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ADVANCE Perspective: Physical Therapy & Rehab Medicine

CSM 2013: APTA Steps Up Advocacy on Federal Affairs

Published January 24, 2013 10:19 AM by Lisa Lombardo

SAN DIEGO--In a two-part session to accommodate a wide range of topics on Medicare and federal health care law changes, APTA presented "Emerging Issues in Medicare and Federal Affairs: What Every PT Needs to Know" to a packed audience on Wednesday at CSM. The first point the speakers felt attendees needed to know was that its government affairs office was more than ready to increase its advocacy efforts on behalf of the profession given the impending changes to health care insurance law.

Mandy Frohlich, director of advocacy efforts for APTA, said the last-minute negotiations on the fiscal cliff agreement out of Congress resulted in a last-minute package for Medicare, resulting in a 26.5 percent fee schedule cut, expansion of the current therapy cap extensions until Dec. 31, 2013, and a short-term fix on sequestration to March 1, 2013.

Frohlich said grass-roots efforts are focusing on "the number 1 priorities" of the Medicare Fee Schedule and the Multiple Procedure Payment Reduction (MPPR) that awaits determination in Congress. APTA has headed comment letter and coalition letter campaigns, attended more than 60 Hill meetings, organized PPS Lobby Days and more efforts to make sure that the decision on the MPPR in particular was not going to be offset for 2013, Frohlich said.

She listed the next steps APTA planned to take prior to the April 1, 2013 decision on MPPR, which affects future changes to therapy cap extensions: Redoubling efforts to find a way out of the cycle of yearly extensions on the cap; preparing for the next series of votes to introduce language changes on cap reform; and gearing up for overall payment reform efforts. Action alerts are already out this month, she noted. "Our grass-roots attempts are aimed at fixing the MPPR within the context of larger legislation," Frohlich stressed.

The Impact of MPPR

Gayle Lee, JD, explained the impact of the MPPR as it would relate to PT and other disciplines. It would apply across the board to all disciplines in all outpatient therapy settings with the exception of critical access hospitals. CMS has identified a list of CPT codes to which MPPR would apply; work costs and malpractice insurance costs would not be reduced under the measure, Lee said.

The larger impact on the profession depends on practice patterns, Lee pointed out, and said APTA has developed a calculator to help PTs determine, based on their own practice billing, how low their cuts will be after the April 1, 2013 deadline. Website instructions are listed on the APTA website.

Cap Decisions Loom

Frohlich noted that the cap on outpatient therapy, in effect since 1997, got yet another extension as a result of the last-minute budget deal last month. But she warned, "this exceptions process is not a given anymore, where it is just renewed for another year every year. We're in a different budget environment now; Congress is confronted with coming up with $1 billion to extend the cap in this budget environment. Congress has always shown a willingness to work with us--but we need to be smarter about our approach to this.

"If this profession isn't smart, we will find ourselves in a position where the caps will go into effect [permanently], that is just the budget reality now. We are working on the language needed to possibly repeal it altogether, but realistically we don't see [Congress] coming up with the $10 billion to repeal it. Congress can work with us, though, to find modifiers to offset any continued extensions," she stressed.

The cap on outpatient physical therapy for both PT and speech therapy is $1,900, and for OT singly is the same, up from $1,880, under the latest extension, Lee said. Claims exceeding $3,700 in exceptions are subject to mandatory medical reviews, and APTA is still awaiting guidance from CMS on what that means for 2013. Manual audits could revert to electronic ones, she said. And advance approval on exceptions doesn't guarantee payment without an audit later, she noted. In addition, clinicians collecting money out-of-pocket must first send the beneficiary a notice of such out-of-pocket payments.

One attendee asked if any possibility remained to separate PT and speech therapy in the cap limit. It is possible, Frohloch said, but this would require a change to the Medicare statute, at a huge cost to the government to change. "We have always believed the real answer is to get out from under these caps altogether," she said, and APTA has directed its advocacy efforts in that direction.




I am pleased to see the APTA spearheading these important issues. Why though, is there no public outcry? Congress reacts to constituents' demands. This effort will demand a double headed approach. The APTA has one covered. Now let's get the public to get on board the other. It is time for greater public engagement.

Dean Metz February 4, 2013 11:20 PM

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