House of Representatives passed legislation that would repeal the Patient Protection and Affordable Care Act (PPACA). The legislation now will move to the Senate. It is likely that the bill will not even be brought to the floor for consideration.
As a part of essential health benefits to be established under the Health Care Exchanges it is important that the IOM consider benefits’ coverage decisions based on effectiveness over cost. and determine essential health benefits based on a national standard of evidence-based medicine divorced from politics and policymakers’ influence.
With the addition of Hawaii, 46 states now give patients the ability to get an evaluation from physical therapists without having to get a referral from their doctor.
Workign together a number of assocaitions provided the governor with “concrete suggestions” including alternative cuts that gave Washington’s governor the information she needed to restore therapy to the Medicaid budget.
The legislation recently stopped the 24.9% payment cut from occurring on January 1, 2011. However, CMS announced that the conversion factor used to update payment for next year will be $33.9764 instead of the $36.8729 conversion factor that was in effect in 2010.
An Accountable Care Organization (ACO), is an organization of health care providers that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it. APTA argues that PTs should be included in the ACO model in order to continue quality of care throughout different treatment settings.
Some major changes are headed our way in terms of the 2011 Medicare Final Rule on the Physician Fee schedule and Other Policies to be effective January 1, 2011. The Rule included a number of provisions that have impact on outpatient therapy services. The net effect of the policies could lead to payment reductions of approximately 30%.
If you see Medicare patients and they impact your revenue, there are several things to pay attention to and deal with proactively. These changes pose a significant threat to a growing population of baby boomers and their ability to access PT. Changes to these payment reductions can only be averted through Congressional action. APTA is notifying its members of opportunities to advocate on behalf of the profession to eliminate these payment cuts and any developments associated with the implementation of the Multiple Procedure Payment Reduction (MPPR). Many believe that an extension of the therapy cap exceptions process and a reprieve for Medicare Fee Schedule cut will be considered and with some heavy lobbying are expected to be passed. Please stay alert to these changes and be pro-active in standing up for our profession and the value of the services that we provide.
Here is a brief summary of these provisions to provide a better understanding of the rulings. For a more comprehensive summary for APTA members, please see the 2011 APTA Fee Schedule Summary.