Medicare Makes Deeper Cuts To Rehabilitation Services

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Rehabilitation / Physical Therapy
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Medicare beneficiaries will continue to see cuts in rehabilitation services next year as new policies released today under the 2011 Medicare Physician Fee Schedule Final Rule create further challenges for providers who care for the nation's most vulnerable citizens, says the American Physical Therapy Association (APTA).

A new multiple procedure payment reduction (MPPR) policy aimed specifically at outpatient therapy services will reduce payment 7%-9% above the approximately 30% across the board reduction contained in the final rule. Also, payment for outpatient therapy services will be limited to $1,870 in 2011 for physical therapy and speech-language pathology services combined, further restricting beneficiaries' access to vital rehabilitation services for stroke, hip replacements, and chronic conditions.

"The situation for Medicare beneficiaries is getting progressively worse with these short-sighted policies that attempt to control costs without regard to the complex needs of this population," said APTA President R. Scott Ward, PT, PhD. "It is time to move away from policies that arbitrarily cut or limit services and move toward policies that ensure optimal function and recovery for each senior. The MPPR policy is ill-conceived and flawed. Such policies run counter to the Administration's stated goals and undercut its motives for health care reform."

On January 1, 2011, physical therapists in certain states could expect to see overall payment reductions of nearly 40%. APTA believes this could lead to some physical therapists closing their practices, which would further decrease access to care - especially for beneficiaries in rural areas. APTA is extremely disappointed with this unjustified payment cut and questions the Administration's desire to cut costs in any form possible without regard for patients' well being and the providers who serve the nation's seniors and individuals with disabilities. As such, APTA will aggressively explore all legal, regulatory, and legislative options to negate the MPPR policy.

Source:
American Physical Therapy Association

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Medicare Roundup: Courts Widen Coverage Of Skilled Care; Experts Give Enrollment Advice

The New York Times: "Two federal courts have ruled that the Obama administration is using overly strict standards to determine whether older Americans are entitled to Medicare coverage of skilled nursing home care and home health care." District courts in Vermont and Pittsburgh said that "Medicare will pay for those services if they are needed to maintain a person's ability to perform routine activities of daily living or to prevent deterioration of the person's condition. ... Skilled care may be reasonable and necessary and covered by Medicare even if the person's condition is stable and unlikely to improve." Medicare officials had previously determined that people with chronic conditions were not eligible for skilled care unless they were expected to get better over time. The ruling may be relevant to those with chronic conditions or disabilities such as Alzheimer's, multiple sclerosis or broken hips (Pear, 11/1).

Kaiser Health News: Meanwhile, "[t]his month marks the beginning of the annual enrollment time when (Medicare Part D) beneficiaries can try to pick the plan that provides the best coverage for their prescription drugs." Some seniors may be reluctant to change plans, but may want to take time during the Nov. 15 to Dec. 31 enrollment period to reevaluate their options, given that "there are some changes in the Part D program that may affect your out-of-pocket costs and coverage for 2011," in part due to the health-care overhaul law.

"Part D premiums are going up an average of 10 percent, to $40.72 monthly. But plans may depart significantly from that average, depending on such factors as deductibles, coinsurance and whether they cover prescription drugs while a beneficiary is in the so-called doughnut hole. There will be some new plan options as well. ... If your plan is being eliminated in 2011, you'll be automatically assigned to another plan in your area. Don't assume that this replacement is the most cost-effective choice for you" (Andrews, 11/2).

The Washington Post: "Medicare eligibility begins at 65, and it's wise to get onboard immediately, even if you're still working." Waiting too long will delay coverage. It's "free to anyone who has paid Medicare taxes for more than a decade or is married to someone who has." After you stop working, sign up for Part B as soon as possible; those who sign up late will incur a permanent premium penalty. Part B isn't free, but it "covers most other medical expenses except prescription drugs." Other pertinent advice: "Don't confuse original Medicare and Medicare Advantage;" "find out how your retiree plan works with Medicare;" check the Medigap coverage rules in your state, and "recheck your Plan D formulary every year" (11/1).

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CMS Releases 2011 Medicare Physician Fee Schedule Final Rule

Statement by APTA President R. Scott Ward, PT, PhD

Today the Centers for Medicare and Medicaid Services (CMS) released the 2011 Medicare Physician Fee Schedule Final Rule, which, I am disappointed to report, contains significant cuts to outpatient therapy services that will negatively impact physical therapists and millions of patients. Under a new multiple procedure payment reduction (MPPR) policy, physical therapists will see a 7%-9% reduction in payment for these services starting January 1, 2011.

The association is deeply concerned about this policy. APTA has worked diligently these past few months educating CMS, White House officials, the Medicare Payment Advisory Commission (MedPAC) and other policymakers about the detrimental effect the MPPR policy will have on physical therapists and the patients we serve. The initial MPPR proposal called for an 11%-13% cut in payments and, while our actions did have an impact, we are nonetheless seriously troubled by this final rule. This lesser reduction of 7%-9% will still mean disturbing repercussions for outpatient therapy providers and their patients. As such, APTA is now aggressively exploring all legal, regulatory, and legislative options to negate the MPPR policy.

APTA believes this policy is unjustified, as it is based on flawed analysis conducted by CMS in the agency's effort to avoid duplication of payment when multiple services are furnished during a session or day. As we know, the practice expense values for the codes reported by physical therapists had already been reduced to avoid duplication during the Relative Value Update Committee (RUC) review process, thus making the MPPR an unfair and unnecessary policy. In addition, CMS only examined the median number of units in private practice therapists' offices and physician offices, which account for approximately 35% of expenditures. Data from skilled nursing facilities, hospitals, rehabilitation agencies, and comprehensive outpatient rehabilitation facilities, which account for the remaining 65% of expenditures, were not taken into account. And, CMS excluded all dates of service during which one unit of service is billed, further skewing the data on which this policy is based.

Lastly, the final fee schedule rule includes several other provisions important to physical therapists, including the implementation of the $1,870 therapy cap without an exceptions process, the projected cut in the sustainable growth rate/conversion factor of approximately 30%, and the expiration of the geographical practice cost index (GPCI) floor. Also in the rule, CMS discusses options for therapy payment alternatives, quality reporting under the physician quality reporting initiative (PQRI), and application of a MPPR policy for therapy services under Medicare Part B.

APTA will work to ensure that CMS establishes payment policies that guarantee appropriate payment for the high quality services we provide our patients. The Association is committed to being a leader in policy change and in developing payment models that accurately reflect the care and treatment provided by physical therapists.

Source:
American Physical Therapy Association

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