AOTA to CMS: Occupational Therapy Must Be Treated as a Distinct Service
By Stephanie Yamkovenko
AOTA met with key representatives at the Centers for Medicare & Medicaid Services (CMS) on February 15, 2011, to reiterate concerns with the multiple procedure payment reduction (MPPR) policy found in the 2011 Medicare Physician Fee Schedule. AOTA is most concerned with the MPPR policy combining all therapy disciplines together and not recognizing the status of occupational therapy as a specified Medicare benefit.
AOTA discussed the issue with staff from CMS's Division of Practitioner Services and Hospital and Ambulatory Policy Group, among others. “We argued the facts of law—that occupational therapy is a distinct service defined by Congress as a separate benefit to which Medicare beneficiaries are entitled,” said Christina Metzler, AOTA’s Chief Public Affairs Officer. “The new approach to payment goes beyond pricing of services and inaccurately assumes there is duplication for tasks such as greeting the patient, taking vital signs, and making post-visit patient calls, and consequently cuts payment in an inappropriate manner.”
AOTA brought outside legal counsel from the firm of Ober|Kaler to the meeting to stress the importance that AOTA is placing on this issue and to inform CMS that in other instances, such as the Medicare therapy cap, there is a clear separation among the therapy disciplines. Occupational therapy is also defined in Sec. 1861(g) of the Social Security Act as a single service.
Congress gave CMS authority in the recent health care reform legislation, the Accountable Care Act, to identify and change payments for codes that are misvalued. However, the legislation clearly states that the review only applies to a single service. By applying the MPPR across multiple therapy services, AOTA believes that CMS oversteps its statutory authority.
AOTA also pointed out that CMS respects the distinctions between occupational therapy and other services because it requires a separate plan of care, a separate physician order, separate documentation and measurement of outcomes, and separate and specially educated providers. AOTA gave examples of how physical therapy and occupational therapy would be treating the same patient but would have completely different goals, outcomes, measurements, equipment, and other components.
“The examples seemed to raise awareness of the validity of our message,” said Metzler. “We must protect the integrity of occupational therapy. The MPPR is designed in a manner that will harm the discrete nature of the services beneficiaries have a right to.”
AOTA believes the meeting was a success because staff talked to key decision makers for nearly an hour. “At the end of the meeting, a CMS medical director in attendance spoke to us to assure us that CMS understands the distinct nature of the therapies,” said Metzler. “This was heartening. He has real world experience and knows what occupational therapy does.”
AOTA invited CMS officials to present at the Annual Conference & Expo in Philadelphia to explain the policy to members. AOTA has not yet received confirmation.
Resources:
For the latest AOTA communication to CMS on the MPPR, see this letter.
For more information on the 2011 Physician Fee Schedule and the MPPR, visit our Fee Schedule resource page.
Stephanie Yamkovenko is AOTA’s staff writer
