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  • For Medicare and Medicaid's 50th, a Look at Physical Therapy's Role

    When it arrived as signed legislation 50 years ago, Medicare and Medicaid was far from the system we know today—especially when it comes to physical therapy. APTA is marking the program's half-century birthday by highlighting how its evolution affected the profession, and vice-versa.

    Just in time for the July 30 anniversary of Medicare and Medicaid, the association has released an infographic (.pdf) that lays out the timeline for physical therapy's involvement in a program that covers an estimated 124,000,000 people (55 million via Medicare and 69 million through Medicaid). The program, controversial at the time of its implementation, now is credited with increasing life expectancy and reducing poverty in the United States.

    Today's Medicare and Medicaid are significantly different from their original forms. Medicaid, for example, was tied to welfare, and Medicare didn't cover prescription drugs. Initially, private insurance played a far less prominent role than it does today, and hospitals and nursing homes were racially segregated (something Medicare and Medicaid helped to eliminate).

    The physical therapy profession became part of this evolution in 1968 and has remained integral to the program ever since. Like almost every other element connected to Medicare and Medicaid, however, the relationship between the programs and physical therapy has changed over time.

    It's a relationship that, judging from the APTA timeline, has had its share of ups and downs. But it generally has trended toward increased patient access to physical therapist services. Among the notable developments listed in the infographic:

    • Reimbursement for physical therapists became possible in 1968 when the definition of outpatient physical therapy services was added to the Social Security Act of 1967.
    • In 1983, the Centers for Medicare and Medicaid Services (CMS) fueled the rise in postacute care by enacting the prospective payment system based on diagnosis-related groups. Prospective payment systems for skilled nursing facilities, home health agencies, and inpatient rehabilitation facilities were added in 1997.
    • The Balanced Budget Act implements a $1500 cap on outpatient therapy in all settings except hospitals beginning in 1999; APTA successfully lobbies Congress to impose a 2-year moratorium on the cap.
    • The number of physical therapist practices participating in Medicare and Medicaid grows rapidly after 2000, when CMS eliminates certain conditions of participation.

    Many more details appear on the timeline, including more recent developments such as the repeal of the flawed sustainable growth rate formula and the signing into law of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act.

    "It's nearly impossible to underestimate the effects Medicare and Medicaid have had on the overall population health of the United States," said APTA President Sharon L. Dunn, PT, PhD, OCS. "The physical therapy profession has had a relationship with these programs for nearly as long as they've existed. We should take pride in the ways our commitment to patient health and transformation has, in turn, helped Medicare and Medicaid evolve."

    Interested in more history and real-world accounts of the ways in which Medicare and Medicaid have made a difference in people's lives? Check out the CMS webpage devoted to the anniversary.

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