Therapy claims, ED transfers: OIG focus
Therapy claims, ED transfers: OIG focus

Tracking therapy minutes may become obsolete within the next few years as payment models shift to focus on patient characteristics, experts warned Tuesday.

“Massive” changes appear on the horizon as the Centers for Medicare & Medicaid Services adopts more alternative payment models, and groups such as the Office of Inspector General and the press place more scrutiny on therapy billing. That was the word from Dan Ciolek, associate vice president for therapy advocacy at the American Health Care Association, during the association’s annual convention in Nashville.

Ciolek spoke during a session entitled “Is Managing Minutes to be Extinct?”

“They’re looking at these things, and obviously you see the headlines. The Department of Justice is coming down hard on a lot of places,” Ciolek said. “It’s very hard. It’s a real challenge.”

CMS has intensified its push toward paying based on patient characteristics rather than therapy minutes. This is particularly true after the agency achieved its goal to tie 30% of Medicare payments to value by the end of 2016, said Nanci Wilson, vice president of research and development for Plum Healthcare Group LLC.

“I think we’re going to have a major, major Armageddon with therapy,” Wilson said. “Probably in two years we’re going to not going to have therapy minutes. CMS has to do a lot of work to make those changes, but that ultimately is going to happen.”

Ciolek cited a recent Medicare Payment Advisory Commission report that slammed high therapy payments as an incentive to provide therapy services without taking a resident’s condition into account. That claim contradicts reports that show increased therapy hours to contribute to overall improvements in a resident’s condition, mobility and likelihood of returning to the community, Ciolek said. It also overshadows what should be the main focus therapy: the ultimate outcomes for the resident, he said.

“If you listen to OIG or MedPAC, it sounds like all these people are getting Ultra High [therapy] but it isn’t Ultra High for everybody,” Ciolek said. “If you look at the patient population, you see a different story, and that’s a story we’re sharing.”

AHCA/NCAL’s 67th Annual Convention & Expo continues through Wednesday at the Gaylord Opryland Resort.