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Medicare Patients, Physical Therapists Stand to Lose in Government’s Outpatient Therapy Reform

The national association representing physical therapists, the American Physical Therapy Association is calling on policymakers to reject some recommendations released by the Medicare Payment Advisory Commission (MedPAC), which would diminish needed coverage for many Medicare patients.

Cutting back on physical therapy services would be a step in the wrong direction for not only patients but also health care reform. As American Physical Therapy Association President Paul Rockar Jr, PT, DPT, MS, said in a June 14, 2013 association press release: “Physical therapy has the potential to reduce spending across the program, improve quality of life for beneficiaries, and advance health care reform initiatives.”

During the MedPAC deliberations, many commissioners acknowledged the importance of therapy services for reducing hospital admissions, preventing readmissions, saving health care costs and improving quality of life. Still, the commission ultimately endorsed recommendations that would restrict patient access to physical therapy care. These two recommendations include:

• Reducing the level of the therapy caps from $1900 to $1270

• Application of a multiple procedure payment reduction (MPPR) of 50% to the practice expense component of therapy services for services provided on the same day.

What do these mean to patients and their physical therapists? Let’s tackle the therapy caps, first. Therapy caps are limits on outpatient physical therapy and other therapy services. Reducing the $1900 cap to $1270 would mean a large percentage of patients would not get the amount of care they need for optimal recovery. Even MedPAC indicated that about one-third, of Medicare beneficiaries would exceed a $1270 cap. The caps discriminate against the most vulnerable of Medicare beneficiaries, such as those who experience stroke, neuromuscular diseases, hip fracture, Parkinson disease, diabetes, arthritis or osteoporosis. Also, beneficiaries who experience more than one episode of illness or injury in a 12-month period are particularly at risk of exceeding the caps.

The 50% MPPR, which Congress implemented in the American Taxpayer Relief Act of 2012, has resulted in arbitrary payment cuts across the board. In 2013, as a consequence of these lower reimbursements, outpatient therapy providers are not being adequately compensated for the resources needed to provide medically necessary and vitally important therapy services.

Click on this link for more about what patients can do to advocate for their rights regarding quality of care and access to physical therapy services.

For more about what physical therapists do to help people recover their abilities to move, function and live independently after diagnoses of stroke, neuromuscular diseases, hip fracture, Parkinson disease, diabetes, arthritis or osteoporosis, contact, contact A Physical Therapist, Inc.

A Physical Therapist, Inc., is a one-on-one physical therapy clinic in Delray Beach, Fla., and Harrisburg, Penn. For patients in Palm Beach County, A Physical Therapist, Inc., is easily accessible from Boca Raton or Boynton Beach. For patients in Dauphin County, A Physical Therapist, Inc., is easily accessible from Hershey and Marysville.

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