Table 3.
Table 3.

Alternative Outpatient Therapy Annual Expenditure Caps, Simulated for 2011a

  • a Therapy disciplines: PT=physical therapy, OT=occupational therapy, SLP=speech-language pathology. Caps are Medicare allowed charges. The alternative caps are chosen so that total Medicare allowed charges above the caps is equal to current cap policy (and thus equal for each cap policy). The analysis assumes no behavioral response by providers or beneficiaries to changes in the therapy caps. “Average amount cap exceeded” is the total amount by which Medicare allowed charges exceed all applicable therapy caps divided by the number of beneficiaries exceeding at least one cap (therapy users above cap). “Therapy users above cap” indicates the count and percentage of therapy users who exceeded at least one cap. This simulation was conducted on a 100% sample of all Medicare outpatient therapy users in 2011 (N=4,898,689). Source: authors' simulation using 2011 Medicare claims and enrollment data.