Multiple choice question-something you won’t see on a PT licensure exam soon I hope.
All of the following are true except:
A. About 2.2% of medicare part B expenditures are for outpatient PT/OT/SLP of which 75% or roughly $3 billion is on PT. 9.7% of medicare beneficiaries access outpatient therapy.
B. Data demonstrates that between 2006 there was an increase of 3.5% beneficiaries accessing outpatient therapy but a reduction of 4.7% in medicare expenditure for outpatient therapy
C. The medicare cap and exemption process caused a reduction in expenditures between 2004 and 2006
D. All of the above are true statements
This is not a trick question.
If you were a member of congress or some type of CMS committee tasked with assessing the therapy cap and exemption process and you relied on recent reports from an entity that you contracted (CSC), you would guess D.
If you work are a PT and have been forced to deal with medicare patients over the last several years, you would answer C.
This is one of some follow ups on my previous post Pay for Caps.
Unfortunately, the most erroneous conclusion from the CSC reports is the following:
The outpatient therapy caps, as implemented in CY 2006 with the exceptions process decreased overall spending and had little or no impact on beneficiary access to outpatient therapy services, in contrast to the negative effects observed in CY 1999,
This is the difficulty in having an external organization examine medicare claims data without likewise examining other changes by medicare that were enacted in the same time. This gross omission completely missed the real reasons that dollars were reduced.
The following are some real reasons almost all of which are regulatory constraints or consequences of them:
1. the superimposed rules (e.g. 8 minute and group therapy)
2. enhanced auditing of claims for technical compliance which causes a “fear factor” by PT’s and thus group therapy or interventions left purposely off the superbill (throw in notable news about companies being penalized by medicare for overbilling ther ex and underbilling group therapy and this adds to this factor)
3. increased medicare patients moving away from a hospital environment to a PTPP which in turn causes increased medicare patients in those settings which in turn causes overlaps which in turn increases an increase in #3.
4. shortage of PT’s which causes more patients per therapist and underutilization
There are other “real reasons” for the decrease in expenditures. Yes, the exemption process in fact is an additional regulatory constraint (let’s make sure we d/c the patient prior to them reaching the cap). Interestingly enough, only about 15% of patients in a non hospital outpatient clinic exceed the cap versus 27% for SNF versus 37% for CORF.
The biggest tragedy that will be disguised as “good news” for the PT industry? You can be guaranteed that the great success of the cap and exemption process will be in place after its current June 30th deadline. Erstwhile, disruptive process and continued medicare patient “hoops and ladders” in your clinic will exist.
thoughts?
