On November 2, 2010, the Centers for Medicare and Medicaid Services (CMS) released the final rule containing the CY 2011 physician fee schedule and related Part B provisions.  The rule did not fully address one of the biggest concerns expressed to CMS by the American Health Care Association (AHCA)—the multiple procedure payment reduction (MPPR).  CMS proposed that, in order to capture efficiencies they believe exist when a patient receives more than one therapy procedure in a single day, they should reduce the practice expense portion of the Part B payment by 50%.  (Please note that the practice expense is only one component of the payment rate, so the overall impact on payment is much less than 50%.)

AHCA argued that in nursing facilities patients often receive multiple procedures from different therapists and the assumption that the services are consecutive and performed by the same practitioner was not justified.  In the final rule CMS reduced the cut from 50% to 25%, a significant reduction and one that represents an important victory.  It is clear that CMS heard some of the arguments we were making and responded to them.

However, there are still serious flaws with the rule.  Perhaps most serious is that CMS, against all evidence coming from clinical practice, still lumps all three therapy disciplines together and does not differentiate among physical therapy, occupational therapy, and speech-language pathology services.  Furthermore, CMS made clear in the final rule that they will continue to examine the issue and may propose further changes in future years.

Patti Cullen, CAE
952.851.2487
pcullen@careproviders.org

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