AOTA advocacy for reform: A broken system

The Medicare Physician Fee Schedule (MPFS) is the system that determines the payment rate for the majority of outpatient Medicare Services (Part B), including occupational therapy. For decades, the MPFS has had challenges ensuring adequate payments for Part B Services. In fact, under the old payment system, known as the Sustainable Growth Rate (SGR), Congress had to intervene 17 times between 2003 and 2014 to avoid cuts to payments. Issues with the MPFS are particularly impactful, as other payers such as private insurers and Medicaid often base their payment rates on the MPFS.

In 2015, Congress passed bi-partisan legislation called the Medicare Access and CHIP Reauthorization Act (MACRA) (H.R.2 — 114th Congress, 2015-2016), which changed how physicians and other health professionals, such as occupational therapy practitioners (OTPs), were paid for Part B Medicare services. MACRA replaced the outdated SGR with a new payment system that was supposed to base pay on quality, value, and outcomes.