Medicare Fee Schedule Cuts Delayed; Cap Goes Into Effect
Physical therapists will continue to be paid under the 2009 Medicare physician fee schedule conversion factor until February 28, thus temporarily avoiding a 21.29% cut in payments. The Department of Defense (DOD) Appropriations Act of 2010, which passed December 22, 2009, suspends for 2 months the 21.29% reduction that was to be implemented on January 1. This delay in cuts will enable physicians, physical therapists, and other health care providers to continue to care for Medicare patients while waiting for Congress to vote on a permanent solution to the fee schedule formula.

However, the DOD legislation did not include language to extend the therapy cap exceptions process. On January 1, a $1,860 per beneficiary annual cap for outpatient physical therapy and speech language pathology services combined, and an $1,860 cap for outpatient occupational therapy services (hospital outpatient departments are exempt), went into effect -- without an exceptions process. The KX modifier used to signify care that is medically necessary when the therapy cap amount is exceeded is no longer applicable.

In addition, a 1.0 minimum floor on the work Geographic Practice Cost Index (GPCI) values that were established by Congress have expired. The expiration of this floor will result in reductions in payments in 2010 for 54 localities.

As Congress moves toward completion of a final comprehensive health care reform bill (see article below), APTA will continue to work vigorously to ensure that the final bill positively addresses key issues for physical therapy, such as the therapy cap and the fee schedule payment cuts, to preserve patients' access to needed physical therapy services.

CMS Issues Final Rules for IRFs and SNFs
On July 31, the Centers for Medicare and Medicaid Services (CMS) released two significant rules that contain its final payment policies and updates for Inpatient Rehabilitation Facilities (IRFs) and Skilled Nursing Facilities (SNFs). Both of these rules contain specific provisions that will have a major impact on the practice of physical therapy within each of these settings. The SNF PPS final rule contains the following provisions:

• negative 1.1% update to SNF payments due to recalibration of case-mix indices
• major revisions to the documentation and calculation of therapy minutes on the MDS, specifically new requirements on allocation, documentation, and provision of concurrent therapy
• establishment of revised RUG-IV case-mix classification and adjustment to therapy minutes based on data gathered from the Staff Time and Resources Intensity Verification (STRIVE) project
• transition to a redesigned nursing home resident assessment instrument called Minimum Data Set (MDS) 3.0 with a phased-in implementation schedule
• new requirements for quarterly reporting of nursing home staffing data

Click here to read APTA's highlights and comprehensive summary of the rule.

Wellmark Physical Medicine Pilot Program
Individuals with musculoskeletal disorders who received physical therapy and other physical medicine services had lower health care costs and were less likely to have surgery than individuals who did not receive those services, according to a recent report by Wellmark Blue Cross and Blue Shield. Wellmark’s 2008 pilot program, a quality improvement program for Iowa and South Dakota physical medicine providers, collected data from various physical therapists and other physical medicine providers who provided care to 5,500 Wellmark members with musculoskeletal disorders. The data showed that 89% of the Wellmark members treated in the pilot reported a greater than 30% improvement in 30 days. In addition, Wellmark claims data for members who received care from physical therapists or other physical medicine providers was compared with data for a member population with similar demographics (including health) who did not receive such services. The comparison showed that those who received physical therapy or physical medicine care were less likely to have surgery and experienced lower total health care costs.

For more information on this study, click here.

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