Advocating For Optimal Physical Therapy Care Under Medicare: The Second Step

The time is upon us to contact our representatives in the 111th United States Congress and remind them that November is coming, and we will let our votes speak for us! At this time, a greater than 21% reduction in reimbursement is scheduled to begin on December 1, 2010 for Medicare Part B Services. As was discussed at great length here, this is a remedy for a disaster.

I encourage all readers to click this link to send a message to your own elected official. If you are so inclined, I welcome anyone to copy/paste from the open letter below to make the process more efficient for you.

Spread this message as far and as quickly as you can: email, Facebook, Twitter, SMS…how the message gets out is not nearly as important as the impact our message can have if it is heard by as many people as possible!

An open letter to Congressional Leaders:

August 28, 2010

On June 24, 2010, you voted in favor of the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, preventing a devastating permanent reduction of 21.3% in physician reimbursement for Medicare services. Unfortunately, the legislation passed is only effective through November 30, 2010, when a greater than 21% reduction in Medicare reimbursement is once again scheduled to be implemented.

The cuts, as currently projected, impact all health professionals including physicians, nurse practitioners, physical and occupational therapists, speech language pathologists, physician assistants, chiropractors, psychologists and more. Each of these practitioners usually employ a support staff including receptionists, medical assistants, billing specialists and other support staff. We do not believe it is likely that practitioners will be able to continue under their current business models with a greater than 20% reduction in reimbursement over the next 20 years, while rent continues to climb, inflation rises and malpractice prices continue to increase. Instead, businesses will fail, directly as a result of a precipitous drop in reimbursement. One needs not be a governmental research analyst to predict the cascade of events that follows including medical field unemployment/layoffs, fewer businesses open to meet the demands of prospective patients, long lines with longer waits to see a clinician. In many cases, clinicians will simply stop participating with Medicare and down size to accept only privately insured or cash pay patients.

As a direct consequence, there will be less choice for the Medicare patient as they have fewer offices with their doors open, and even fewer offices that participate with Medicare Part B insurance. The clinics/businesses that remain available to the Medicare patient will be swamped with too many patients to treat, and too little time. Regardless of the clinicians experience or good intentions, quality of care will most certainly suffer.

This is not acceptable. Our Medicare beneficiaries deserve better. Please be a voice in the United States Congress against the implementation of Medicare reimbursement reduction in December 2010, America’s seniors need your support and initiative to maintain the availability of high quality care that they are entitled to.

Sincerely,
Keith P. Waldron PT, DPT

Reprinted with permission from The Concerned Physical Therapist

MPPR: Congress Gets Involved

Sixty-Eight members of the US Congress (including Mr Arcuri from a neighboring district) have weighed on the issue of MPPR in Medicare services provided in the outpatient therapy clinics nationwide.

Dear Administrator Berwick:

We Write to you to express our concern over the significant cuts in payment for outpatient physical therapy, occupational therapy, and speech-language pathology services proposed by the Centers for Medicare and Medicaid Services (CMS) in the CY 2011 Physician Fee Schedule Proposed Rule. If implemented, these cuts would apply to outpatient therapy services furnished by outpatient clinics, hospitals, skilled-nursing facilities, home health agencies, comprehensive outpatient rehabilitation facilities and other entities.

CMS has estimated implementation of the proposed changes would result in a 12-13 percent out in payment for outpatient therapy services starting on January 1, 2011. Specifically, CMS proposed to reduce payments by 50 percent for the practice expense component of therapy procedures for the second and subsequent procedures or units of the service furnished during thesame day for the same patient. The rehabilitation community strongly believes that a cut of 50 percent is unwarranted and is concerned that CMS’ proposed policy is based on a flawed assumption that there is duplication of services when rehabilitation services are billed. Therapy codes are unlike most other Current Procedural Terminology (CPT) codes in that the practice expense component for a typical visit is spread out among multiple codes since multiple services are typically provided to a patient during a visit. The purpose of spreading out the practice expense component was endorsed by the agency to prevent the chance of duplication.

Given that this represents a significant cut to a group of services in the proposed Medicare Physician Fee Schedule and given the large number of Medicare beneficiaries who rely upon these therapies, we ask that CMS provide us with a detailed justification, including an explanation of the methodology used to calculate the new rates. We also ask that CMS work closely with stakeholders in the rehabilitation community toward the production of a final rule that will not adversely impact access to care, particularly in rural and other underserved areas.

Lastly, Congress has acted on numerous occasions to extend an exceptions process to the Medicare Part B therapy caps, now scheduled to expire on December 31, 2010. In addition to reviewing the proposed fee schedule cuts for CY 2011, we also urge CMS to closely examine other therapy payment methods and altematives to the therapy caps that will preserve and improve access to necessary services for Medicare beneficiaries.

I would like to extend a sincere thank you to all the parties who signed onto this letter to Mr. Berwick. If your local congressional representative failed to be contribute to this letter, I would encourage you to contact them and ask them to send a letter as well if they have not done so already.

Reprinted with permission from The Concerned Physical Therapist

Advocating For Optimal Physical Therapy Care Under Medicare: The First Step

The first, and most pressing issue at hand is that CMS (Center for Medicare and Medicaid Services) proposes to implement a multiple procedure payment reduction (MPPR) policy that would result in significant reductions in payment for outpatient therapy services. Specifically, CMS proposes to make full payment for the first 15 minutes of therapy service, then reduce a portion of payment each of the next 15 minutes of therapy service by 50%. The American Physical Therapy Association estimates that this reduction in reimbursement alone will result in a 12-13% reduction in reimbursement to the physical therapy service provider. Coupled with a scheduled 23% reduction in reimbursement in December 2010, physical therapy offices are being asked to take a 33% total cut in payment from Medicare. As discussed here, this is an unreasonable cut for the physical therapy provider withstand, and will only diminish the quality of care available to the Medicare beneficiary in the future.

CMS is only accepting letters regarding MPPR until August 24, 2010, so time is of the essence! Action is needed now, not later. We have approximately 2 weeks to make ourselves heard. For your convenience, sample letters have been provided at the links below to upload/attach onto the regulations.gov website (the content of the letter is too long to fit in the comment field provided).

Sample Letter for Concerned Citizens

Sample Letter for Physical Therapists

Time is short. Act now. Click here to be directed to Regulations.gov and let your voice be heard.

Reprinted with permission from The Concerned Physical Therapist

Physical Therapy Under Attack: Medicare To Make Devastating Cuts In Reimbursement

A member of our staff has developed a blog of his own to keep the public informed of how quality medical care in the United States is being threatened by a significant reduction in reimbursement rates for Medicare Part B services. With his permission, we have decided to publish his content on our blog as well.

From The Concerned Physical Therapist:

On Saturday, August 7, 2010, President Obama’s Saturday radio address touted the benefits seen in Medicare after the passing of his health care plan earlier this year. According to an Associated Press report:

“Medicare isn’t just a program,” Obama said Saturday in his weekly radio and Internet message. “It’s a commitment to America’s seniors — that after working your whole life, you’ve earned the security of quality health care you can afford.”

“As long as I am president, that’s a commitment this country is going to keep,” he said.

An annual report this week from the trustees who oversee Medicare, including the Treasury and Health and Human Services secretaries, said the program will stay afloat for a dozen years longer than previously projected, due to the sweeping health care overhaul Obama signed in March.

Was the passage of the “Obamacare” really that large a boost to Medicare? Probably not…

In their recent annual report, the Trustees of the Social Security and Medicare trust funds reported that the projections include Medicare Part B (medical insurance) reimbursement cuts “by 18-21 percent in 2015, and by up to 10 percent in 2030 and beyond”. Additionally, CMS (Centers for Medicare and Medicaid Services) is looking to further reduce a portion of therapist reimbursement if the therapist spends more time with the patient*. To put it more simply, in order to be more efficient, Medicare is simply going to pay less for services to save money.

Some people may not see a problem with this plan. Perhaps they believe that health professionals already make too much money. Some people believe that health care, overall, is overpriced and a 20% reduction in price is a good thing. And while in some instances, those thoughts may be true, they unfortunately fail to tell the whole story.

The cuts, as currently projected, go to all health professionals including physicians, nurse practitioners, physical and occupational therapists, speech language pathologists, physician assistants, chiropractors, psychologists and more. Each of these practitioners usually employ a support staff including receptionists, medical assistants, billing specialists and other support staff. Is it a reasonable expectation for practitioners to remain in business with a 20-30% reduction in reimbursement over the next 20 years, while rent will continue to climb, inflation rises and malpractice prices continue to increase? No.

Businesses will fail, directly as a result of a precipitous drop in reimbursement. One needs not be a governmental research analyst to predict the cascade of events that follows. There will be a rise in medical field unemployment/layoffs. With fewer businesses open to meet the demands of prospective patients, lines will grow longer, and it will take longer to see a clinician. Some clinicians will simply stop participating with Medicare and down size to accept only privately insured or cash pay patients.

As a consequence. there will be less choice for the Medicare patient as they have fewer offices with their doors open, and even fewer offices that participate with Medicare Part B insurance. The clinics/businesses that remain available to the Medicare patient will be swamped with too many patients to treat, and too little time. Regardless of the clinicians experience or good intentions, quality of care will most certainly suffer.

As a physical therapist, I would like to focus on a scenario: a patient who needs physical therapy services after a total knee replacement. On average, a total knee replacement surgery (with hospitalization for 3 days) costs Medicare approximately $12,000 to $13,000, assuming there are no complications. After 2 weeks in rehabilitation (costing Medicare upwards of $6,000) or receiving home-care medical services (nursing, physical therapy, occupational therapy), the patient often arrives to their initial physical therapy appointment lacking the necessary range of motion and strength to walk without a limp. Their balance is poor, and they continue to present with a significant amount of pain and swelling. Even after Medicare has spent approximately $18,000 on this patient’s care over the course of nearly 3 weeks, aggressive rehabilitation, provided by a knowledgeable physical therapist, is often required to help this patient achieve their goals.

Unfortunately, this patient may find themselves in a quandry when trying to receive physical therapy in an outpatient setting. With the projected cuts to Medicare Part B reimbursement, rural patients are likely to have to drive farther for treatment as it is likely that smaller clinics with less patient volume are already working on limited profit margins, and are going to be hit hard in the months ahead. As clinics are forced to close their doors across the nation, patients will be left with fewer choices where they intend to receive their rehabilitation.

Wherever they choose to go, the patient will likely spend less time with their therapist next year than they would have 2 years ago. With Medicare paying less for a visit overall and reimbursing the therapist less as they spend more time with the patient (reducing a portion of reimbursement by 50% for every additional 15 minutes they spent with a patient), it is foreseeable that the amount of time spent in the therapy office will likely be diminished as well. The therapist will have no choice: they either treat a greater number of patients for less time, or see fewer patients for longer periods of time while receiving less in reimbursement from Medicare. The former keeps them in business, the latter has them in the unemployment line.

What happens to the patient who just had their knee replaced? It is impossible to say. Based on clinical experience, I would say that the best case scenario would have the patient walking with a mild limp with less than functional range of motion for the rest of their lives with recurrent bouts of tendinitis in the hips/knees and/or LBP from the stresses of walking improperly while favoring the “new” knee. The worst case scenario could involve the patient stepping off a curb with a knee that never got strong enough, falling to the ground with a resultant hip fracture, followed orthopedic surgery and more rehab and physical therapy…again with poor outcomes, setting the patient up yet again for another fall, or perhaps a loss of independent living. Both scenarios involve a return to the hospital or more physical therapy with a greater cost to Medicare. No one wins from this scenario. The patient fails to get better. Medicare has greater expenses for the overall care of this patient over their lifespan. Taxpayers then need to pay more into a system that is not helping patients to begin with.

Regardless of this patient’s outcome, the system is broken. A system that dis-incentivizes a clinician and creates an environment where choice is limited for the patient is a bad system. In an effort to rescue a failing Medicare insurance system, Medicare itself is directly creating an economical climate where excellent and effective treatment is no longer available to the patients they intend to provide coverage for.

I understand that apathy is easier than interest and participation, but the time for apathy has passed and the time for action is upon us. If we do not act now, and provide a voice of opposition to the dis-incentivization of physical therapy by Medicare, by the time the consequences come to fruition, it will be too late. Please…contact Medicare and tell them that cutting benefits for physical therapy is not a solution. Tell them that cutting reimbursement indiscriminately is short-sighted and will only further burden both the patient and the medical community with unnecessarily poor outcomes and greater financial burdens that neither the patient or Medicare can afford.

*Medicare pays physical therapists per 15 minutes spent with a patient. The new regulations proposed by CMS would reduce payment by 12-13% for each 15 minutes of service provided beyond the initial 15 minutes.

Medicare Cuts to Physical Therapy Benefits Will Likely Decrease Availability of Physical Therapy Care

ATTENTION MEDICARE BENEFICIARIES: Medicare patients may be severely affected by a new regulations proposal.

Currently, there is a government proposed regulation to deeply cut Medicare payouts to Physical Therapy providers. The cuts, coupled with legislation that is already set to reduce reimbursement greater than 20% at the end of the year, are so severe, they will result in either (1) physical therapy practices closing their doors and going out of business or (2) ensuring far fewer practices accept Medicare in the future.

A lack of PT practices participating in Medicare, coupled with fewer choices for the consumer directly results in poor care (or no care at all) and bad outcomes. This begs us to ask the question:

"Is it fair to tell people who've paid Medicare their entire lives that they will no longer have access or availability to treatment, simply because Medicare itself created a climate where the treatment is no longer available?"

Consider for a moment the predicament for a person who breaks a hip. Without PT, the hip will certainly heal, but the musculature will atrophy to a point the patient will be disabled or will be left to figure out how to walk again on their own. The best case scenario would be a patient that lives in pain and walks with a limp. The worst case scenario would be another fall, another break, another stint in the hospital.

No one wins from this scenario. The patient fails to get better. Insurance companies have greater expenses for the overall care of this patient over their lifespan. Taxpayers then need to pay more into a system that is not helping patients to begin with.

Please...contact Medicare and tell them that cutting benefits for physical therapy is not a solution,but will only further burden both the patient and the medical community with unnecessarily poor outcomes and greater financial burdens that neither the patient or Medicare can afford.

Posted by Keith P. Waldron PT, DPT