The final mandated report on “Improving Medicare’s Payment System for Outpatient Therapy Services” is due on June 15, 2013.  However, Congress has asked MedPAC to forward the recommendations in early- November so they are relevant to the discussion that will take place during the Lame-Duck session, when Congress is expected to consider Medicare extenders, which includes extending the therapy cap exceptions process that expires on December 31, 2012.

Draft recommendations center on assuring access to outpatient therapy services while managing Medicare’s costs and include the following:

  1. Congress should reduce therapy caps for PT and SLP services combined and implement a manual review process for requests to exceed cap amounts, and provide the resources to CMS for this purpose
  2. Include services delivered in hospital outpatient departments and therapy caps, and
  3. Apply a Multiple Procedure Payment Reduction of 50% to the practice expense portion of outpatient therapy services provided to the same procedure in the same day

Other controls that could be included in the recommendations include: reducing payment rates, prohibiting the use of V-codes, collecting functional outcome measures (acknowledging that CMS is developing the CARE tool), reducing the certification period from 90 days to 45 days, focusing reviews in high use geographic areas and for aberrant providers using the new Affordable Care Act authority given to the Secretary, and adjusting co-sharing for beneficiaries.

Several therapy providers will be bringing ideas very quickly to MedPAC on how to control the growth of therapy, but I believe the message is clear.  Providers and beneficiaries can expect continued changes in the reimbursement for Part B therapy services.