MedPAC September 2012 Meeting: Improving Medicare’s Payment System for Outpatient Therapy Services
On Friday, September 7, 2012, MedPAC staff publicly presented their preliminary thoughts regarding outpatient therapy delivery, utilization, and payment. MedPAC is an independent commission charged with making recommendations to Congress regarding Medicare policy. The organization’s recommendations will shape the future of payment for occupational therapy in Medicare and will impact Congress’ decision on whether to extend the exceptions process to the therapy cap and whether to extend the application of the therapy cap to hospital outpatient departments (HOPDs) in 2013.
The Middle Class Tax Relief and Job Creation Act of 2012 requires MedPAC to study outpatient therapy services delivered under Medicare Part B and to present recommendations on how to improve the payment system for such services via a Report to Congress in June 2013. Specifically, the legislation directs MedPAC to address how the Medicare outpatient therapy benefit can be better designed to reflect functional limitations, severity, and the therapy needs of the patient, and to review how private insurance manages the benefit. In order to inform this work, MedPAC met with AOTA staff this past spring and, among other things, convened an Expert Therapy Panel earlier this summer that included occupational therapists Elizabeth Skidmore and Trudy Mallinson.
MedPAC staff Adaeze Akamigbo and Ariel Winter presented options to the MedPAC Commissioners on three policy options: (1) improving management of the benefit by permanently including services from HOPDs under the cap, implementing focused reviews, eliminating the use of V-codes, and/or adjusting the cost-sharing breakdown; (2) collecting information on functional status using a single, standard instrument across disciplines; and (3) reforming the payment system for outpatient therapy services by making in episodic or adopting strategies currently in use in the private sector, such as visit limits or prior-authorization requirements.
AOTA staff provided testimony at the meeting and submitted formal written comments to MedPAC.
MedPAC Brief
MedPAC PowerPoint slides
AOTA Written Comments (September 2012)
