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  • MedPAC Weighs Options for Outpatient Therapy Reform

    Yesterday at the March meeting of the Medicare Payment Advisory Commission (MedPAC), APTA provided comments on the value of physical therapy, support for short- and long-term payment reform, and an update on the associations' work on the severity/intensity model.

    Among its agenda items, MedPAC discussed outpatient therapy services and the mandated report it is required to deliver to Congress by June 15, 2013, as authorized by the Middle Class Tax Relief and Job Creation Act of 2012. The law specifically charges MedPAC with creating recommendations on how to reform payment under Medicare Part B and to examine private sector initiatives as they relate to outpatient therapy services.

    In its discussion, MedPAC considered background on therapy services and providers under Medicare, current trends in spending for outpatient therapy services, and concerns about payment policies regarding therapy services—such as the variety of settings in which therapy is provided under Medicare Part B, the growth in volume of therapy services, and variances in spending by setting and region. Commissioners also voiced concern over using diagnosis as an indicator of therapy need.  

    MedPAC provided 4 options for the commissioners to consider: (1) major systems reform; (2) tighter coding (short-term reform); (3) improved management of the benefit; and (4) benefit refinement and improvement.

    APTA will work with MedPAC in the coming months as it examines ways to reform the Part B outpatient therapy benefit and prepares its recommendations to Congress.       


    • Thank you for such great advocacy for the profession. This is one of the reasons I am proud to be an APTA member.

      Posted by Nancy Paddison, PTA on 3/9/2012 2:43 PM

    • Having worked both in outpatient ambulatory settings w/ higher functioning older adults and currently in a SNF w/ older adults who often face multiple impairments, it is important to consider that although SNF patients often take much longer to respond to PT, nonetheless they do respond and their functional gains are often profound. Some have been able to return home or at least to a assisted living facility at a great personal financial savings over the SNF. In establishing reimbursement policies for Part B, SNF patients should be considered separately because of the uniqueness of their situation: current Part B limitations often do not allow the time necessary to optimize the SNF patient's function and penalize those therapists and their facility who feel ethically committed to continue their patient's progress, even though they know the Part B reimbursement will probably be terminated because of the length of time involved. Furthermore, SNF patients need to be studied as a unique population so that good cost-effective, evidenced-based treatment outcomes can be established and thus, reimbursed appropriately.

      Posted by Michael Roberson PT, GCS on 3/10/2012 4:43 PM

    • I think the most important aspect is that physical therapy continues to have an impact on the daily functional lives of every age group. The benefits of quality time with each and every person a physical therapist connects with can have additional benefits to the caregivers and provide additional resources for all healthcare professionals to assist in the continuum of care process. Thank you for the information.

      Posted by Heidi Harris on 3/11/2012 5:35 PM

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