MedPAC Doubles Down

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.

2 Replies to “MedPAC Doubles Down”

  1. With regard to the MPPR 50% reduction, that was already rolled out in April 2013. Yeah, like when was greeting and gowning a patient considered a payable code? Their examples are hogwash. Wish my lease agreement had the first 15 days of the month at one rate and the next 15 days at an 11% reduced rate because I’m using the space for the same service day in and day out. I wonder how that would fly with my landlord? SAME for the electric company! The first time I flip a switch it costs me the going rate, the next times… it’s at an 11% reduction! I mean, once they hook me up for electricity, it’s not like they have some extra substantial practice expense. I think we need to inundate them with videos: Can you tell if this is the 1st 15 minutes of a procedural code OR the 2nd 15 minutes?

    The wonderful MedPieceACrap is also suggesting that certification be changed from 90 days to 45 days so physician oversight is tighter. Guess there were problems with 30 days, (can’t remember if they tried 60 days), they don’t like 90 days, so why not 45 days? As if a physician even has a clue about quality of the services provided or if the provided care is in align with evidence OR if the patient is progressing/responding as would be anticipated.

    And of course, MedPieceACrap still advocates for the $3,700 because? I mean… they are advising increased physician oversight but… yeah, the medical professionals don’t know if services are truly warranted or not.

    And, how could you leave out CARE-C and CARE-F? The RTI piece of crap for DOTPA? 2 all encompassing tools: guess outpatient facilities and private practices need to be separated? Should outcomes be different based on setting?? And a single long cumbersome piece of crap tool that hasn’t been studied long enough in research to know its validity or reliability. Heaven forbid even thinking of minimal clinical difference! We have already seen how sub-OPTIMAL is doing. It’s not highly recommended for outpatient services. A single long piece of crap is a waste… science is showing that. The more general the tool, the less value or information gained from it. Oh… and we’re required to predict outcomes too! Guess those CARE crapolas will help with that? Do we truly want something like the CARE-less C or F to be used to determine payment for episodic care or even global care?

    You missed lots of talking points in that report, Eric.

    What’s really sad… MedPieceACrap is comprised of what you’d expect to be smart individuals… I think they need some help in truly understanding physical therapists and what we do. They need help in understanding outcomes. They need project their recommendations into the future to see the ill-effects for Medicare beneficiaries.

    Thanks for the opportunity to express my major dislike for MedPieceACrap recommendations!

  2. The whole third party payment system follows Medicare’s lead, so you can expect any change to reduce payments that Medicare successfully implements to rapidly become the standard for commercial insurers. Hang on for more rapid changes in the futher, most not good

Comments are closed.