Ok, Ok, you have got my attention now.  Just when I had finished celebrating health care festivus and had packed in my aluminum pole and  finished the celebratory “airing of grievances” for not being paid the last two weeks of September, I get thrown a loop by CMS.  Sure, anticipating the 5% reduction for not meeting the sustainable growth rate (SGR) was to be expected, but then another 5% for not meeting “budget neutrality”?  It’s time to really party now.

We are getting a 10% reduction and nobody seems to care except to say the exceptions process is also being termed notwithstanding some action during the “lame duck” session.  AND, this is coming off of the release of the CSC data which shows that outpatient PT accounts for 1.5% of all medicare expenditures (not a misprint)!!!!  Outpatient PT per 2004 data (including part B SNF) which was recently released shows about 3.2 Billion in paid claims by CMS or roughly 1.5% of medicare expenditures. The point is that they can stop paying for all outpatient PT regardless of setting and it won’t save the medicare program!

What is more frustrating is that CMS’ own data demonstrates shorter visits in PT but more intensity per episode (units per visit) which they account for as the key driver of the 13% increase.  So much for the re-weighing of E&M codes to get “doctors spending more time with their patients”.

I guess that CMS must think that our labor, insurance, liability, and other business costs are going down so that we can just sit back and tolerate a 10% decrease.  From my vantage point, the exceptions process is a “red herring”.  We ought to be raising furor over the rates first.

Larry

also posting in myphysicaltherapyspace.com discussion group for health policy and legislative