Developing Outpatient Therapy Alternatives

Project Overview

Outpatient therapy services are composed of physical therapy (PT), occupational therapy (OT), and speech language pathology (SLP). These services have accounted for a small but growing share of the Medicare expenditures, accounting for about three percent of Medicare Part B spending in 2004. The past growth in Medicare expenditures led to increased attention to these services. Attempts to address the increased expenditures through payment policy changes led to the realization that CMS cannot adequately assess the appropriateness of utilization patterns or the impact of changes in payment policy without access to better information tied to patient need and the effectiveness of outpatient therapy services.

In 2007, the Centers for Medicare & Medicaid Services established a research project titled “Developing Outpatient Therapy Payment Alternatives” (DOTPA). The purposes of this project are to identify, collect, and analyze therapy-related information tied to beneficiary need and the effectiveness of outpatient therapy services. The ultimate goal is to develop payment method alternatives to the current financial cap on outpatient therapy services.

The five year contract for implementing DOTPA was awarded on January 29, 2008 to RTI International. This is the official website for this project.

CMS Project summaries (April 22, 2008)