MPPR: Congress Gets Involved

Sixty-Eight members of the US Congress (including Mr Arcuri from a neighboring district) have weighed on the issue of MPPR in Medicare services provided in the outpatient therapy clinics nationwide.

Dear Administrator Berwick:

We Write to you to express our concern over the significant cuts in payment for outpatient physical therapy, occupational therapy, and speech-language pathology services proposed by the Centers for Medicare and Medicaid Services (CMS) in the CY 2011 Physician Fee Schedule Proposed Rule. If implemented, these cuts would apply to outpatient therapy services furnished by outpatient clinics, hospitals, skilled-nursing facilities, home health agencies, comprehensive outpatient rehabilitation facilities and other entities.

CMS has estimated implementation of the proposed changes would result in a 12-13 percent out in payment for outpatient therapy services starting on January 1, 2011. Specifically, CMS proposed to reduce payments by 50 percent for the practice expense component of therapy procedures for the second and subsequent procedures or units of the service furnished during thesame day for the same patient. The rehabilitation community strongly believes that a cut of 50 percent is unwarranted and is concerned that CMS’ proposed policy is based on a flawed assumption that there is duplication of services when rehabilitation services are billed. Therapy codes are unlike most other Current Procedural Terminology (CPT) codes in that the practice expense component for a typical visit is spread out among multiple codes since multiple services are typically provided to a patient during a visit. The purpose of spreading out the practice expense component was endorsed by the agency to prevent the chance of duplication.

Given that this represents a significant cut to a group of services in the proposed Medicare Physician Fee Schedule and given the large number of Medicare beneficiaries who rely upon these therapies, we ask that CMS provide us with a detailed justification, including an explanation of the methodology used to calculate the new rates. We also ask that CMS work closely with stakeholders in the rehabilitation community toward the production of a final rule that will not adversely impact access to care, particularly in rural and other underserved areas.

Lastly, Congress has acted on numerous occasions to extend an exceptions process to the Medicare Part B therapy caps, now scheduled to expire on December 31, 2010. In addition to reviewing the proposed fee schedule cuts for CY 2011, we also urge CMS to closely examine other therapy payment methods and altematives to the therapy caps that will preserve and improve access to necessary services for Medicare beneficiaries.

I would like to extend a sincere thank you to all the parties who signed onto this letter to Mr. Berwick. If your local congressional representative failed to be contribute to this letter, I would encourage you to contact them and ask them to send a letter as well if they have not done so already.

Reprinted with permission from The Concerned Physical Therapist