Just when I was about to start my summer reading list, I was sent this:
Download medpac_report_jun06_ch06.pdf. Fresh and hot off the press is the Medpac’s report to Congress regarding outpatient therapy and it is interesting to say the least. This report have more posts, comments, and participation than any other EIM blog post in our history. The implications from this report are numerous-outcomes, future payment approaches, guidelines, provider variation, geographic variation, caps-I can go on forever. Before, I list some of the points made in this report, I must confess that I am inherently biased by the fact that they analyzed only 5% of the claims in 2004 from fiscal intermediary and carrier claims, yet make fairly bold conclusions regarding provider setting. Regardless, this is interesting and should spark a flurry of debate. Should be mandatory reading by all outpatient PT’s.
Amongst some of the points:
Spending for outpatient PT almost doubled to $3.9 billion from 2000 to 2004
About 12% of beneficiaries use outpatient therapy (about three quarters of which is PT and over half of the billing codes were therapeutic exercise and therapeutic activities)
PT private office and in nursing homes account for the largest share of Medicare payments to outpatient services (of note is that private office includes POPTS where they use the PT’s provider but not POPTS where spending is “incident to service”
Spending on private practice grew faster than for other providers from 2000-2004. A few explanations on the proliferation including changes that allowed PT’s to have their own provider numbers in POPTS
On average, hospital departments treat beneficiaries for a shorter time period and fewer services per day (no analysis in this chapter tracked whether these patients were then sent out to a different provider)
Commission convened an expert panel, interviewed numerous researchers, medical directors, rep form companies that market guidelines and outcomes tracking systems, and private plan representatives
Of the strategies explored, developing guidelines and tracking resource use and patient outcomes are the most promising avenues for CMS to pursue
While spending averaged $883 per user, there was more than a threefold difference across settings. CORF’s, particularly in Florida, were the most costly
Although there are mixed opinions about applying guidelines for beneficiary service use (including use of the evidence), most agreed that guidelines could reduce variation in service
Various outcome tools were analyzed and put in use.
By comparison, FOTO was particularly cited for its strengths of its large database, risk-adjusted predictive model, and reporting features. Other tools analyzed included APTA’s OPTIMAL, AM-PAC, and NOMS.
Their was some additional discussion on computer adaptive technology (CAT) versus traditional survey methods and the issue of exploring the use of a privately held tool was raised.
Let the games begin.
Larry
