Speech-language pathologists who treat Medicare Part B patients may be interested in participating in a project designed to develop alternatives to the current Medicare outpatient therapy payment system.
Under current law, Medicare places caps on the amount of outpatient therapy that beneficiaries may receive each year (in 2010, the caps are a combined $1,860 for speech-language pathology and physical therapy services and a separate $1,860 for occupational therapy). Ever since the cap was implemented in 1999, Congress routinely has passed legislation to place a moratorium on the cap or to implement an exceptions process that allows beneficiaries to access medically necessary outpatient therapy services beyond the cap. The current exceptions process expires Dec. 31, 2010; Congress again is expected to take action that will extend it.
In response to calls to overhaul the caps and the exceptions process, the Centers for Medicare and Medicaid Services (CMS) established a research project in 2008 that ultimately will develop alternatives to the current outpatient therapy payment system. The project, "Developing Outpatient Therapy Payment Alternatives" (DOTPA), has developed a tool that will be used to identify, collect, and analyze information related to beneficiary need for and effectiveness of outpatient therapy services.
For the past two years, ASHA has provided input to CMS and RTI International, a CMS contractor, to ensure that speech-language pathology services and patient disorders, deficits, and needs are adequately represented in the assessment tool. Different versions of the tool have been developed for patients in nursing facilities/day rehabilitation settings and for those in community-based (outpatient) settings.
RTI is actively recruiting approximately 190 Medicare Part B therapy providers (SLPs and physical and occupational therapists) nationwide from nursing facilities, hospital outpatient departments (including day rehabilitation programs), private practices, and outpatient rehabilitation facilities and agencies. Over a period of up to six months, each provider participant will assess up to 150 Medicare Part B patients at admission and discharge using the DOTPA assessment tools.
Participating providers will benefit by having their patient case mix included in the data that will be analyzed to determine future utilization and payment rates for Medicare Part B therapy services, and RTI and CMS will solicit their feedback on use of the instrument. Participants also will gain familiarity with a tool that may become the basis for a universal tool for assessing Medicare beneficiaries across settings.
The assessment tools are available at RTI International's website. SLPs interested in the project can find participation information online; by e-mailing email@example.com; or by contacting Judith Abbate, deputy project director, at 781-434-1793 or firstname.lastname@example.org.