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Medicare Update: Physical Therapy Cap Exceptions Is Back

Yesterday both the House of Representatives and the Senate override the President's veto of bill HR6331/S3101. The House vote was 383 - 41, while the Senate voted 70 - 26. Congress accomplished two-thirds of the vote to allow the bill to be override.  It's amazing when Congress wants to accomplish something how fast they can move.  This should happen all the time.
                                   The key points to bill HR6331/S3101 for physical therapy.

The therapy cap exceptions process is extended to December 31, 2009. This applies not only to physical therapy ,also to occupational therapy and speech-language pathology services.
An increase of .5% in 2008 for conversion factor in physician fee schedule.  There will be a 1.1% increase in 2009 for conversion factor.  The reduction of physician fee schedule will not occur.
An increase of 2.0% in the Physician Quality Reporting Initiative bonus payment program. This will occur in 2009 and 2010.
Improve Medicare coverage of prevention services for seniors and persons with disabilities.

Congress did the right thing for now.  We still need to think outside the box to develop a cost effective  system.  The first wave of the baby boomers will hit the system in 2011.  We have two years to seriously  decided upon the future of Medicare and find a solution.  We are a little behind the eight ball.

President Veto Bill S3101: Medicare And Physical Therapy

Today President Bush veto bill S3101/HR6331. Now the bill must go back to House of Representatives and the Senate for the bill to be override.  There's suppose to be enough votes to over ride the President's veto.
Hopefully Congress will act before the summer recess in August.  We will be watching Congress.

Update: Medicare and Physical Therapy

As of this afternoon the President still has not sign bill S3101. As you know Medicare started processing claims as of July 11, 2008.  The cap is in-effect with no exceptions and there will be a 10.6% reduction in the physician fee schedule. Hopefully the President will sign the bill soon or veto the bill. Congress will then override the cap.  Stay tune.

Balance & Falls In People Over 65.

Did you know one in three seniors age 65 or older will suffer a fall in a given year?  Falls are a major problem for this age group, and are the leading cause for Emergency Room visits.  Fifty percent of falls occur in the home setting.  Many times falls are not severely injurious, but often they are.  Broken bones, head trauma, loss of mobility and independence occur some 50% of the time.  More startling however, is that twenty five percent of the time a fall can result in death.  This can be from immediate consequences, but more often from injury related complications, surgery, infection, prolonged hospital stays, etc.   

There are several risk factors predisposing one to a fall, and Physical Therapy intervention can help.  A Medical exam by a Doctor and related specialists if necessary, combined with a visit to a knowledgeable Physical Therapist are the first steps.  For more information contact John Fornabaio, PT, CSCS at (518) 477-6179.

Update: Medicare and Physical Therapy

One step closer to keeping the physical therapy exception cap and stopping the 10.6% reduction in the physician fee schedule. The Senate pass bill S3101 today by 69 - 30. The bill will now travel to 1600 Pennsylvania Ave and awaits our President to the sign the bill into law. The President does have 10 days to either sign or veto the bill. Lets hope the President will act swiftly to sign the bill into law. Remember tomorrow will be the last day before Medicare starts to process the claims under the existing law. Which means the cap is in effect and there will be a 10.6% reduction in fees.  It's in your court Mr. President.

Update: Physical Therapy,Congress and Medicare

Rumor has it, the Senate will bring a cloture vote to floor on Wed,July 9, 2008 concerning bills S3101 and S3118.  Cloture is " a parliamentary procedure by which debate is ended and an immediate vote is taken on the matter under discussion." The first cloture failed, vote was 58 - 40 on Thurs., June 26, 2008.

Lets hope the Senate does the right thing and vote this week.

Also on June 30, 2008, Medicare announced the proposed rule for the 2009 Medicare Physician Fee schedule.  The rule proposes a 5.4% reduction in the 2009 conversion factor based on the current law pending the action by the Senate.

The definition taken from The Free Dictionary.

Why Does Physical Therapy Have A Cap?

I would like someone from CMS to answer the title question?  I believe physical therapy is the only discipline that has a financial cap from Medicare. I can not understand the reason behind this decision. Physical therapy is cost effective.  If a senior can not receive physical therapy due to reaching the cap then the patient will seek other alternatives.  The other alternatives could and most likely cost Medicare more money in the end.
Medicare will allow seniors to seek treatment in a hospital outpatient physical therapy center or the ER. What's the difference financially between hospital outpatient physical therapy center vs. outpatient physical therapy center. Nothing, except the bank account of the hospital.  A patient can be treated in ER for physical therapy, what a joke.  No wonder our ER departments are in bad shape.
Our seniors should stay in outpatient physical therapy centers. Where they will receive the best care. We need to develop a better plan than the financial cap.  If Medicare or our government is worry about money then we should develop a outcome plan for continuing services. We should have a range of a flat fee, which increases each year.  After all, there are expenses such as employees, office rent, equipment leases, etc.  There is no reason to have a cap, its not fair to the seniors who need the therapy. If the cap remains then  most likely some other group was rewarded.

Senator Fails To Vote: Physical Therapy Cap Is Back

Well the Senate failed to vote on bills S 3101 and S 3118 this past weekend.  The Senate will reconvene on Monday, July 7,2008. Meanwhile Medicare will not process claims from July 1 - 10 to give the Senate time to negotiate bills S 3101 and S 3118. American Physical Therapy Association (APTA) met with senior administrators  of Medicare and Medicaid Services (CMS) to request an administrative delay for the therapy cap.  The officials of CMS denied the requested from the APTA. Which needs the therapy cap starts as of July 1, 2008.
OK, CMS will not process claims for 10 days.  The problem for physical therapy practices are twofold, first the therapists will need to inform their senior patients either you have reach the cap or near cap or over the cap. The patient will have to make a decision, do I continue therapy at my present location as a self pay or relocate to an  hospital outpatient physical therapy center. Another option for the senior patient is to end therapy session regardless of their  functional level..  Yes both party's can roll the dice and hope our"all mighty" Senate passes the bills (therapy cap exceptions intack). The senior patient will not be happy and this could affect their health ;ex patient's who had a stroke or knee replacement .  Seniors are very loyal patients. They also love coming to therapy, therapy has a positive effect on our seniors.
Oh yes, Medicare will not process claims for 10 days.  Who will  benefit the most, my vote is for Medicare. Physical Therapy practices are a small business.  Cash flow is very important, remember the insurance industry is the only business that does not paid within 30 days. Medicare's normal turn around time for processing claims and paying is 2 weeks.  The 10 days of no processing claims will turn payments into 30 days or possibility 45 - 60 days if there is a "problem" with the claim. Medicare is  in a better position than either the patient or provider.
My question to Medicare, the reason for the therapy cap was to save money but why do you allow hospital outpatient physical therapy center to be uncap?  Medicare is not saving money  by allowing this to occur.
I hope our society realizes that you can not depend on our government to take of you.  We need stand up for ourselves and make the government work for us. Right now the government is working for themselves. Seniors and providers should be calling their Senators right now.   

Update: Changes in Medicare For Physical Therapy

On Tuesday, June 24, 2008 the US House of Representatives pass the bill (HR 6331), Medicare Improvements for Patients and Providers Act. This bill will prevent a 10.6%  decrease in payment under Medicare's physician fee schedule and ensure our seniors the ability to continue their physical therapy treatment under the therapy cap exceptions process. The vote was 355 - 59. There are numerous other Medicare issues in this bill.
The legislation is now in the Senate and as of Friday, June 27, 2008, the bills S-3101 and S-3118 did not receive approval. Senator Reid inform the members of the Senate, there will be another vote on Sunday, June 29, 2008.  Hopefully the Senate will be able to negotiate a deal before Congress convenes on July 1,2008. If the bill is not pass before July 1, 2008, then there will be seniors who will not be able to continue their physical therapy treatment due to the financial cap. Yes, some seniors will be able to continue for number of reasons; they have a true secondary insurance policy or the ability to be a self pay. I'm sure there will be number of clinicians who will treat the patient for free. Of course the clinicians will receive a decrease in payment.  Now if the Senate decides to pass the bills sometime in July or after their summer vacation, the clinicians will be paid retroactive from July 1, 2008, this will be accounting nightmare. Plus the most important issue, what about the patients who did not receive treatment?   Again Congress at its finest. Can you image if we operated our businesses or companies similar to Congress....we would be out of business. This will be another topic in the future.

New Product for the Spine

Last week I went to a physical therapy center in Orange County, NY to try a new product called the Spine Six.  The Spine Six allows the patient to perform functional range of motion in a non-weight bearing environment.  The experience was great.  I did not feel like I was exercising and I was relaxed during the session.  Three other individuals with clinical symptoms also tried the Spine Six.  They reported no pain during the procedure and felt relaxed as the treatment was progressing.  All three patients experienced positive results in their active range of motion,walking  and state of mind.
                                                       Function of Spine Six

• Spine is moved in multiple planes of motion in a safe and controlled environment.
• Eliminates spinal load from being in an upright position.
• Relaxed spinal movement at the neck and low back.
• Gentle motion to increase Range of Motion and functionality.
• Accelerate healing by decreasing soft tissue/joint stiffness, increasing range of motion, and preventing scar tissue accumulation.
• Assists in reeducation of paraspinal musculature.
• Option to treat cervical and lumbar regions individually or simultaneously.
• Treatment can be conducted in a seated,reclined, or lying position.
• Treatment can be active or passive.
• Unit allows for multi-planar motion - rotation,forward/side bending.

                              Conditions to be treated with the Spine Six

• Cervical or lumbar pain with or with out associated limb pain.
• Spinal motion deficit not associated with clinical judgments listed below.
  
• Disc bulges.
• Radiculopathy.
• Disc protrusions.
• Neuromuscular deficits of the spinal musculature.
• Spinal kinesthetic deficits/proprioceptive deficits.
• Muscle spasm and other dysfunctional muscle states.
• Muscle strength deficits.
• Sprain/Strain.
• Whiplash.
• Cervicocranial syndrome.
• Post-surgical mobilization and neuromuscular and desensitization.
• Pre-activity warm-up before therapy or exercise.

                                                   Use Clinical Judgment

• Serious systemic disease.
• Progressive neurological deficit.
• Fractures.
• Recent Surgery.
• Gross spinal instability.
• Pregnancy.
• Infections.

The Spine Six is something you should consider checking out and speaking with your health care provider, if you have spine or back problems.  Please feel free to contact me if you have any questions or want more information concerning the Spine Six.