Lifting burdensome restrictions on PTA and occupational therapy assistant supervision in outpatient settings could save Medicare as much as $242 million over 10 years, according to a new study commissioned by a coalition of provider groups including APTA.

That simple change, included in bipartisan legislation focused on the PTA and OTA pay differential, could in turn help offset the costs of improving access to therapy services for Medicare beneficiaries in rural and underserved areas.

The study looked at the potential financial impact of the Stabilizing Medicare Access to Rehabilitation and Therapy Act, or SMART Act (H.R. 5536), introduced in the U.S. House of Representatives by Rep. Bobby Rush, D-Ill., and Rep. Jason Smith, R-Mo. The bill aims to exempt rural or underserved areas from a 15% Medicare payment cut when services are provided by a PTA or OTA. That cut was implemented on Jan. 1, and applies to PTA and OTA services under Medicare Part B.

The study was conducted by Dobson DaVanzo & Associates, an independent nonpartisan research firm commissioned by the American Physical Therapy Association, APTA Private Practice, American Health Care Association, American Occupational Therapy Association, Alliance for Physical Therapy Quality and Innovation, National Association of Rehabilitation Providers and Agencies, and the National Association for the Support of Long Term Care.

While the study finds that the SMART Act's exemption could cost Medicare between $741 million and $1.58 billion over 10 years, researchers say that cost could be partially offset by another feature of the legislation: shifting PTA and OTA supervision requirements in outpatient settings from "direct" to "general" supervision.

According to the report, moving to general supervision in outpatient settings could result in estimated savings between $168 million and $242 million over 10 years, as outpatient clinics increase access to PTAs and OTAs. The change would also bring the outpatient practice supervision of PTAs and OTAs in line with all other Medicare settings that provide therapy services.

In a news release, the study's sponsors describe the findings as a "win-win" for the ways the SMART Act would create Medicare savings while reducing administrative burden — and increasing access to PTAs and OTAs across the country.

"This new study reinforces what APTA and other organizations have been saying about the SMART Act all along — it's common-sense legislation that would have a very direct and positive impact on the lives of Medicare beneficiaries," said Justin Elliott, APTA's vice president of government affairs. "The SMART Act improves patient access to care, particularly in underserved areas where Medicare beneficiaries are 50% more likely to receive therapy from a PTA or OTA, and at the same time, it reduces unnecessary administrative burden. Lawmakers should recognize a good thing when they see it."

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