new millennium need to stop depending on the revenue $'s of Medicare and recognize that the only way to get commercial insurance to anti-up and pay better for HMO plans is to: CREATE COMPETITION FOR PROVIDERS TO WANT TO PARTICIPATE. The federal government through the Affordable Care Act (Obama Care) will do this through the medicaid system by: 1) providing an incentive to states to mandate an expanded contributory insuance policy alternative to the employer based insurance industry that abuses care decisions delivered via an IMPAIRMENT model. 2) allow development of a health care delivery system using the INTERNATIONAL CLASSIFICATION OF FUNCTION model by the World Health Organization. This will creating fiscal solvency and the ability of small providers nation wide to tell commercial mafia insurance HMO plans that YOU DON'T NEED THEIR STINKIN CONTRACT TO SURVIVE! Medicare is keeps revenues upin afluent areas. And those in afuent areas don't want to offer health insurance to those who live in impoverished areas for being a CNA for their elder while they live a life away from that responsibility. .regarding this manner is

      Posted by David Bullock -> >LU`CH on 11/4/2012 10:01 PM

    • Why did you reduce the cap and continue with it being combined PT with SLP? That make no sense. Rather, do away with the Medicare cap and place a heavier burden on medical necessity. As professionals, we need to be policing our own ranks.

      Posted by scott gibson on 11/5/2012 7:05 AM

    • In the hospital arena a shared $1270.00 CAP does not cover the costs of providing care. The shared CAP was a result of a typographical error(which CMS has admitted) and was not intended to be shared by the writers in the first place. At least get rid of the shared cap. The reduction is severe and with the 1 on 1 requirement in the physician fee schedule, there will be many who do not make it with this payment.

      Posted by Laurie H on 11/5/2012 12:31 PM

    • Really sad, we fight the nickle and dimes and miss the big picture. Experience and skill are ignored in the payment process, no one attributes the increase in costs to the aging population and their complexities, we are coming to a point where reimbursement does not cover the cost of one PT/PTA who is required to provide care let alone any overhead and to put the crowning star on the whole mess, PTs can't even opt out of Medicare.

      Posted by Leon Bradway -> AGQ^E on 11/5/2012 6:14 PM

    • This is bad for patients and bad for therapists.

      Posted by Carol Barker on 11/7/2012 1:41 PM

    • Can someone stand up and protect physical therapy profession? What kind of role is APTA playing in this issue?

      Posted by Wei on 11/8/2012 2:05 PM

    • Yes, what is APTA position in this issue? How can we still provide quality Tx for our Medicare pts with such drastic reimbursment restrictions? I would love to provide charity care for them (because that is where it all is coming to), but I simply couldn't afford it because I have to pay rent, salary to all my employees, etc. So, pls APTA, give us specific answer here!

      Posted by Bella Kavalerchik on 11/12/2012 12:39 AM

    • It does not appear that MedPAC took any of the APTA recommendations seriously. The rationale given to MedPAC by the APTA in Oct letter for not reducing the cap or considering MPPR seem to have been ignored or perhaps not even read.

      Posted by Betty Fackler on 11/15/2012 11:41 PM

    • APTA members should be aware that one of MedPAC's recommendations was addressed in legislation that Congress passed on January 1 to bring the nation back from the "fiscal cliff." The American Taxpayer Relief Act of 2012 (HR 8) applies the multiple procedure payment reduction (MPPR) to therapy services at 50%, up from 20% for office settings and 25% for facility settings, beginning April 1. APTA is strongly advocating to fix this flawed policy. For more information, visit APTA's 2013 Medicare Changes: January 2013 webpage at http://www.apta.org/Payment/Medicare/2013/Changes/.

      Posted by News Now staff on 1/7/2013 2:07 PM

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