Coping With the Therapy Caps It’s been a long, hot summer for Medicare beneficiaries. First their hopes for prescription drug relief were put on hold while the enormously complex Medicare bill was dissected in congressional conference. Then, on Sept. 1, the Centers for Medicare and Medicaid Services imposed stiff annual limits on outpatient therapy under ... Bottom Line
Free
Bottom Line  |   September 01, 2003
Coping With the Therapy Caps
Author Notes
Article Information
Speech, Voice & Prosodic Disorders / Special Populations / Healthcare Settings / Practice Management / Regulatory, Legislative & Advocacy / Telepractice & Computer-Based Approaches / Bottom Line
Bottom Line   |   September 01, 2003
Coping With the Therapy Caps
The ASHA Leader, September 2003, Vol. 8, 1-23. doi:10.1044/leader.BML.08162003.1
The ASHA Leader, September 2003, Vol. 8, 1-23. doi:10.1044/leader.BML.08162003.1
It’s been a long, hot summer for Medicare beneficiaries. First their hopes for prescription drug relief were put on hold while the enormously complex Medicare bill was dissected in congressional conference. Then, on Sept. 1, the Centers for Medicare and Medicaid Services imposed stiff annual limits on outpatient therapy under Medicare Part B for the first time since 1999. As a result, many of America’s frailest citizens—both young and old—will have far fewer Medicare dollars to draw upon in recovering from an injury, stroke, or other disability.
The caps—originally set at $1,500 per year, now at $1,590—affect beneficiaries who need speech-language pathology, physical therapy, or occupational therapy services in an outpatient setting. After implementing the caps in 1999 as a cost-cutting measure, Congress lifted them twice in response to the outcry from patient advocates, ASHA members, and other provider groups.
Beneficiaries who need speech-language pathology and physical therapy services—stroke patients, for example—will reach their financial limit quickly. A technical glitch in Medicare law combines physical therapy and speech-language pathology services into a single $1,590 cap, which Congress so far has refused to correct. Occupational therapy has a separate $1,590 cap.
With Congress back from its summer recess, political pressure will increase for passage of a Medicare bill. The legislation is now in a joint House/Senate conference, which is struggling to produce a compromise bill. It faces high hurdles, with serious policy differences and a huge price tag. The House version of the bill includes a one-year moratorium on the therapy caps for 2004.
Speech-language pathologists and rehabilitation agency administrators continue to advocate against the caps and to voice their opposition.
“With the caps in place, those who are physically unable to get to hospital outpatient clinics will have to go without medically necessary rehabilitation. That, to me, is intolerable,” says Joanne Wisely, an SLP and manager of regulatory affairs for Genesis Rehabilitation Services.
“How can we live in one of the most technologically advanced countries in the world and not provide for the medical needs of those who have worked all their lives to build the nation we have today?”
To prepare for implementation, Wisely says the company has developed a tracking system “to allow us to inform patients about when they approach their cap.”
“We’ll work with our contract sites in educating the patients of their options and will provide the best treatment and information we can, including services that will provide for patient safety.”
But although the company is operationally prepared, she adds that “emotionally, I don’t think we will ever be ready to cap medically necessary rehabilitation.”
Adam Steinberg, president and CEO of Universal Institute Inc.—a rehabilitation company in Livingston, NJ, that provides treatment for clients with severe injuries, strokes, and other serious disabilities—has been advocating vigorously against the caps.
“It’s a horrible thing for our clients,” he says, citing the case of a young man struck by a bus while traveling in Europe. “He needs significant rehab and his family wants to bring him home, but they feel they can’t because of the limits imposed by the cap. They’re keeping him in an inpatient facility as long as they can so that he will get as much therapy as possible.”
“It’s a lose-lose-lose situation,” he says. “It’s a loss for the client and his family, a loss for the government—which spends more on inpatient than outpatient services—and for the rehab industry, which may be forced to downsize and lose valuable clinicians.”
If the caps continue into 2004, Steinberg believes the problems will worsen. “Many of our clients will cap out early in the year,” he said. “This is a tragedy because people can make substantial progress if given the opportunity. But that opportunity is being denied to them.”
0 Comments
Submit a Comment
Submit A Comment
Name
Comment Title
Comment


This feature is available to Subscribers Only
Sign In or Create an Account ×
FROM THIS ISSUE
September 2003
Volume 8, Issue 16