CMS Proposal for Policy and Payment Change in 2010
What do these potential changes mean for PT? I haven’t a clue-do you?
Some of my takes:
-we are still looking at a 21.5% reduction in 2010 but it might actually be more given the “redistribution” in codes which have to be balanced. This might mean that it could be a more draconian cut than 21.5. On the other hand, we have been exposed to supposed cuts since 2002 and yet a reprieve has always occurred. The whole SGR has faulty premises acknowledged by almost everybody and in the context of bigger reform, I would have a hard time believing that something won’t change
-looks like specialists won’t be getting bigger bucks for “consultation” and will have to take the E&M route and this reduction will increase primary care type of payments by 6 to 8%. (note for file: check again why PT’s are one of about 3 practitioners left that cannot bill using E&M)
-in what might be the most crafty strategy that I have ever seen CMS devise, they are going after referral for profit imaging by decreasing payments and wanting outside accrediting bodies to credential imaging services! There are other regulation suggestions on this 2 part initiative and MedPAC and GAO have obviously substantial data that suggests overutlization of these hi cost drivers. The big question for us as PT’s-why can’t they extend this same philosophy for other conflict of interest scenarios like physical therapy centers? Could an MD owned PT clinic withstand even rehab agency survey yet alone something more onerous like CARF? (note for file: find out why our national association doesn’t list this as a hi priority for their healthcare reform position)
-PQRI, the voluntary reimbursement cut that almost nobody is doing is going to expand the number of measures and seek the ability to utilize systems contained within an EMR in an effort to streamline efficiency
While this is not an exhaustive list, these appear to be the major points of the proposal. keep in mind that it must go thru comment periods and will undoubtedly have major changes in it prior to implementation at some level in 2010. Likewise, while all this is occurring, the national debate and potential massive reform legislation continues.
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