On July 31, CMS finalized the IRF Prospective Payment System Rule for 2020. In the final rule, CMS has deferred to the inpatient rehabilitation facility to define and assess the definition of “rehabilitation physician.”
While this is a disappointing outcome, our work is far from over. AAPM&R is taking action.
Your Academy will be convening key stakeholders across rehabilitation to establish consensus guidelines to better define the qualifications of a rehabilitation physician and set clear and necessary expectations and standards for rehabilitation. We believe physiatrists are a necessary and integral leader of the rehabilitation team within the IRF setting.
Collaboration, open dialogue, and a united voice among physiatrists will be essential to our success. In the weeks and months ahead, please be on the lookout for requests from AAPM&R to get involved and to support our efforts. AAPM&R will continue to advocate for the long-term interests of physiatrists, IRFs, Medicare beneficiaries in need of intensive, coordinated, interdisciplinary inpatient hospital rehabilitation, and the Medicare program itself.
Despite this outcome, we are immensely proud of the work more than 1,100 of our members put into advocating against this proposal being finalized. In their preamble to the final rule, CMS acknowledged the comments received from AAPM&R and other collaborators. Our members demonstrated that physiatrists are advocates for their patients, in and out of the treatment setting.
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So folks, are we screwed for inpatient sides?
I am not an expert in billings and I am not qualified to talk about why this has happened. But, If I have to do root analysis on my own, I think that inpatient rehab facilities run by PM&R have called too many consults and many of consults were not necessary. Many consults were called to cover out butts.
Even though it is my own experience, I remember asking an embarrasing consult to GI for PINWORM. I did not want to do it of course but my attending made me do it. Inpatient rehab patients' demands for medicine or other services due to their complicated comorbidities have become too much for inpatient physiatrists who have one yr of internship from the past. At the same time, inpatient rehab facilities are forced to accept patients and fulfill empty beds. Maybe, CMS thinks that there is too much money spent on consults so why gerontology manages rehab????
I am really not happy with this outcome. Where do we go from here? More graduates with TBI and SCI fellowships to make themselves competitive in the market? more IM/PM&R combo ???
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