As part of its June report to Congress entitled “Increasing the Value of Medicare”, the Medicare Payment Advisory Commission (MedPAC) called for better data collection by the Centers for Medicare and Medicaid Services (CMS) in order to assess a beneficiary’s need for outpatient rehabilitation services.  MedPAC reviewed four assessment tools for the purposes of the report, including ASHA’s National Outcomes Measurement System (NOMS), in Chapter 6 of the report entitled, “Toward Better Value in Purchasing Outpatient Therapy Services”. The other three tools were predominately physical and occupational therapy oriented and used patient-self reports. MedPAC recognized that patient self-report tools would be clinically inappropriate for beneficiaries receiving speech-language pathology (SLP) services.

MedPAC also highlighted the importance of a Medicare provider number for speech-language pathologists to improve accountability and if Medicare payments are linked to outcomes.  Currently, only physical therapists and occupational therapists have provider numbers. Throughout the report, MedPAC recognized speech-language pathology as a distinct and separate profession in its referencing of the three major outpatient rehabilitation services.  

The MedPAC report also outlined possible next steps for the CMS to take in developing alternatives to the therapy caps including, the selection of outcomes measurement tools, conducting pilot studies on the feasibility of using such tools, and the design of a new payment system that utilizes outcomes measurement systems. Two options presented by MedPAC include episode-based payments and value-based purchasing.  

ASHA will continue to work with both CMS and Congress to ensure that NOMS is utilized in the assessment of SLP services and work to pass legislation that would allow speech-language pathologists to obtain a Medicare billing number. ASHA members can support this effort by taking 5 minutes to request that their federal lawmakers co-sponsor H.R.3795 and S.657 at http://takeaction.asha.org/asha2/home/ .

MedPAC is an independent federal body established in 1997 to advise Congress on issues affecting the Medicare program.  ASHA provided extensive comments and feedback to MedPAC in the development of the outpatient rehabilitation chapter. Chapter 6 of the MedPAC’s June report can be found at
www.medpac.gov/publications/congressional_reports/Jun06_Ch06.pdf.  For further information, please contact Ingrida Lusis, ASHA’s Director of Health Care Regulatory Advocacy, via email at reimbursement@asha.org.