In this article, written over a year ago, I indicated that I don’t believe all of the new Medicare regulations are designed with bad intent. They are all well intended programs that are complex, poorly designed, and clumsily administered.
The Therapy Cap
The Therapy Cap is awful. The intent was to contain the costs of therapy services. So, good intent. But why in the world would someone with a tennis elbow be subject to the same cap as someone who had a CVA? It makes no sense, and it hurts our most disabled patients the most.
Functional Limitation Reporting
Functional Limitation Reporting has the worthy intention of gathering data about effectiveness. But, as I have written earlier, the program is so poorly designed that it will not provide any useful data. It will likely be a classic case of meaningless data (Garbage In) that will be used to design new regulations and requirements (Garbage Out).
PQRS
PQRS has the worthy intention of improving quality. But, the measures were really designed for physician practices. The subset of measures that may be used by PT, OT and Speech bear little relation to rehabilitation practices. PQRS looks more like a way to decrease reimbursement than to improve quality.
Multiple Procedure Payment Reduction Program
It is a little more difficult to see the worthy intent of the Multiple Procedure Payment Reduction program, but from Medicare’s perspective, an argument can be made that it should cost you less per procedure to provide multiple procedures. Of course, the MPPR affects therapy providers more than anyone in health care because our payment system of timed procedure codes is actually designed so that we charge a procedure for every 15 minutes spent providing most services.
Manual Medical Review
It is a lot more difficult to see any good intentions behind using RAC auditors for Manual Medical Review. It makes no sense. RAC auditors have a financial incentive to deny claims. They have the power to deny claims based on medical necessity standards. I know that there are definitions of skilled care and medical necessity, but I also know they are open to interpretation. I also know that a RAC auditor may not be someone with any experience in rehabilitation. If someone’s salary depends on denying claims, they will find a way to deny claims.
It seems clear that none of this will change anytime soon if we rely solely on our professional associations and our personal political action. We will have much more success achieving real change if we can recruit our patients to lobby on our behalf. They have the credibility and the political clout that could change things for the better. But, they need to understand the problem first.
Three Things You Can Do to End the Cap
Of all of the programs mentioned above, the Therapy Cap is the most arbitrary and unfair. Right now, there is a chance that the Therapy Cap exceptions process will not be extended past March 31, 2014. Ideally, the Therapy Cap should be finally put to rest. If that isn’t possible this year, it is vital that the exceptions process for the Cap is extended, so you can continue to treat Medicare patients beyond the cap based on medical necessity.
- Educate your patients on these unfair Medicare programs. I have created a slide deck explaining some of the Medicare programs that affect therapy services. The intended audience is any health care consumer, but especially your Medicare patients. Please review it and give me your feedback, but, more importantly, share it with your patients. Go over it with them. Explain to them why this is important to them. Blog it, tweet it, and share it. Here is a link to the slides: Medicare Regulations for Therapy
- Ask your patients, friends and family for help . Ask them to let Congress know that the arbitrary, unfair Therapy Cap needs to end now. The APTA has provided a resource to make this easy for them to do: Stop the Therapy Cap
- If you are an APTA member, click here and take action: Legislative Action Center