Therapist advocates complain that fiscal cliff negotiators’ decision to cut $1.8 billion in payments for therapy multiple procedures, an offset for the one-year Medicare physician payment patch, is blatantly unfair as it cuts across therapy disciplines that are normally paid separately, and some advocates say they will seek to have the cuts eliminated or at least to lessen their impact on therapists. The newly enacted fiscal cliff bill reduces payments for subsequent therapies when therapies are provided on the same day.

Mandy Frohlich, senior director of government affairs for the American Physical Therapy Association, said that as the provision does not go into effect until April 1, the group plans to talk with congressional staff to look for a way to eliminate the reductions as part of a future package, or at least to lessen the burden on therapy providers. Each form of therapy, whether occupational, speech or physical, is a distinct and separate benefit under the physician fee schedule, noted Christina Metzler at the American Occupational Therapy Association. Adding an additional 25 percent cut to practice expenses when a beneficiary has more than one therapy appointment on the same day — even if the therapies are different - is inappropriate, Metzler said.

There is no rational reason for it, National Association of the Support of Long Term Care Vice President Cynthia Morton said. It’s a blunt instrument to cut costs and it simply becomes luck of the draw for whatever therapy comes first, she added. Morton said companies are considering laying off therapists.

The cuts increase the existing multiple procedure payment reductions from 25 percent to 50 percent for a savings of $1.8 billion to help offset the one-year physician payment patch. Frohlich said the combined MPPR cuts translate to about a 14 percent payment reduction for therapists. While that is smaller than the 27 percent cut that was scheduled to go into affect without the patch, it is almost on the level of a fee schedule cut, Frohlich noted.

Metzler said the cuts could inconvenience beneficiaries if hospitals say beneficiaries need to split up outpatient therapy sessions over multiple days, but added that she was not sure how the association would respond to the cuts. Congress’ Medicare payment advisors recommended increasing the multiple procedure payment reduction as part of a package of recommendations in November. But that package also included replacing the hard therapy cap, using the funds within the therapy sector, which would have been more acceptable, Gayle Lee, also from the APTA, said. Following the MedPAC recommendations, advocates said they knew the reductions would be looked at as part of the fiscal cliff negotiations, but leading into the final talks Frohlich said the APTA had been hopeful. Therapists were handed a really bad policy, Frohlich added.

NASL’s Morton said that the reductions might have been more rational if they did not cut across disciplines.

Many beneficiaries could be receiving two different types of therapy per day, but if the cuts were changed so that the reductions affected only the same kind of therapy received multiple times a day, that would be particularly helpful for nursing homes and some hospital outpatient departments.  Lee said.

January 4, 2013