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.
2 Comments
MedPAC is like a sherriff without a six-shooter…
I put the blame on the current mess on the 1997 Balanced Budget Amendment – like so many big, political levers the true effects did not become apparent for many years. This is the act of the Congress that put in place the annual Sustainable Growth Rate (SGR) adjustment to the Medicare Physicians’ Fee Schedule.
The SGR was supposed to ratchet down payments when utilization grew faster than the Medicare Economic Index (or GDP, I forget which).
Declining Medicare payments – the first attempt to “bend the cost curve” – would have substantially reduced government spending to a level that allowed the Clinton administration to balance the budget. In fact, that budget was built on projected numbers that never materialized.
The SGR first kicked in in 2003 and the Congress intervened to stop the supposedly disastrous cuts – about 3% in that year, I think. This year the cuts will be 27%.
I’m optimistic about the future – America’s healthcare system still has the potential to become the finest in the world.
I’m voting for Obama to try to make sure that happens.
Tim Richardson, PT
Perhaps if sufficient well grounded research is done a cap can be established that is reasonable enough that exceptions would be rare not automatic. To be sure there is more pork in the system that can be eliminated to allow for people to receive needed treatments.