Has CMS gone too far?
Shelly Mesure, MS, OTR/L
The Center for Medicare & Medicaid Services always maintains a viewpoint that it is only dictating what are reimbursable services, and that the actual clinical/medical decisions are ultimately up to the medical professionals. But, did any of you listen to the National Provider Calls from CMS on Aug. 23 and Sept. 1?
I was offended by several training scenarios that related specifically to group treatment. CMS officials stated their reasoning for allocating group minutes by a division of four is that in their opinion, a group treatment session is only effective with four residents. Their position is a group larger than four makes it difficult to manage all of the patients effectively; and groups smaller than four limits the ability of patients to interact and learn collectively.
As an occupational therapist, I am offended by these statements. I feel they have overstepped their boundaries and have created a system that eliminates the clinician's ability to best determine the course of group treatment for his or her patients. CMS officials also explain that they expect that every group will contain four participants, and if fewer attend, all remaining participants will have their treatment minutes divided by four.
I would love the opportunity to explain to CMS the many, many, many excellent and clinically appropriate group sessions that I've had with only two or three patients. For example, let's play bingo. Many residents refuse therapy in the gym if it interferes with their bingo time in the lounge. I've provided treatment with those residents at their bingo game while addressing their therapy goals and relating it back to their individualized treatment plans.
Patient #1 was working toward goals with low vision, and patient #2 was working toward goals with fine motor coordination and sequencing. At the time, according to my remaining caseload, I did not have any other patients who were clinically appropriate to participate in this group activity.
As of Oct. 1, 2011, CMS says that I must attempt to find two other participants, and I will still have my treatment minutes divided by four. Their explanation is that the small group of two is limiting and not as beneficial as four participants.
In addition, their training slides provided a comment of, “Remember: Patients are Individuals." This statement was in bold font and I'm not sure how it was intended. I interact with hundreds of therapists, nurses, and healthcare professionals every year. Whether I'm teaching my seminars through Cross Country Education or providing direct consulting services, it's my opinion that the majority of our industry, throughout the entire country, tries to provide the best quality of care available.
I do realize there are those “other” companies or professionals that have taken advantage of our system. But I feel CMS is penalizing the majority for what the minority has done. If we accept these types of regulations, I'm fearful that we will be going down a path that will eventually have CMS dictating exactly what treatment approaches are relevant for our patients.
Shelly Mesure ("Measure"), MS, OTR/L, is the president and owner of A Mesured Solution Inc., a rehabilitation management consultancy with clients nationwide. A former corporate and program director for major long-term care providers, she is a much sought after speaker and writer on therapy and reimbursement issues.