The Greek philosopher, Heraclitus, mused “the only thing that is constant is change.” In life, change often comes in waves that may be sudden and unexpected, altering our individual existence drastically. Changes within the post-acute care industry are often cumbersome and occur gradually, but once enacted, the ripple effect is far reaching. Such is the case with our recent industry shift to the Patient-Driven Payment Model (PDPM) and the annual, regulatory updates of healthcare. Although change is inevitable, the consistency of our mission, vision, and values, which is patient-centered, quality care that reflects successful outcomes, do not change. With this in mind, advocacy becomes paramount to ensuring our patients’ access to quality care.
The industry entered 2020 alert and aware of the need to remain abreast of regulatory updates and to affect change through advocacy. One excellent example includes the NCCI edits that CMS announced on January 1st that precluded clinicians from providing therapeutic activities or group intervention on the same day the patient was evaluated. The immediate effect included lack of patient access to potential treatment approaches at the onset of intervention, preventing the evaluating therapist from assessing patient response in order to develop the most effective, individualized plan of care. Reliant provided education on workable solutions to ensure our patients continued to receive the most individualized and appropriate treatment approaches within this regulatory limitation. At the same time, we encouraged every avenue of advocacy, and ultimately, the industry prevailed in repeal of these edits imposed on rehabilitation codes.
Current advocacy efforts surround proposed payment reductions impacting rehabilitation directly. Beginning January 1st, modifiers must be present to denote outpatient therapy services furnished in whole or in part by a PTA or an OTA. This data will be utilized to reflect a payment reduction beginning in 2022. These services will be reimbursed at 85% of the physician fee schedule. The proposed reimbursement decrease is of significant concern. Daily interventions provided by a licensed PTA or an OTA are of a skill, quality, and caliber that should continue to receive value recognition through reimbursement. As a result, advocacy should be a priority for all!
An additional area of advocacy opportunity surrounds CMS’ proposed 8% cut to outpatient therapy service reimbursement starting in 2021. This is in addition to the changes to reimbursement for services provided by a PTA/OTA as noted above. Many details are still needed to better understand why these rehabilitation codes were selected as a pay-for to a physician outpatient evaluation code increase. Advocacy efforts seek transparency surrounding this selection process, the data used, and continue to point out how this reduction runs counter to CMS’ mandate for patients to have access to accurate and appropriate quality of care.
Let’s not wait until the next round of regulations are implemented before making our voices heard. Who better to anticipate how regulations may impact our patients’ access to services than the professionals of the industry who provide patient care and have a vested interest in ensuring their outcomes are positive? May our care for the patients and their needs embolden us to action, to become agents of change.