Site Neutral Payments, EMG, and more (RTS Newsletter #4)

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First, a laugh 🤣 

Community Spotlight: Vijay Muni, OTR/L, CHT 🚀

❋ Why are you excited about the Rehab Tech Stack newsletter and community?

Vijay: RTS offers an excellent way to stay current with the latest information in our rapidly evolving field. I’m excited about how AI can help with everything from scheduling to care delivery to managing my day-to-day tasks.

❋ What innovative technology or approach have you implemented in your practice, and how has it improved patient outcomes or your clinical workflow?

Vijay: Utilized AI to improve documentation and patient care, including remote monitoring. I’ve used AI to improve efficiency in documentation while managing a busy caseload to avoid burnout. I’ve used AI, particularly remote monitoring with Squegg, to improve patient compliance with HEP and track their progress

❋ Is there a particular area of rehab therapy where you think technology could make a big impact but hasn't yet?

Vijay: Comprehensive patient education that visually demonstrates how specific conditions impact daily activities and illustrates how occupational therapy interventions can enhance functional independence and quality of life.

❋ What advice would you give to other therapists who want to integrate more technology into their practice?

Vijay: You need to start using it more, especially in your daily life, and slowly implement it in documentation and patient care. The best way to integrate technology is to embrace and start using it slowly and surely.

World of Rehab 🌐

• [Speech] As a result of ASHA and Michigan Speech Language Hearing Association (MSHA) advocacy, the Michigan legislature appropriated a $5.5 million increase for speech-language pathology codes in 2025, resulting in a 23% rate increase across all codes for which we requested increases.

• [Physical] Thought Technology Ltd will showcase MyOnyx, an advanced sEMG monitoring and electrostimulation device for physical therapy, at the Medica Trade Fair in November 2024, highlighting its benefits for muscle activity tracking and rehabilitation in the physical therapy market.

• [Occupational] Washington University professor and her daughter are working to expand the Home Hazard Removal Program (HARP), a proven fall prevention intervention for older adults, by developing an online training platform called AgeSafe Assist to reach more occupational therapists nationwide.

• [Physical] The 2024 APTA Benchmark Report reveals that outpatient physical therapy practices are experiencing significant hiring challenges, with a 9.5% vacancy rate, despite industry growth and increasing demand for PT services.

• [General Rehab] A UCLA-led study will evaluate the effectiveness of intensive home-based telerehabilitation for stroke patients with arm motor deficits compared to typical in-person care.

Indie’s Insights: Site Neutral Payments in Rehab💡

While reimbursement isn’t necessarily a technology-specific topic, it is the number one concern for just about every rehabilitation provider. It’s also what enables most business practices to function. Over the last few weeks, I’ve been chatting with many clinicians, excited about the potential of site-neutral payments in rehab.

Members of RTS suggested I write up more of an overview of the topic.

The current rehabilitation payments system

Under the current system, the same service can be reimbursed at different rates depending on where it's provided.

For example, an outpatient therapy session might be paid more if provided in a hospital outpatient department compared to a freestanding therapy clinic. Here are some more examples:

1. Inpatient Rehabilitation Facilities (IRFs): Paid under the IRF PPS, which provides a single, adjusted payment for the entire stay based on patient condition and facility characteristics.

2. Skilled Nursing Facilities (SNFs): Paid under the SNF PPS using an adjusted daily rate based on patient needs and resource use.

3. Home Health Agencies (HHAs): Paid under the HH PPS for 60-day care episodes, adjusted for patient factors and services provided.

4. Hospital Outpatient Departments (HOPDs): Paid under the OPPS, typically at higher rates than community-based settings for similar services.

5. Physician Offices and Community Settings: Paid under the MPFS, typically at lower rates than HOPDs for similar services.

At Indie Health, we’re all about provider independence. This structure clearly impacts independent practice owners, who often provide the same level of service, if not better, than a hospital.

Site Neutral Payments

Site-neutral payment policies aim to address this difference in payment rates across settings. The goal is to eliminate these disparities and ensure that everyone pays the same rate for the same service regardless of the setting.

KFF, a non-profit focused on healthcare policy and research, wrote an excellent breakdown of the topic related to Medicare, which I encourage everyone to read. While the estimated cost-savings range significantly from $5b to $100b, they reflect the varying scope of the reforms being discussed in the US.

Critics, mainly from the hospital industry, warn that site-neutral payment reforms could reduce hospital revenues, potentially forcing cuts to services in hospital outpatient departments (HOPDs) and other areas. Some patient advocacy groups argue these reforms might prioritize cost savings over appropriate care and outcomes.

Relevance to an Independent Practice Owner

We’re all about promoting independence and improving outcomes for patients and providers.

And while site-neutral payments could be beneficial in many situations, these changes are mostly outside of an independent practice's control.

Instead, practice owners should focus on reducing administrative costs, which they can directly influence. Data shows that U.S. physician practices spend around $83,000 annually on administrative costs per doctor. This is roughly 30-40% of their time.

Administrative work is necessary, but practices should know there are better ways to deal with it.

If you’re an owner or operator, the best way forward is to concentrate on managing internal costs and administrative efficiency, which are within the practice's sphere of control.

See you in two weeks,

Eddie

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