MEDICARE PATIENTS ARE LOSING BENEFITS: TAKE ACTION!

Unbeknown to many of their constituents, Congress has failed to prevent the implementation of an arbitrary therapy cap for all Medicare patients. As of January 1, 2010, all Medicare patients seeking speech, occupational, or physical therapy in an outpatient setting (under Part B) are subject to a cap of $1860 per calendar year. Physical and speech therapy have a combined $1860 cap and occupational therapy has its own $1860 cap. As a result, if you (or someone you know) needs physical therapy after a surgical procedure or suffers from a debilitating injury (i.e. total knee replacement or stroke, respectively) Medicare will likely only cover approximately 14-20 physical therapy visits. As a result, if a patient were to attend 3 sessions of physical therapy per week, they would be covered for less than 2 months of care prior to reaching their maximum Medicare benefit. After reaching their maximum benefit, patients are left to either go to a hospital for therapy (which is covered under Part A) or pay out of pocket.

What this means for the patient is that the United States Congress has limited the choices available to patients regarding their own medical care; forcing them to attend only hospital clinics should they need therapy beyond their cap. This is a significant obstacle for patients who reside in rural areas who do not find it convenient to travel to hospitals for their therapy services 2-3 times per week. Additionally, even if a patient is making significant progress in a local physical therapy clinic and has developed a fruitful relationship with the physical therapist of their choosing, Medicare will not continue to cover therapy services with that therapist, forcing the patient to pay "out-of-pocket" or change therapists.

Since 1999, the United States Congress has acted to prevent the implementation of these caps by initially passing several moratoria and later authorizing an exceptions process to allow patients to continue to receive rehabilitative services beyond the $1860 cap so long as the services were deemed "medically necessary". To date, Congress has not acted, and the caps are now in place. The American Physical Therapy Association (APTA) states in a recent press release:

"The lack of action by Congress is troubling, especially as it had the opportunity to attach a temporary extension to the caps exceptions process to the Department of Defense Authorization Act as it did with physician and provider payments, including those to physical therapists. APTA is discouraged and disappointed that Congress is allowing an arbitrary annual cap on outpatient rehabilitation services to be placed on Medicare beneficiaries on January 1, 2010. This is clearly inconsistent with efforts by President Obama's administration and the Democratic majority to reform health care by eliminating arbitrary limits imposed by private insurance companies. Congress must hold the Medicare program to the same standard. Ensuring payments to providers, including physical therapists, while allowing this cut to rehabilitation services for seniors and people with disabilities during the health care reform debate is gravely disconcerting."

If you are bothered and troubled by our legislators inaction, or you are angered over the obstacles now placed before Medicare patients in attaining proper rehabilitative care, Mary Lou Corcoran Physical and Aquatic Therapy encourages you to take action and contact your United States representatives at both the senate and congressional levels. The APTA has provided a simple online format to allow you to contact your senate and congressional representatives regarding the Medicare Part B rehabilitation caps here.

The only way that you can let Washington know that they need to do what is right for patients with Medicare is contact them. Do not allow your voice to go unheard!

Posted by Keith P. Waldron PT, DPT