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The Centers for Medicare & Medicaid Services officially announced Tuesday afternoon that they have finalized their 2021 schedule physician compensation rule, which cuts physiotherapy and occupational therapy payments for nursing home patients by 9%.
Long-term care advocates sounded the warning over these planned cuts for months after the proposal was released in early August. They said they would appeal to lawmakers for relief. Last year, therapy providers suffered an 8% reduction.
The rule was written to give some primary care physicians a pay rise. Nurse practitioner services will also benefit from a salary increase (7%), but only in an office; when billed in a nursing facility, there will be a decrease.
“The steps taken by CMS to finalize these policies that impact nursing home patients are shocking in that CMS is drastically cutting back on services that help our patients recover from COVID or maintain good health and hopefully not succumb to COVID-19, ”said Cynthia Morton, executive vice president of the National Long-Term Care Support Association.
“Services such as rehabilitation therapies that patients need to increase their mobility after being lying in bed for a long time, x-rays to detect lung problems due to COVID-19, and nurse practitioner services are cut. CMS is very useful for providers of nursing facilities on the one hand, but on the other hand, it cuts these vital services quite deeply which will hamper the ability of providers to deliver these essential services, ”he said. she adds.
CMS is making “significant” increases in chronic care and primary care for Medicare beneficiaries who see doctors in the office, Morton added. The increases are offset by decreases in nursing home care and approximately 40 other specialties paid for through the physician fee schedule.
“This policy finalized today leaves me wondering about chronic patient care in nursing homes,” Morton said.
The expansion of telehealth hailed
The administration played on the vast expansion of telehealth services which it also approved. CMS is bound by statutory limitations that limit its capabilities, which vendors readily recognize. Congress is expected to approve expanding telehealth coverage for therapists, or expanding coverage beyond nursing homes in rural areas.
“During the COVID-19 pandemic, the actions of the Trump administration have sparked an explosion of innovation in telehealth, and we are now working to make those changes permanent,” the Secretary of Health said Tuesday afternoon. Health and Social Services, Alex Azar. “Medicare beneficiaries will now be able to receive dozens of new services via telehealth, and we will continue to explore ways to provide Americans with access to health care in the right setting with their doctor.
CMS administrator Seema Verma said the pandemic “accentuates how transformative telehealth can be” – beyond the permissions previously granted only to rural health providers. Before the public health emergency was declared, telehealth services were used by 15,000 fee-for-service beneficiaries per week. The administration added more than 140 telehealth services to the coverage list, and more than 24.5 million (out of 63 million) and registrants received Medicare telemedicine service between mid-March and mid-October – about 60 times the rate of pre-pandemic levels. – official reports.
“Several months later, it’s clear that the healthcare system has adapted perfectly to a historic expansion of telehealth that ushers in a new era in healthcare delivery,” Verma said in a statement.
Tuesday’s actions include favorable responses to concerns from long-term care workers that a limit on once-per-month telehealth follow-up visits was too restrictive. CMS had considered revising the frequency limit from one visit every 30 days to once every three days. However, amid concerns about the lack of in-person contact, the agency said it had reconsidered and landed on a limited frequency of one visit every 14 days.
CMS also said it has created two new payment codes (G2010 and 22012) to cover invoices for remote review of patient-submitted videos or images and virtual recordings. They will benefit clinical social workers, psychologists, physiotherapists and occupational therapists and speech language pathologists, who can provide brief online assessments and management services, as well as virtual recording and assessment services.
The agency further clarified that the services can be declared as telehealth even if a doctor or practitioner is in the same building as the beneficiary but uses telecommunications to stay away in order to limit the risk of exposure to infections.
A CMS fact sheet on the expansive pay rule can be found here. It explains, among other things, new lists of coverage areas until the end of the calendar year when the public health emergency ends.
The final physician compensation rule also makes the extension of Medicare licensing to practice permanent for certain non-physician practitioners.
Under the banner of the administration’s “Patients Over Paperwork” initiative, CMS finalized these changes:
- Some non-physician practitioners, such as nurse practitioners and physician assistants, may oversee the performance of diagnostic tests within their scope of practice and state law, as they maintain the required statutory relationships with physicians. supervisors or collaborators.
- Physiotherapists and occupational therapists may delegate “maintenance therapy” to a therapy assistant.
- Physiotherapists, occupational therapists, speech-language pathologists, and other clinicians who bill Medicare directly can review and verify, rather than re-record, information already entered by other members of the clinical team in a patient’s medical record. Officials say this will allow practitioners the flexibility to delegate certain types of care, reduce duplication of documentation, and oversee certain services they previously couldn’t.
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