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

Physical Therapy For Balance Problems

Do you feel unsteady on your feet? Are you finding that you need to use a cane to feel safe when you leave your home? Have you recently fallen or found yourself losing your balance more often? These are the hallmark signs of balance problems, a condition that is often reversible.

Some people lose balance due to Parkinsons MS, cerebral palsy, peripheral neuropathy, a cerebrovascular accident (CVA), or some other neurological condition. Other people may have balance concerns that they incorrectly attribute to a normal consequence of the aging. Physical Therapists are trained to examine the multifaceted causes of balance deficiencies, and design a treatment program to reduce a person’s risk of falling.

During the examination process, your physical therapist conducts an assessment of musculoskeletal causes of poor balance. These include ROM/flexibility, muscle strength, and muscle tone. Good flexibility is essential as all muscles have an optimal length to work effectively to maintain balance. Muscle strength plays a role as well; muscles must contract in a controlled manner to correct for a loss of balance. Muscle tone can be an issue with those with neurological conditions as the damaged central nervous system may have a tendency to over or under utilize the correct muscles.

The physical therapist also takes into account sensory systems related to balance including the visual system, somatosensory system, and the vestibular system. Many people are “visually dependent” which means they use vision to adjust to changes that may upset their balance. The somatosensory system refers to neurological “receptors” in joints and muscles that, among other things, detect the position of body parts in space. The vestibular system refers to the sensory organs within the inner ear that are particularly important to balance when vision and somatosensation are unreliable, such as in a dark room or on a moving surface.

After a detailed balance assessment, which will also include functional tests to assess overall fall risk, your physical therapist is able to tailor an individualized treatment program to address the specific needs of each patient based on the findings of your examination. This will often involve therapeutic exercises to improve strength and flexibility as needed, and working with the appropriate sensory systems for improvement or adaptation.

From pediatrics to geriatrics, the skilled physical therapy staff at Mary Lou Corcoran treats patients from all phases of life. If you are suffering from balance difficulties, you may want to consider asking your physician for a prescription for physical therapy and make an appointment for an evaluation, the first step on your way to feeling more confident and steady on your feet.

Sources:
Motor Control: Theory and Practical Applications, 2nd ed. Shumway-Cook and Woollacott; Williams and Wilkins, 2001.
Mosby’s Medical, Nursing, & Allied Health Dictionary, 6th ed. Mosby 2002.
Course notes and handouts from “Assessment and Treatment of Balance Dysfunction: Systems-Based Task Oriented Approach,” presented by Jan Coy M.A., PT, September 15, 2003.

Posted by SHERRY MOSER, MPT

ARE YOU AT RISK FOR AN ACL INJURY?

At one time, it seemed that the majority of injuries or tears to the Anterior Cruciate Ligament (ACL) happened to professional athletes. In recent studies, however, it is estimated that there are nearly 200,000 ACL-related injuries annually in the United States (1). Unfortunately, females (particularly athletes) are up to 9.7 times more likely to have ACL injuries than males. The increased rate of ACL injuries in central New York athletes was so dramatic by 2007 that Syracuse-area orthopedic surgeons held a meeting with all New York State Division III High School Athletic Directors to address the need for ACL injury prevention programs for the spring of 2008.

There are a variety of non-contact ways to tear your ACL including (but not exclusive to):

• Trying to slow down while running
• Jumping and landing off balance
• Leaping and landing on one foot
• Quick change of direction
• Jumping and landing with stiff legs/knees

Why do non-contact ACL injuries to occur?

Poor functional movement is the main cause for non-contact ACL injuries. Muscles of the hips and legs that are tight, weak and lack coordination produce abnormal stress on the joints they surround. During activity, joints can be limited in normal motion by stressed muscles and produce abnormal stress on the ligaments that hold the joint together. The ligaments are then unable to handle the stress load on the joint and tear.

Why is the ACL injury rate so high among young females?

Young women have a higher rate of ACL injuries for two main reasons:

1. During adolescence, young women are begin to develop wider hips, producing greater biomechanical stresses in the knee joints
2. Young women are less likely to have the muscle mass developed around the hips and legs to adequately control stress on the knee

Can ACL injuries be prevented?

There is no guaranteed way to prevent ACL injuries, however, the risk of an ACL injury can be reduced through physical assessment and functional screening. Physical assessment of joint and muscle function occurs during an anatomical screen where each joint range of motion, muscle group flexibility, and muscle group strength are assessed throughout the trunk, pelvis and legs. In comparison, a functional assessment looks at how well the muscles and joints work together during specific movements, keeping proper body alignment and minimizing stress on the body. If you would like to determine your own potential risk for ACL injury, here are 2 functional tests you can try at home:

• SQUAT TEST:Stand in front of a mirror, hands on hips, feet shoulder width apart and toes pointing straight forward. Squat down slowly and try to get your thighs parallel to the floor. You could be at risk for ACL injury if: (1) your heels rise off the floor, (2) your knees go inward, (3) your hips shift to left or right, (4) you lose balance and step out of squat position.
  

• SINGLE LEG STANCE BALANCE TEST: Stand and lift your right foot from the floor, bringing your right knee forward and up to about waist height. Try to balance on your left foot for 20 seconds. Try the same test on your right foot for 20 seconds. You could be at risk for ACL injury if: (1) you are unable to maintain balance for 20 seconds, (2) your arms, non stance leg or upper body wave around during test

If you have difficulty with any of these tests, you may want to find a ACL Injury Prevention program or Sports Performance program to evaluate what you have to work on to avoid injury. Mary Lou Corcoran Physical and Aquatic Therapy offers an Athletic screening program and ACL Injury prevention program. These programs are administered by physical therapists who evaluate an individual's risk for injury based on medical history, anatomical screen, functional screen, running analysis and sport position played (if appropriate). After the screen, problem areas are identified and an exercise program can be designed to address these areas. This program can not only reduce the risk of ACL or other injury, but can improve sports performance.

If you have any questions regarding ACL injury prevention or Athletic screening please call 315-637-4747 or send an email inquiry to ptinfo@mlcpt.com.

Reference

(1) Gammons M, Schwartz E. January 5, 2010 Anterior Cruciate Ligament Injury. Retrieved from Medscape website: http://emedicine.medscape.com/article/89442-overview

Posted by TROY ANDREWS PT, CES

MLCPT- Racing For the Cure...and For Local Children

On May 15th, MLCPT joined over 8,000 other central New Yorkers at the NYS Fairgrounds to raise money and increase awareness for breast cancer research at the Susan G Komen "Race for the Cure". The day was colder and windier than expected, but the weather could do nothing to dampen the spirits of those around us. Whether we were speaking with survivors and their families or groups of local youths/volunteers who were there to help in any way that they could, the collective energy at the fairgrounds filled us with a positivity that is difficult to put into words.



To show our solidarity as a team, MLCPT wore our Breast Cancer Rehab shirts that read "We Make BooBoos Feel Better", the Friday before the race and the day of the event. The shirts were designed specifically with the Komen Race in mind, but they were very warmly received in the clinic and there were many people who expressed an interest in acquiring one. So many patients, (both from our exclusive Breast Cancer Rehab program and orthopedic patients) requested shirts, we needed to place a second order of shirts. If you have any interest in a shirt for yourself (or someone else you may know), please do not hesitate to stop in or call for details.


The following weekend, MLCPT rallied together to participate in the 5k walk/run to benefit Charity for Children. For those who may not be familiar with the group, Charity for Children is:

"...a registered 501(c)(3) non-profit charitable organization dedicated to providing financial and educational services to needy families in Onondaga, Madison, Cayuga and Oswego counties with children who suffer from disabilities, diseases and disorders."

As one of the leading pediatric outpatient physical therapy offices in the Syracuse area, the staff at MLCPT witnesses first-hand the financial and emotional burden that many families experience in their efforts to do everything that they can for the health and wellness of their children. It was with those personal experiences in mind that we gathered at Green Lakes State Park to walk/run for yet another worthy cause. For the second weekend in a row, the sun chose not to shine, but it didn't prevent the event from being a tremendous success: a total of $10,000 raised for the charity.


The MLCPT team is proud to have spent the last 2 weekends working together to benefit the the CNY community. With a staff that is comprised of 3 cancer survivors and 2 parents of children with special needs, these 2 events in particular held a special place in our hearts and we are happy that we are able to contribute in some way. And although the race events themselves have concluded, the organizations that they benefit continue to provide a valuable service to the community all year long and would be grateful for any contributions that you can afford to give. Should you wish to make a donation please click the links below.