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Washington State Capitol Legislative2014 saw a year of stabilization in the therapy industry as well as the larger healthcare community. It was a year that saw the ACA smooth out some of its implementation problems while expanding care for new populations.We also benefited from the distancing of the sequester budget battles- and more specifically – significant provider cuts that had the industry reeling a short time ago. The 2015 outlook is bright indeed.


We will continue to see various pilot programs expand with quality of care and positive outcomes prioritized over volume treatments. The sustainable growth rate (SGR) dilemma will continue to loom large over 2015. A permanent fix remains the priority but it is unclear whether the political will exists to do the responsible thing and eliminate the severely flawed formula. With an April 1st deadline fast approaching, it is imperative that doctors, therapists, and providers keep the pressure on Congress. In 2015, look for CMS to continue to update therapy codes that better reflect current trends and practice patterns. The hated Manual Medical Review process that justifies therapy expenses in excess of $3700 will continue to be in place through March 31, 2015.


CMS has worked to streamline and improve the reporting delays, auditing troubles, and differing standards that have plagued providers and patients alike. The Physician Quality Reporting System (PQRS) will become more strenuous with a possible 2% cut in 2017 for those not meeting the reporting standards for 2015. The reporting requirements are quickly moving from an incentive-based system to a mandatory penalty-based requirement.  In addition, the Value-Based Payment Modifier (VM) was delayed a year by CMS due to the outstanding efforts of organizations like the AOTA, who argued for improved educational materials and clearer guidelines before implementation. As always, Advanced Medical urges you to get involved and make your voice heard. Organizations like the AOTA, APTA, and ASHA can be a valuable resource and vocal outlet in prioritizing the therapy profession a midst a rapidly changing healthcare landscape. Until next time…