Mounting evidence that physician self-referral encourages unnecessarily higher use of certain services more than justifies the introduction of the Promoting Integrity in Medicare Act today in Congress.
Rep Jackie Speier (D-CA) introduced the bill, announcing during a press conference that it is intended to remove physical therapy and other health care services from the in-office ancillary services (IOAS) exception, which allows for self-referral.
APTA and its partners in the Alliance for Integrity in Medicare, or AIM Coalition, strongly support this move to exclude these services from the IOAS exception. The exception—originally intended for same-day services, such as x-rays or blood draws, that are integral to the physician's services and convenient for the patient—has instead encouraged misapplication for financial self-interest. The result is overuse and hundreds of millions of Medicare dollars in unneeded treatments.
A series of reports from the Government Accountability Office (GAO) is but one source of evidence that supports this claim. Two published reports have concluded that when physicians provide certain services in their own facilities instead of referring the service to an outside lab, the number of procedures increases, and costs go up. GAO so far has investigated self-referral in advanced imaging services and anatomic pathology. GAO is expected to release a third report, on radiation oncology, any day now, and APTA anticipates the last—and most telling for our profession—report in the series, on physical therapist services, later this year.
"APTA strongly supports all efforts to eliminate self-referral situations and relationships that compromise patient access and quality or add cost," said APTA President Paul A. Rockar Jr, PT, DPT, MS. "APTA has worked hard to reach a solution to close this loophole, and we are pleased to see this important legislation introduced."
View APTA's Self-Referral webpage for more information and background.
The 2014 prospective payment system (PPS) final rules for skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs) call for market basket updates of 1.3% and 2.3% respectively. The Centers for Medicare and Medicaid Services (CMS) released the final PPS rules for these facilities July 31, and the Federal Register will publish both rules August 6.
Also for SNFs, an item is added to the Minimum Data Set to permit SNFs to record the number of distinct calendar days of therapy provided by all rehab disciplines—physical therapy, occupational therapy, and speech-language pathology—over the 7-day look-back period. The final rule clarifies that classification into the Medium Rehab category requires 5 distinct calendar days of therapy, and classification into the Low Rehab category requires 3 distinct calendar days.
For IRFs, the rule revises the list of diagnosis codes that may be counted toward the threshold to determine "presumptive compliance" (the "60% Rule"), removing nonspecific, arthritis, unilateral upper extremity, some congenital anomaly, and miscellaneous diagnosis codes. However, in response to stakeholder comments regarding implementation of these changes, the effective date is delayed for 1 year. Therefore, these codes will be removed for compliance review periods beginning October 1, 2014.
Under the IRF Quality Reporting Program, CMS adopts the following quality measures:
Both final rules become effective October 1, 2013. APTA will analyze them and provide summaries in the coming weeks.
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