In theory, the Medicare Payment Advisory Commission (MedPAC) advises Congress on the best actions to take to ensure both the long term survival of the Medicare program, and that health care needs are met for Medicare beneficiaries. This is a tough task, as tipping too far to one side or another can result in wildly out of control costs, or decisions that harm the public health overall. It’s a tough assignment for MedPAC. Some decisions have been good, such as the overall shift to quality-based reimbursements. Others, like the arbitrary cap on physical therapy services haven’t been so smart. The cap limit has required action by Congress on an annual basis for over a decade to ensure there is an exceptions process.

MedPAC released their report to Congress this month. You can find the June 2013 report here. In the report, there are two recommendations suggested that negatively impact patients with Medicare through burdens placed on physical therapy providers. First, the cap limit has been recommended to be reduced from $1900 per year to $1200 per year. Remember, this is a cap that is shared with Speech and Language Pathologists. Imagine how quickly this goes away if a Medicare beneficiary has a stroke. Unlimited reimbursement can’t be a realistic thing, but minuscule caps on reimbursement demonstrates the continued poor value MedPAC places on physical therapy services.

The second recommendation is one of those curious things in healthcare. The recommendation concerns the multiple procedure payment reduction (MPPR) that went into effect in 2012. The MPPR basically says that if more than one unit of something is billed, the second unit will be billed at some percentage less. For 2013, MedPAC suggests that the MPPR be increased to 50%. Essentially, the first 15 minutes of therapeutic exercise is magically worth more than the second 15 minutes. Since the MPPR’s inception, a decline in payment for therapy services has resulted, further squeezing outpatient therapy services that already have a high administrative burden to treat Medicare beneficiaries. This further reduction will make this much worse.

In a letter from the American Physical Therapy Association (APTA) about the 2013 MedPAC recommendations, president Paul Rockar Jr, PT, DPT, MS, referred to the recommendations as “akin to doubling down on a bad policy.” I have to concur. It seems MedPAC has shifted too far on the mission of “save money” and isn’t considering the affect this has on patients with Medicare.

The APTA has an advocacy page,, where you can learn more about this, and members can take action and let their representatives in Congress know about the negative impact these recommendations have for their constituents with Medicare. The APTA remains in dialogue with policy makes and MedPAC, as well as continuing in advocacy efforts in Congress, but the collective public needs to raise a loud cry against these proposed changes.