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.
The Centers for Medicare and Medicaid Services (CMS) has issued a new rule for the Outpatient Prospective Payment System (OPPS) that will create 29 comprehensive Ambulatory Payment Classifications (APCs) to handle payment for the most costly device-dependent services, require direct supervision for a range of outpatient services in critical access hospitals (CAHs), and increase the payment rates under the OPPS by 1.7 %. The new rule will be effective January 1, 2014; however, CMS will delay implementation and final configuration of the new 29 comprehensive APCs until 2015.
The comprehensive APCs would treat all individually reported codes as components of a comprehensive service, resulting in a single prospective payment based on the cost of all individually reported codes. CMS will make a single payment for the comprehensive service based on all charges on the claim, and charges for services that cannot be covered separately by Medicare Part B or that are not payable under the OPPS will not be reimbursed. Although physical therapy services are typically paid separately under Medicare Part B, some therapy services would be considered part of the comprehensive service based on several factors. In general, physical therapy services that occur in the perioperative period would be paid under the comprehensive APC payment.
The new rule also establishes a direct supervision requirement for outpatient therapeutic services in CAHs, a change that CMS believes will ensure quality and safety. Additionally, the rule reiterates the requirement in the physician fee schedule that the therapy cap must be applied to CAHs.
APTA submitted comments regarding the proposed rule and will continue to monitor the effect that these provisions will have on physical therapy. APTA will post a detailed summary of the final rule shortly.
Physical therapists (PTs) have long understood that mobility plays a key role in a patient's recovery from the Intensive Care Unit (ICU), but now national-profile articles are bringing this fact to a much wider audience. In recent articles in The Wall Street Journal and The Atlantic, physical therapy is being identified as 1 of several post-ICU treatments that can reduce the risk of long-term cognitive and physical impairment after stays in the ICU.
WSJ reported on November 25 on the prevalence of post-intensive care syndrome, a condition that includes brain dysfunction, post-traumatic stress symptoms, depression, fatigue, and muscle weakness.
Researchers quoted for the story pointed to the importance of "hard-core physical and mental rehabilitation" in successful recovery and asserted that "post-ICU patients need the same kinds of occupational and physical therapy as heart attack and stroke survivors."
A related essay in the November 21 Atlantic by Daniela J. Lamas, MD, touches on the long-term challenges faced by patients treated in ICUs and advocates for treatment approaches that acknowledge that release from the ICU "is not a victory narrative now, but one person's unfinished story."
The articles echo earlier pieces of reporting that appeared on National Public Radio and other outlets, most of which were sparked by a Vanderbilt University report on post-ICU conditions.
PTs play a key role in successful treatment of patients in ICUs, recently released from the units, and throughout the post-acute care continuum. APTA offers multiple resources on ICU-related practice, including a video on collaborative care models in the ICU and continuing education on promoting early mobility. The latest evidence-based research, including an article titled "Innovative Mobility Strategies for the Patient With Intensive Care Unit-Acquired Weakness: A Case Report," are available through PTNow, APTA's research access tool.
When Time magazine asked Sen Mark Kirk (R-Ill) to share what he was thankful for, he came right to the point. "I am thankful for the more than 300,000 physical and occupational therapists in the U.S.," he wrote, adding that without these professionals "there is no way I could have returned to the U.S. Senate … after I suffered a massive stroke in January 2012."
The statement from Kirk appeared in the November 25 issue of the magazine, which asked several public figures "to share what they're grateful for." Kirk described how he recovered from the ischemic stroke he suffered less than a year ago thanks to the work of his rehabilitation team, and how his experiences inspired him to introduce a "Stroke Agenda" that seeks legislative changes to enhance stroke research and rehabilitation access. APTA has worked with Sen Kirk to advance these efforts, and supported his introduction of the Rehabilitation Improvement Act (S 1027) targeted at advancing rehabilitation research within the National Institutes of Health (NIH). Sen Tim Johnson (D-NM) introduced the bill with Kirk.
"Having a stroke shouldn't mean the end of a productive life," Kirk wrote. "Physical and occupational therapists make a major difference in countless Americans' lives, including the life of this U.S. senator."
Sen Kirk's return to the U.S. Senate was documented in an NBC video, and photos of Kirk in rehabilitation are available at the Huffington Post.
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