MEDICARE FEE SCHEDULE CUTS: NO CARE FOR SENIORS?Private practice physical therapy facilities provide quality treatment for senior citizens in accessible environments where they can receive the type of care required.
Medicare payment cuts proposed by the Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS), in the July 13, 2010, Federal Register, stand to eliminate private practice in the physical therapy industry.
This would be devastating to seniors, as it would severely reduce not only the number of accessible facilities, but also the quality of care they would receive, if they were able to receive care at all.
It may not be well known that insurance companies across the board have significantly cut payments to physical therapists (PTs) making it increasingly difficult for private practices to accept all insurance plans and even to support a business or a staff and provide quality care based on the cuts. If you have one of these insurance companies in yor area, then you know precisely what we are talking about. Many patients have difficulty finding in-network providers, or have co-payments that are so high they can't afford needed treatment. Private insurance companies are, of course, free to do as they wish and PTs are free to choose not to accept those plans. This is precisely what will happen if the proposed Medicare cuts are approved. They are drastic, to say the least. If you have not researched this for your own benefit, you should stop what you are doing right now and do it. Private practices may be forced to drop Medicare from their lists of accepted insurers.
Is it fair to tell people who've paid into a system their entire lives that they will no longer have access to treatment? Consider how it will affect a person who breaks a hip. Without timely or appropriate physical therapy, the hip will certainly heal but the musculature will atrophy, disabling the patient and leaving them on their own to figure out how to walk again. In the best case scenario, the patient lives in pain and walks with a limp; the worst case is another fall, another break, another stint in the hospital, or worse. For those interested only in the bottom line, how is that cost efficient? For those of us who care about the patient, how is this acceptable? In answer to both questions, it's not.
One major tenet of the federal regulations proposed that guarantees the failure of private entities is the reduction of payouts by 50% for what CMS deems duplicate codes in billing. They plan to cut by 50% any subsequent code after the first code is billed on that day. It appears that a lack of understanding of what the codes actually represent plays a role in this scenario. One such example of duplicate codes provided in the document asserts that "neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities" (CPT97112) is the same as "therapeutic exercises to develop strength and endurance, range of motion and flexibility" (CPT97110). The fact is, one has to do with educating the mind-body connection so the brain can send the correct messages to the muscles (hence, the use of the terms neuromuscular and proprioception), while the other has to do with the actual physical performance of the task. In aging bodies, the neuromuscular connection is already degraded, making its correction an even more challenging and delicate task. Then, once the re-education is complete, the patient must perform the physical task from what they've learned in that particular session, with the guidance of the PT (CPT97530). Each session, something new is learned and built off the success of the previous session in an appropriate progression. How a manual therapy code could be seen as a duplication of one of the codes above is a mystery to me, and no explanation can be imagined.
The other misunderstanding is that the fee set for each code takes into account that multiple codes would be billed and reduced to the point that a fair fee would be paid when three or four codes are billed for a 45- or 60-minute treatment. The cuts would reduce the total fee by 30 to 40 percent at a time when private physical therapy practices are only just surviving with the fees being paid while all expenses increase.
Once these rules are passed and private practices fall by the wayside, the public is left with overcrowded institutional facilities that have no choice but to give compromised quality of care or restrict access to care. How would they ever accommodate the influx of patients now rejected by private practices, and how would they maintain quality care at one-third less of a payment on service? The answer is, they can't. It's simply impossible. They will be forced to cut services, so seniors who've paid into a system their entire lives face the possibility of getting 10 to 15 minutes of an overworked PT's attention and hoping they absorb enough of what they were taught to perform the movements correctly, unsupervised. In 10 to 12 sessions, they have about a 50-50 chance of getting well, creating a 50-50 chance they'll be back in the Medicare system somewhere for the same problem that was never fixed the first time.
Arguably, the proposed cuts would create a tremendous shortfall in available physical therapy for seniors. In turn, older people with injuries won't be able to recover without treatment and could very realistically be forced into nursing homes. Again, who suffers? Seniors. Why? Not only do they face the possibility of being debilitated, but they will also have to give up their homes and lives to live in a facility of Medicare's choosing.
Medicare cuts based on what legislators believe are duplicate billing codes will only reduce available care to seniors, diminish the quality of care that is left, cost Medicare more later, and put many private practices out of business entirely. It's hard to find a winner amid all this fallout.
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Written by Ann Duffy, PT, and Dana TamuccioEXPRESS YOUR OPINION.
Contact State Representative John Evans and ask him to prevent these Medicare cuts.
Edinboro: 814-734-2793
Girard: 814-774-2892
Linesville: 814-683-5550
Harrisburg: 717-772-9940
E-Mail Representative Evans: jevans@pahousegop.com