Time To Act: Lawmakers Must Address the PTA Differential

Congress is back in session and the push is on to fix this threat to patient access to care. Your voice is needed.

An APTA-supported bill now in the U.S. House of Representatives has the potential to address some of the most damaging elements of the flawed differential system that reduces payment for services delivered by a PTA or occupational therapy assistant by 15%. But lawmakers need to pay attention and act.

That's where you come in: You can help by by sending an email to your representative urging them to cosponsor H.R. 5536, as well as push for the legislation to be added to the next continuing resolution that Congress must pass in February. The APTA Patient Action Center makes it easy through a template system that only takes a few clicks to complete.

Click here to read more. 

MedPAC: Majority of Medicare Beneficiaries to be on MA by 2023, but Coding Issues Remain Rampant

Fierce Healthcare | Jan 14, 2022 5:05pm
 
Most Medicare beneficiaries in Parts A and B are expected to be enrolled in Medicare Advantage plans by next year, but spending on the plans is going to continue to outpace traditional fee-for-service, a congressional advisory panel found.
 
The Medicare Payment Advisory Commission (MedPAC), a panel that makes recommendations to Congress on Medicare policy, released new findings Friday on the program, which has surged in popularity in recent years. It also continues to raise alarms over practices plans have done such as upcoding that have increased Medicare spending.
 
MedPAC found 46% of beneficiaries in Parts A and B were enrolled in MA plans, and that figure is expected to stretch past 50% in 2023.
 
“Despite a decrease in MA rates, the MA enrollment has continued to grow rapidly,” said Luis Serna, a MedPAC staff member, during the panel’s meeting Friday.
 
The panel also found that for this year, 99% of Medicare beneficiaries have access to at least one plan, and 98% of them can choose a plan with a Part D benefit.
 
But MedPAC found that the explosion of growth has not also led to more savings for traditional Medicare.
 
The panel discovered that this year spending in MA will be 4% higher than fee-for-service Medicare after considering coding practices such as upcoding, which leads to higher quality bonuses for plans.
 
"MA plans have a financial incentive to document more diagnoses than providers in fee-for-service Medicare, leading to larger MA risk scores and greater Medicare spending on the beneficiary that enrolls in MA,” said staff member Andy Johnson, Ph.D.
 
In 2020, MedPAC found MA risk scores were 9.5% higher than fee-for-service beneficiaries that had a similar health status.

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