Statement of American Occupational Therapy Association

 The American Occupational Therapy Association (AOTA) submits this statement for the record of the May 9, 2007 hearing.  While the hearing is focused on potential methods to improve efficiency among physicians in Medicare, AOTA appreciates the opportunity to provide comment on what AOTA is doing in order to improve efficiency among occupational therapists in Medicare.  As the Committee looks at alternatives within the physician fee schedule, AOTA would also like to highlight some areas in Medicare where the Committee should focus, particularly in regard to AOTA’s efforts relating to the physician quality reporting initiative (PQRI) and the Medicare Part B outpatient therapy caps.

The Balanced Budget Act of 1997 [Public Law 105-33] moved outpatient rehabilitation services, including occupational therapy, to the physician fee schedule.  Occupational therapists and occupational therapy assistants are subject to yearly proposed cuts to the physician fee schedule.  AOTA applauds past congressional action to avoid the proposed cuts to the physician fee schedule and is committed to working with Congress to avoid the proposed 10% cut for 2008. Simultaneously, therapists must also confront the uncertainty of the arbitrary therapy cap which literally prohibits care for high cost patients.

Physician Quality Reporting Initiative (PQRI)

The Tax Relief and Health Care Act (TRHCA) of 2006 included a provision that directed the Secretary of Health and Human Services to implement a system for the reporting by ‘eligible professionals’ of data on quality measures.  CMS has recognized occupational therapists as professionals eligible to participate in the system, and AOTA is working diligently to address new quality and payment options for Medicare Part B outpatient therapy, which take effect July 1, 2007. 

AOTA is positioned to begin participation in the deliberations of the Ambulatory Care Quality Alliance (AQA), the National Quality Forum (NQF), and the Physician Consortium.  These three consensus organizations recognized by Congress in the TRHCA inform the physician quality reporting initiative at CMS.

AOTA is also developing outcomes measures for occupational therapy as part of its Centennial Vision and Strategic Plan.  A committee of distinguished occupational therapy practitioners with experience in outcomes measures has been formed and is in the process of examining existing outcomes measurement tools and determining the most appropriate measures for occupational therapy. 

AOTA continues to rely on the work done as part of its Evidence-Based Literature Review Project. AOTA offers a series of Evidence Briefs to inform the practice of occupational therapy.  These summaries of articles selected from scientific literature cover a wide variety of areas of occupational therapy practice including: attention deficit/hyperactivity disorder, brain injury, cerebral palsy, children with behavioral and psychosocial needs, chronic pain, developmental delay in young children, multiple sclerosis, older adults, Parkinson’s disease, school-based interventions, stroke, and substance use disorders. 

These documents offer a bridge between scientific research and clinical practice to aide occupational therapy practitioners in providing therapy that is based on evidence in order to provide efficient and effective care and to improve patient outcomes. 

Therapy Caps

 The annual cap on outpatient rehabilitation, commonly referred to as the “$1,500” cap, imposed by the Balanced Budget Act of 1997 and currently under an exceptions process through Congressional action, would, if implemented, limit access to occupational therapy that would enable an individual to fully recover from a stroke, to overcome limitations resulting from severe burns, or to achieve independence in self-care to enable living at home among other illnesses or injuries.  AOTA has worked for many years to repeal this cap and appreciates Congress’ willingness to stop implementation.  Most recently, a 1-year extension of the exceptions process was included in the Tax Relief and Health Care Act of 2006 [P.L. 109-432], however, that will expire on December 31, 2007 unless Congress takes action this year. 

 MedPAC has expressed concerns with the therapy caps because they do not discriminate between necessary care and unnecessary utilization.  AOTA remains committed to working with Congress and CMS to deter unnecessary care or overutilization.  AOTA has held discussions with Congress, CMS, and other provider and consumer groups to determine ways to refine the exceptions process to ensure that patients continue to receive appropriate care.  Efficient and effective delivery of therapy services is also about ensuring access to services that have a proven impact on lifestyle choices, healthy living, and avoiding illness and injury (such as those resulting from falling, poor driving, or limits in self-care).

AOTA strongly supports the Medicare Access to Rehabilitation Services Act of 2007 (S. 450/H.R. 748).  AOTA supports passage of legislation that would repeal the caps, and is dedicated to working with CMS, Congress, and other provider and consumer groups to find an appropriate long-term solution.  Financial limitations to proper therapy services impede the therapists’ ability to care for their patients appropriately and use professional judgment effectively, and ultimately hinder the ability of a therapist to provide high-quality, efficient care to Medicare beneficiaries.

AOTA is the nationally recognized professional association of 36,000 occupational therapists, occupational therapy assistants, and students of occupational therapy.  Occupational therapy is a health, wellness, and rehabilitation profession working with people experiencing stroke, spinal cord injuries, cancer, congenital conditions, developmental delay, mental illness, and other conditions. It helps people regain, develop, and build skills that are essential for independent functioning, health, and well-being.  Occupational therapy is provided in a wide range of settings including day care, schools, hospitals, skilled nursing facilities, home health, outpatient rehabilitation clinics, psychiatric facilities, and community programs.

Occupational therapy professionals assist those with traumatic injuries—young and old alike—to return to active, satisfying lives by showing survivors new ways to perform activities of daily living, including how to dress, eat, bathe, cook, do laundry, drive, and work.  It helps older people with common problems like stroke, arthritis, hip fractures and replacements, and cognitive problems like dementia. In addition, occupational therapists work with individuals with chronic disabilities including mental retardation, cerebral palsy, and mental illness to assist them to live productive lives.   Occupational therapy practitioners also provide care to Veterans who suffer from traumatic brain injuries, post-traumatic stress disorder, spinal cord injuries, and other conditions.  By providing strategies for doing work and home tasks, maintaining mobility, and continuing self-care, occupational therapy professionals can improve quality of life, speed healing, reduce the chance of further injury, and promote productivity and community participation for Veterans.