MedPAC October 2012 Meeting: Potential Changes to Medicare’s Payment System for Outpatient Therapy
On Friday, October 5, 2012, MedPAC staff followed up on ideas regarding outpatient therapy delivery, utilization, and payment initially presented at their September 7 meeting. MedPAC is an independent commission charged with making recommendations to Congress regarding Medicare policy. The organization will vote on recommendations at the November 1-2, 2012 meeting that will have the potential to shape the future of occupational therapy utilization and payment under Medicare.
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 recommendations to the MedPAC Commissioners that included cuts to therapy payment (a 50% multiple procedure payment reduction (MPPR) across all settings, or a reduction of the statutory cap amount, or both) and increased manual medical reviews. Staff were clear that it was not desirable to have a “hard cap” for therapy services without an exceptions process of some sort. A discussion was also had regarding the long-term collection of functional data using a uniform tool for all disciplines, though that providers could continue to use discipline-specific tools of their choice for patient planning purposes.
AOTA is concerned about these possible MedPAC recommendations, and AOTA staff provided testimony at the meeting and met with Commission leadership in Washington, DC on Thursday, October 18, 2012.
MedPAC October Brief
MedPAC October PowerPoint slides