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    CMS Issues Final 2014 Physician Fee Schedule Rule

    The final 2014 Medicare physician fee schedule rule (.pdf) released by the Centers for Medicare and Medicaid Services (CMS) sets the therapy cap amount on outpatient services at $1,920. In addition, the rule announces a 20.1% reduction in Medicare payment rates for physical therapists (PTs), physicians, and other health care professionals—a cut linked to the flawed sustainable growth rate (SGR) formula being discussed in Congress.

    The new rule also updates payment amounts for physical therapists, physicians, and other health care professionals, makes changes to the Physician Quality Reporting System (PQRS), and revises other payment policies.

    The final rule’s 20.1% reduction is to the conversion factor used to determine Medicare payment rates, a reduction generated by the flawed SGR formula. Since 2003, Congress had enacted legislation preventing the reduction every year. The president’s budget calls for averting these cuts and finding a permanent solution to this problem, and Congress is currently working to address an alternative payment method that would include permanent repeal of the SGR. If Congress does stop the 20.1% payment cut, the aggregate payment for outpatient physical therapy services due to changes in practice expense, work, and malpractice relative value units would remain unchanged from 2013.

    Aside from setting the therapy cap at $1,920 for 2014, the rule makes changes to payments to critical access hospitals (CAHs) beginning January 1, 2014. Despite strong objections from APTA and other stakeholders, the rule subjects CAHs to the therapy caps, as well as any potential extension of the therapy cap exceptions processes, in the same manner as other providers of outpatient therapy services. The therapy cap automatic exceptions process and the manual medical review process, applicable to outpatient therapy expenditures exceeding $3,700 per beneficiary, will expire on December 31, 2013, unless Congress acts to extend them. APTA is working aggressively to have Congress address the therapy cap through repeal or extension of the exceptions processes.

    CMS has finalized its proposal, supported by APTA, to require that individuals performing “incident-to” services in the physician’s office must meet any applicable state requirements, including licensure. This would enable the federal government to recover funds paid if services are not furnished in accordance with state law.

    PQRS will see major changes for 2014. Physical therapists, physicians, and other eligible professionals will be able to avoid the 2016 2.0% PQRS penalty by reporting at least 3 individual measures via claims or registry for 50% or more of eligible Medicare patients in the 2014 reporting period. Though opposed by APTA and other stakeholders, CMS will increase the number of PQRS quality measures that providers must report either via claims or registry from 3 to 9 to qualify for the 0.5% bonus payment in 2014. CMS will maintain the current 12-month calendar year reporting period for the PQRS program but will eliminate the option to report on measures groups via claims.

    APTA submitted extensive comments in response to the proposed rule that was issued in July 2013. The final rule with comment period will appear in the December 10 Federal Register. APTA will post a detailed summary of the final rule shortly.

    Congressional discussions on SGR and therapy cap repeal will be taking place soon. Join APTA's grassroots efforts to call for an end to both flawed policies on December 2. Find out how to make your voice heard.


    Comments

    Why are we expected to provide more and more data when we are being paid less and less. Even with EMR that helps guide us, reporting 9-12 measures is overly burdensome.
    Posted by Caroline Taylor on 11/30/2013 4:52 PM
    We can not endure any further cuts to our fee schedule. We have had 10 consecutive years of cuts. We have tightened our belts and reduced our expenses but at some point you can no longer cut. The medical professionals are working at the same rate of pay as they were paid in 2008. There is no opportunity to increase pay rates due to the continuous cuts. Increased costs on the provider side for EMR, Licensed professionals, Privacy practices, HIPAA compliance, portals, and billing agencies have completely taken all of the profit margin. Increased Deductibles, Copays and co-insurances AKA Patient portions are not getting paid. The insurance companies are increasing the premiums while also increasing the patient portion of each claim. This is increasing the cost to collect the allowable amount for each claim. Patients do not pay their bills. Then the Provider is forced to send these patient portions to collections again reducing our collectable amounts. One policy pays $10 of the $110 allowable we must go to the patient to pay the $100 copay. All we hear is we can not afford it. Our cost for this procedure is over $70.00 How do make a profit we we only collect $10.00 while spending $70.00 to perform the procedure??? The patients are hearing affordable care and what they think is FREE! Not increased premiums co-pays and co-insurances. We need insurance reform not Healthcare. Healthcare providers went into the healthcare filed because they love what they do but we can not do it for FREE.
    Posted by Gretchen Kollhoff on 12/1/2013 9:44 AM
    Really? More reporting? With all due respect to massage therapists. I now get paid the same or less than massage therapists for the same time period of service. Add in the administrative cost/time of insurance billing and functional/PQRS reporting, it is definitely less reimbursement. Why would anyone now consider a DPT degree? Very soon hospitals (and the public) will not be able to afford us.
    Posted by Gary on 12/3/2013 7:25 AM
    For PQRS: Is the 2014 requirement that PT's report on 9 measures? The summary above states, "Physical therapists, physicians, and other eligible professionals will be able to avoid the 2016 2.0% PQRS penalty by reporting at least 3 individual measures via claims or registry for 50% or more of eligible Medicare patients in the 2014 reporting period." Does this mean that if you report on 3 measures you will avoid the 2016 2% cut but not receive the .5% bonus for 2014 unless you report on 9 measures? Cathy Anastasio
    Posted by Catherine Anastasio -> EHYc on 12/3/2013 10:58 AM
    Amen Gretchen Kollhoff! I could not agree any more with all your eloquent comments. Great job of explaining the struggles that private-practice clinics face with Medicare rules and reduced reimbursement rates year after year. If this trend continues, seniors are going to have a really hard time finding clinics to provide physical therapy services anywhere near where they live because the providers cannot continue to accept such low reimbursement rates and survive (let along thrive)!
    Posted by Larry Bryant -> >NYcCO on 12/3/2013 1:33 PM
    Why is our government forcing physical therapists to volunteer our time to participate in physician-focused programs  (e.g. Physician Quality Reporting System, Physician Compare, Physician Fee Schedule) but then not allow physical therapists to receive compensation (e.g. $44,000 annual incentive payments) for these horrendous adminsitrative burdens? Why is our government setting up a tiered payment system so that physical therapy services are being reimbursed at lesser rates when performed by physical therapists compared to physicians or nurses who perform the same service? Are physicians really better at providing physical therapy care than physical therapists? Do physicians have more stress when providing physical therapy services? Does electricity cost more when used by physicians? Do physicans have more expensive homes and cars than physical therapists?  Why does our government continue to aggressively inspect physical therapy practices for compliance errors (e.g. CERT reviews, Manual Medical Reviews, probe audits) when compliant PT practices have already been vetted by these programs through multiple and varied audits over the past year?  Why do our government agencies and departments not accurately and consistently describe current physical therapy practice? National Institue of Health repeatedly tells consumers that PTs are like trainers and patients should see their doctors first. If a physical therapist holds a DPT is she not a physical therapy doctor? Various CMS Medicare manuals refer to PTs as non-physician practitioners while others exclude PTs as ineligible because of ancillary status.  If our governement and society respect the education and credentials of professionals who hold doctorate-level degrees (e.g. doctors of medicine, doctors of podiatry, doctors of chiropractic), why are doctors of physical therapy not also supported as highly educated practitioners and given preferential treatment? Does DPT have any real value to our society? I find my government's attitude expressed by the behaviors I have questioned above to be discriminatory, and simultaneously childish and overly parental. This is Sneetch-like behavior = physicians are superior to physical therapists in providing physical therapy care because they have MD stamped on their bellies. I have a DPT and GCS stamped on my belly from accredited institutions; other PTs may have BS and MPT stamped on their bellies. Are physicial therapists with higher levels of schooled education really better at providing physical therapy care than those with a BS or MPT degree with years of experience and continued education?  Physical therapists evaluate, diagnose and treat people of all ages who have concerns/problems with potential/real impairments, functional limitations and disabilities within the context of having one or more medical condition. Would it help us gain entry into the "medical club" if we used more inclusive language to define physical therapy as a "medical healthcare profession"? I think CMS, NIH and AMA are continuing to demonstrate bulleying behaviors that are grossly discriminatory against physical therapy practice in general.  I am extremely displeased that they do not support or encourage quality physical therapy practices to thrive knowing there is a huge shortage of all medical healthcare professionals, including physical therapists.
    Posted by Dr. Lise McCarthy, PT, DPT, GCS on 12/5/2013 9:17 AM
    CMS has finalized two thresholds for reporting via claims in the PQRS program. The two-tiered reporting approach allows eligible professionals, including physical therapists (PTs) to either (A) qualify for the 2014 0.5% bonus and avoid the 2016 payment penalty of 2%, or (B) avoid the 2016 payment penalty only. In order to qualify for the 2014 bonus of 0.5% and avoid the 2016 2% payment penalty, eligible providers reporting via claims, including PTs, will need to report at least 9 measures covering at least 3 National Quality Strategy (NQS) domains. However, if 9 measures covering at least 3 NQS domains are not available, then PTs can report 1 – 8 measures covering 1—3 NQS domains and still qualify for the bonus and avoid the payment penalty. In the case where fewer than 9 measures are available, eligible professionals will be subject to the Measure-Applicability Validation (MAV) process, which would allow CMS to determine whether an eligible professional should have reported quality data codes for additional measures and/or covering additional NQS domains. We anticipate that physical therapists will be eligible to report on 8 measures, covering 4 of the NQS domains for the 2014 reporting year via the claims reporting mechanism. We will confirm the 2014 measures once the 2014 measure specifications documents are released. Measures must be reported on at least 50 percent of the Medicare Part B FFS patients seen during the reporting period, or calendar year. If you just want to avoid the 2016 2% payment penalty and aren't interested in getting the 0.5% bonus in 2014, there is a lower threshold. To meet this lower threshold, PTs reporting via claims will need to report at least 3 measures on at least 50 percent of the Medicare Part B FFS patients seen during the reporting period or calendar year. We will be hosting a webinar on the 2014 PQRS program on Thursday December, 19. We are also updating our PQRS website to reflect the 2014 requirements, and will notify members when PQRS updates are available.
    Posted by News Now Staff on 12/6/2013 1:30 PM
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