Payment Reform Takes Shape
2015 is shaping up to be a critical year for making incremental progress on a host of legislative initiatives facing the therapy community. With overall healthcare costs slowing while overall access grows via the ACA, therapy organizations are working on smart reforms a midst a rapidly changing landscape. Jockeying near the top of the list sits the dauntingly complex issue of payment reform. The current trends in reform move away from fee for service models that emphasize quantity over quality. This shift has been deliberate and in many ways experimental; with a number of competing approaches that emphasize a value based system. Regardless of the speed of change, the writing is on the wall and organizations like the APTA have been laying the groundwork for years to ensure that the interests of therapists are well represented.
The APTA and other therapy organizations advocate a hybrid approach that puts a stronger focus on quality of care, while still maintaining elements of the fee-based model essential to ensuring the economic viability of the profession and increasing access to care. Inherent in any guidelines moving forward would be an elimination of the arbitrary therapy caps under Medicare Part B, reform of the onerous manual medical review process, and proposals to lessen the financial burden of the MPPR (multiple payment procedure reduction) policy. Any future alternative payment system must adapt in the area of removing the dreaded “waste, fraud, and abuse”, moniker so prevalent and publicized in the Medicare platform. Therapy organizations have taken these concerns seriously and have made enormous progress in ensuring accurate evaluations, billing code integrity, and quality reporting measures.
Proposed payment reform guidelines would separate all CPT codes into two categories: evaluation and intervention. There are 12 evaluation codes – four each for PT, OT, and athletic trainers. The codes measure the intensity of the examination and the subsequent volume of the practice decision- making. The intervention billing would vary by severity of injury and difficulty of the treatment. The system has been undergoing small-scale experimentation with the hope that it can be launched into widespread use by January 2017. Last week, the bustling and information packed Combined Sections Meeting took place in Indianapolis. Therapists, students, educators, and providers came together in one place to exhibit the robust health of the profession and embrace the challenges ahead. With the valued input of industry voices, the future of therapy remains bright. Advanced Medical encourages you to find your voice. Until next time…