WASHINGTON, DC—The Medicare Payment Advisory Commission (MedPAC) on June 14, 2013 shared its recommendations for reforming outpatient therapy services in Medicare with Congress. As a member of the Therapy Cap Coalition—a collaboration of patient and consumer advocates, health professionals, and provider organizations—the American Occupational Therapy Association (AOTA) appreciates MedPAC’s efforts to put forth meaningful reform proposals. However, some of the panel’s final recommendations would serve to significantly reduce access to vital rehabilitation care and do little to ensure appropriate payment for services or minimize inappropriate utilization.
Despite serious concerns with many of the recommendations, the coalition is pleased by the Commissioners’ recognition that a hard cap on outpatient therapy without an exceptions process would create enormous barriers to care.
“For tens of thousands of Medicare beneficiaries seeking much-needed occupational therapy, the exceptions process is critical. MedPAC is right to reject a hard cap on therapy services,” said Christina Metzler, Chief Public Affairs Officer at AOTA.
AOTA is concerned, however, about MedPAC’s recommendation to lower the annual allowable limits for outpatient therapy services from $1,880 to $1,270. Under such a proposal, Americans most in need of rehabilitation therapy would, undoubtedly, see their recovery efforts halted by delays in care and barriers to access.
“Lowering the cap simply makes a bad policy worse,” said Metzler. “We understand MedPAC’s interest in containing costs in the Medicare program, but limiting access to medically necessary services with any arbitrary cap is the wrong approach. AOTA much prefers MedPAC’s suggestions about targeting those who abuse the system.”
Occupational therapy has been proven to result in lower health care costs and improvement in quality of life for patients and consumers requiring these services. Occupational therapy practitioners help people across the lifespan participate in the things they want and need to do through the therapeutic use of everyday activities (occupations). Occupational therapy practitioners help the senior population cope with physical and cognitive changes, including anything from stroke rehabilitation, fall prevention, and low vision, to recommendations or adaptations for safe driving.
“Research shows that occupational therapy access improves quality of life and can reduce costs. Without these services, how will beneficiaries maintain their independence? How will they be safe in their own homes? How will they recover from strokes or broken bones? We must live within limits, but those limits must be fair and equitably applied,” said Metzler.
AOTA remains committed to working with MedPAC and Congress to achieve meaningful reform that ensures access to care, maintains program integrity, and captures the value of therapy, including its potential to reduce spending and promote better health outcomes throughout the system.
Founded in 1917, the American Occupational Therapy Association (AOTA) represents the professional interests and concerns of more than 140,000 occupational therapists, assistants, and students nationwide. The Association educates the public and advances the profession of occupational therapy by providing resources, setting standards including accreditations, and serving as an advocate to improve health care. Based in Bethesda, Md., AOTA’s major programs and activities are directed toward promoting the professional development of its members and assuring consumer access to quality services so patients can maximize their individual potential. For more information, go to www.aota.org.