When your honey-do list involves analysis of Medicare expenditures

The title explains my role in all this fully.

A rather complex report was commissioned by AOTA that involved data related to the distribution of fee for service therapy spending in the Medicare program, as well as how different cap thresholds would impact the system.  The report also breaks out information about where spending is happening based on place of service.

Now the reason why I was given this task is because if you read the report, and my first paragraph, your eyes might already be glazed over.  My purpose will be to put all of this in very plain language.

Here are the three primary takeaways from this report, and I will provide the detail below each statement:

1. The 'cap problem' impacted PT significantly more than it impacted OT.

The reason why the 'cap problem' impacts PT significantly more than it impacts OT is based on volume.  Of all the Medicare patients out there who use Part B services, 90% of them get PT.  By contrast, of all the Medicare patients o…

The curious incident of the changing dates and content of web pages.

I was a little surprised to see a message from AOTA today that states
After the late-night release of the bill, the following day, Tuesday February 6, while the Senate was still creating its version of the budget package, AOTA reached out to our Congressional champions to oppose these provisions, and, alongside the American Physical Therapy Association, proposed alternatives to the OTA provision—alternatives that would have stopped its adoption or minimized its impact. Additionally, on Tuesday AOTA changed all grassroots advocacy messages related to the repeal of the therapy cap, to include details of the OTA payment changes. 
This was surprising to me because I read every available piece of documentation on this as it was unfolding and I did not recall seeing any such messaging.  In fact, I was so distressed that AOTA did not inform anyone that I wrote a blog post about it.

I was surprised to go back today and re-read the AOTA 'messages' and I was surprised to find that they al…

Deconstructing the sausage - Analyzing provisions for therapy assistant payment differentials

It is commonly stated that the process of legislating is like making sausage - you generally don't want to see how it happens.

The therapy community was recently disappointed with the announcement that facilities would have to code their Medicare B claims with a modifier and would receive payment at 85% of the standard rate whenever that therapy was delivered in whole or in part by an OTA or PTA.  This is hard coded into legislation - and is not a rule or regulation.  For reference, this is included in the legislation that has been called "The Bipartisan Budget Act of 2018."

The addition of this requirement was included in the recent legislation as an offset to the cost of repealing the Medicare therapy caps.

Professional associations like AOTA have stated that they were surprised by a 'last minute' inclusion of payment differentials that they report to have learned about on  February 5, 2018.  Since the AOTA employs a professional staff of lobbyists and legisla…

This week's timeline for the #StopTheCap effort

Thanks to the efforts of the American Occupational Therapy Association, beginning in 2022 occupational and physical therapy assistant Medicare reimbursement will be cut by 15%.  Oh, and they solved the cap problem for PT and speech therapy by doing so.

Per a CBO report from February 6th, 1.2 billion of the 6.45 billion cost to repeal the therapy cap would be offset by the reimbursement changes.

Let's get the background here.  Therapy caps have been in place for many years, and for nearly every year there has been an exceptions process that worked around the cap.  This was a bigger problem for PT and speech, who because of a misplaced comma (so the mythology goes), had to share one cap while OT had its own cap.

The exceptions process worked to solve this problem for many years.  Several members of the OT community tore this issue apart and discussed it ad nauseum on the OT Connections site to help educate students and members about Medicare reimbursements.  None of that convers…

AOTA and ACOTE plan for credential inflation receives national attention

Two days ago an Op/Ed appeared in the Washington Examiner, a national newspaper, about the AOTA/ACOTE decision to increase degree requirements for OT practitioners.

The headline of the piece was unfortunate - but headlines are frequently written by editors and not by people who write articles.  What is interesting is that the article was written by people who work for R Street, which is a conservative and libertarian-oriented think tank that promotes free markets.  That the issue of AOTA, ACOTE, and credential inflation caught the attention of this group is noteworthy.  This is not an OT group.  These are external stakeholders interested in trade and market issues.

Concerns about the decision to raise degree requirements without any functional justification or evidence, and the concerns that the decision will damage the profession and its consumers, are not going away.

The occupational therapy profession should continue to question and pressure its professional association.  OTA schoo…

Analyzing the AOTA/ACOTE Data Dump, Part Two: Some Stakeholders Are More Equal Than Others

Please refer to this earlier post for background reading.

According to the 'ACOTE Entry-Level Task Force Report to ACOTE in December, 2014 (p. 381-393), some stakeholders appear to be 'more equal' than others.

The notion of being 'more equal' is a reference to Animal Farm and the pigs who ran the farm.  They famously stated that "All animals are equal, but some animals are more equal than others."  In simple terms, the ruling elites of Animal Farm made claims that everyone is equal, but then we discovered that they provided benefits and power and privileges only to their elite comrades.

What privileges are handed out by AOTA/ACOTE?  The answer can be found starting on page 381.

AOTA/ACOTE overtly places stakeholders onto different 'lists.' These are not categories or labels of my design - these are the actual lists of AOTA/ACOTE:

The 'A' List:
Educational Program Directors
Academic Fieldwork Coordinators
OT/OTA Faculty
OT/OTA Clinicians a…

Analyzing the AOTA/ACOTE Data Dump, Part One

Today AOTA/ACOTE released 897 pages of information, stating 

In response to requests for background information on ACOTE’s decision on the entry-level-degree requirement, we are sharing this workbook (see link below). The workbook includes a timeline of events and discussions undertaken by the Council leading to publication of the 2017 mandate statement. It also includes reports, surveys, open hearings, and publications reviewed by the members of the Council in coming to their decision. These materials support both the pros and cons of the entry-level doctorate mandate. The Council took all of these materials into account when making their decision.
The materials are not organized at all, making understanding of the released data difficult.  Here is a link to a Google Sheets doc that might be helpful for interested parties to sort through the material:


Readers are directed in particular to those lines in the document th…