Try to put yourself in Medicare’s shoes for a few minutes. Health care costs are increasing. Outpatient therapy services are poorly understood and are rising faster than other costs. In fact, from Medicare’s perspective, outpatient therapy services may seem like a “nice to have” set of services and not essential. It is a political year and everyone is clamoring for health care reform.
On October 5th, the Medicare Payment Advisory Commission (the independent agency that advises Congress on Medicare Policies) presented their recommendations on outpatient therapy services. I believe Slide 6 in this presentation is very telling.
My interpretation is that MedPAC wants to know:
- Who should get therapy?
- What type?
- How long?
- Do therapy patients actually improve?
- If so, how much?
- Why is there such a large regional variation in cost?
I believe that from MedPAC’s perspective, using physicians as gatekeepers for therapy services with the Plan of Care mechanism isn’t working. A therapy cap with an automatic exception process* isn’t working either. So, MedPAC is recommending reduced payment rates, an increase in the MPPR, a decrease in the level of the caps, and a reporting mechanism for functional improvement of therapy patients.
*Rhetorical question… how can you have a payment cap, but have an automatic exception? It is like using a colander instead of a bowl to hold hot soup.