AOTA Opposes National Therapy Cuts
Update: AOTA participated in a coalition meeting at the Centers for Medicare & Medicaid Services (CMS) with senior staff officials on September 21, 2010. CMS listened to coalition concerns regarding multiple procedure payment reductions (MPPR) proposed for therapy. In addition, AOTA President Florence Clark met recently with top officials from the Department of Health and Human Services (DHHS) regarding the same proposal. A final rule is expected on or about November 1, 2010.
The Medicare Physician Fee Schedule is the most prevalent system of payment for occupational therapy services in the country. It does not affect just Medicare settings and payment, however. Medicaid programs in many states rely on Medicare to guide payment amounts and rules. Private insurers in some cases build their fee schedules on the Medicare relative value system. Workers’ compensation in California is proposing to use the relative values and some of the policies of Medicare to guide payment. In other words, it is big.
To protect your payments and economic well-being, AOTA has been advocating on many fronts to oppose cuts contained in the proposed 2011 Medicare Physician Fee Schedule rule published in the July 13, 2010 Federal Register (75 Fed. Reg. 40040).
The proposal affects occupational therapy payments for all outpatient services. Relevant proposed changes in the Medicare fee schedule reverberate throughout the health care system. When AOTA works on Medicare, it has wide-ranging consequences. This year, Medicare is proposing a new approach to payment that will pay less for all therapy units after the first on any given day. Furthermore, the proposed multiple procedure payment reduction (MPPR) policy lumps occupational therapy, physical therapy, and speech-language-pathology services together, cutting all services in a day after the most expensive service. It is a complicated proposal but even by Medicare’s estimates it could achieve reductions of 12%–15% for Medicare Part B in all settings, including private practices, hospital outpatient departments, and skilled nursing facilities. Such cuts are inappropriate and, in AOTA’s view, would adversely affect patient care. And similar cuts may be seen wherever the fee schedule policy is adopted by private insurers, Medicaid, or others. Read more in AOTA’s in-depth analysis of the rule.
AOTA has been active in pushing back this proposal. The proposed fee schedule rule was published with a 60-day comment period. AOTA reached out to volunteer experts and our champions on the Hill, and met with the Medicare Payment Advisory Commission (MedPAC) to make them aware of the flaws in the proposal. MedPAC’s comment letter to CMS was consequently skeptical of the proposal. AOTA worked to get 68 House representatives and 24 Senators to sign-on to House and Senate letters to CMS to oppose the cuts, and AOTA was instrumental in convincing Rep. Pomeroy and Rep. Thompson to send a letter to CMS directly opposing proposed therapy cuts. AOTA posted information so all members could submit their own personalized comments. Furthermore, a coalition of several organizations, including AOTA, requested that CMS provide more of the data it used to come up with this approach.
"Our advocacy has truly been in high definition on this issue—reaching out to press all the levers of influence on this rule," said President Florence Clark. "Our success on the Hill and in presenting cogent arguments to MedPAC, and working with other organizations has come together to ensure that our vision for occupational therapy is not blurred by these inappropriate restrictions on payment."
In the proposed rule, CMS erroneously claimed that therapy services are misvalued for physician fee schedule payment when multiple services are furnished to a patient, because duplicate labor and supply costs are included in the practice expense (PE) values. To account for this perceived duplication, CMS proposed an MPPR for therapy that would make full Medicare payment for the therapy service/unit with the highest PE value and then apply a 50% payment reduction to the PE component of all subsequent therapy services/units furnished to a single patient on a single day.
In AOTA’s final comment letter submitted August 24, 2010, we strongly oppose the proposed MPPR and argue:
- Any redundancies have already been addressed through the American Medical Association’s (AMA’s) Health Care Professionals Advisory Committee (HCPAC) and Relative Value Update Committee (RUC) process.
- The proposed 50% reduction figure is arbitrary and unsupported by available data.
- The policy does not distinguish between the separate and distinct therapy professions.
- The policy could deny patient access to medically necessary care.
- The failure to share crucial data and data analysis limits our ability to provide meaningful comment.
AOTA believes that the proposed MPPR for therapy is unsupportable and that it undermines the formal, accepted AMA’s process for identifying and addressing misvalued codes. AOTA requested that CMS withdraw its proposed MPPR for therapy and rely—as it has historically—on the RUC’s analysis and recommendations for therapy code valuation.
CMS is expected to publish a final rule on or about November 1, 2010 – before the January 1, 2011 date when changes would go into effect.
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See AOTA's 2011 Fee Schedule Resources page and the Legislative Action Center for continued updates
CMS Fact Sheet: "Affordable Care Act Provisions and the CY 2011 Medicare Physician Fee Schedule Proposed Rule" (June 25, 2010)
CMS Fact Sheet: "Changes to the Physician Quality Reporting Initiative and the Electronic Prescribing Incentive Program (Included in the Calendar Year 2011 Medicare Physician Fee Schedule Proposed Rule)" (June 25, 2010)
Support AOTA’s advocacy efforts by encouraging your occupational therapy colleagues to become members of AOTA to raise our collective voice
Last Updated: 9/30/2010