The Automatic Exceptions Process is an essential mechanism to assure that physical therapy services are accessible by the people who need it most.
A recent study ordered by the Centers for Medicare and Medicaid Services (CMS) found that, due to the cap, for the first time since 1999 the cost and the growth in physical therapy expenditures declined during 2006.
The... "study reveals that from CY 2004-2006, although the total number of therapy users continued to increase by 3.5% the overall expenditures actually decreased 4.7%.
This represents the first observed negative growth in payments per beneficiary since the implementation of the therapy caps during CY 1999."
Further, the intended effects of the Medicare cap appeared to be met since the number of beneficiaries accessing physical therapy services actually increased in 2006 by 3.5%.
The mean payment per physical therapy user declined 8% in 2006.
The Medicare cap, first implemented in 1999, is the attempt by Medicare to limit the growth in federal physical therapy expenditures.
The Value Proposition
Medicare would like to measure the value for its health care dollar.
In 2006, Medicare spent $3.05 billion dollars on physical therapy.
From 2002-2004, the growth rate in expenditures was 26%.
The Medicare value proposition is Value = Quality / Cost.
Cost is easy to measure (see above).
Quality, however, is not.
Current projects, like Pay for Performance (P4P), are Medicare's attempt to measure quality.
Too many physical therapists dismiss attempts to measure quality.
What are we afraid of?
Al Amato, PT, MBA replies to a statement by made on August 12, 2007 by Larry Benz, PT that "P4P ...is a fad":
"The momentum is moving toward P4P. I think it imprudent that this trend be ignored. At the least, consider collecting outcomes to be able to compare your care to a national average."
Congratulations to Senator Max Baucus. He is taking a tough stance in the short run - standing up for physical therapy.
In the long run, however, Senator Baucus understands that physical therapy provides value to Medicare.
And to Americans.
Find other ways to measure the value of physical therapy.
See How to make a Physical Therapy Diagnosis