On January 23rd, the House of Representatives voted for a three month increase of the debt ceiling. Given the short term nature of the legislation no action was taken on larger issues including a fix for the multiple procedure payment reduction (MPPR) policy passed on January 1st as part of the year-end legislation to avoid the fiscal cliff. Without Congressional action, the MPPR policy will increase from 20% for private practice settings and 25% for facilities to 50% across all outpatient therapy settings on April 1, 2013.Contact your members of Congress TODAY using APTA’s Legislative Action Center and ask them to delay implementation of this flawed policy until January 1, 2015. This date is the scheduled start of APTA’s Alternative Payment System (APS), a new payment system for outpatient therapy that would move payment away from multiple procedures.

APS, also known as the Physical Therapy Classification and Payment System (PTCPS), will reform the current fee-for-service, procedural based payment system to a per session payment system. As part of the Balanced Budget of 1997, Congress charged CSM with developing an alternative to the Medicare therapy cap. In response to this directive, APTA began developing APS and expects to transition to the new system by January 1, 2015.

APTA estimates the application of a 50% MPPR policy will reduce aggregate payments for outpatient therapy services (physical therapy, occupational therapy, and speech language pathology) by 6-7% from the 2012 payment amounts. Please be aware these are aggregate spending numbers and there will be variation among practices with regard to the impact. To determine the impact on your individual practice, refer to both the 2012 and 2013 MPPR calculators available on APTA’s website.

You can also call the Capitol switchboard at (202) 224-3121 and ask to speak with your members of Congress. Ask your legislators to delay implementation of this provision until January 1, 2015 by inserting a fix in the next possible legislative vehicle! Don’t forget to personalize your message and tell your members of Congress how this will impact his or her patient and provider constituencies.

Tell your legislators the impact this additional cut would have on your practice or facility:

  • This new reduction is in addition to the current MPPR that applied beginning in 2011 which reduced payments by 6-7%. This means that in calendar years 2011 and 2013, outpatient therapy services were subject in aggregate to a 12-14% reduction in payment overall.
  • An increased MPPR would restrict patient access to vital therapy services. Particularly hard hit would be patients with multiple chronic conditions, who might benefit the most from intensive therapy treatment programs. Many therapists will be forced to choose not to treat Medicare beneficiaries.
  • Patients who do not receive timely outpatient therapy services would be at increased risk for hospital readmissions, additional injuries, and other complications.
  • It will be difficult for all outpatient therapy settings from small businesses to large facilities to continue caring for vulnerable Medicare patients with cuts of this magnitude.

Tell your legislators that MPPR is a flawed policy when applied to therapy for the following reasons:

  • MPPR is based on the assumption that duplication exists in the practice expense portion of therapy codes billed on the same day. However, the practice expense portion of the therapy codes were already reduced when these codes were initially valued since multiple services are typically provided to a patient during a visit.
  • The current MPPR policy on therapy imposes a reduction to all therapy services and is not a discipline specific policy. To spread an MPPR over the three therapies equates to reducing payment for a cardiologist because a patient saw their general practitioner earlier in the day.

Comments are closed