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  • APTA CEO Moore Testifies to Congress on Repeal of the Therapy Cap

    APTA Chief Executive Officer Justin Moore, PT, DPT, was offered an opportunity to testify on repeal of the Medicare therapy cap before a House of Representatives subcommittee on July 20. He cut right to chase.

    Calling the Medicare Part B cap on therapy services "an arbitrary barrier for Americans who are in need of rehabilitation services," Moore made the case to the House Energy and Commerce Committee's health subcommittee that now is the time to do away with the yearly ritual of quick-fix exceptions to the $1,980 combined limit on physical therapy and speech language pathology services and the $1,980 limit on occupational therapy.

    According to Moore, the fundamental problem is the same as it's been since the cap was implemented in 1997: if actually adhered to without exceptions, the payment limits would be detrimental to patients in need of rehabilitation, particularly among the most vulnerable. And the traditional workaround—instituting an exceptions process—is disruptive.

    "This pattern of yearly extensions without a permanent solution creates uncertainty for beneficiaries and providers, threatens access to care, and is not in the best interest of patients, providers, or the Medicare program," Moore told legislators.

    Moore pointed out that with 177 cosponsors, the bill to repeal the therapy cap now in the House (HR 807) has strong bipartisan support, and said that while there are costs associated with a repeal, those costs only will go up the longer Congress doesn't act. Moore also reminded legislators that the scramble to create exceptions processes has a price tag of its own. "With the money spent on these temporary patches over the past 2 decades, we could have easily paid for a permanent solution," he said.

    The effort to end the therapy cap marks the 17th attempt to move away from what originally was intended to be a temporary provision adopted as part of the 1997 Balanced Budget Act. Support for ending the cap reached its highest level yet in 2015, when repeal efforts were backed by 238 cosponsors in the House but came up 2 votes short in the Senate. The vote was for an amendment to legislative package that ended the flawed "sustainable growth rate" policy regularly requiring damaging payment cuts, avoided only by nearly annual ad-hoc "doc fix" legislation.

    In his testimony, Moore suggested that changes proposed in 2015 set the stage for viable review programs that would ensure appropriate spending without resorting to caps. The cap could be replaced with a "thoughtful medical review that is more targeted, ensures that care is delivered to more vulnerable patients, streamlines the ability to deliver that care, and ensures the long-term viability of the Medicare program," Moore said. He added that the current $3,700 review threshold is providing "appropriate oversight, and could be improved and incorporated into a permanent solution."

    Moore spoke on behalf of APTA, the American Speech-Language Hearing Association, and the American Occupational Therapy Association, which have worked together for years to end the therapy cap. He told lawmakers that the coalition advocates that any therapy cap repeal plan be based on 3 basic principles: ensuring patient access without unnecessary delays, establishing a targeted oversight systems that do not result in interruptions in care, and creating better alignment with value and performance-based models of care.

    "The therapy community stands ready to work with this committee to finally, after 20 years of extensions and moratoriums, repeal the therapy cap and find a permanent fix," Moore said.

    In an APTA video dispatch after his testimony, Moore described the targeted medical review process enacted as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) as a "positive result" that should give Congress and the Centers for Medicare and Medicaid Services confidence that there are more effective ways to monitor costs. Those confidence-building MACRA results, along with the strong grassroots advocacy efforts of APTA members and enthusiasm in Congress, may be combining to make the end of the therapy cap a reality, according to Moore.

    "We're really in a good place," he said. "Both the data and what we know about the profession and its value in health care set us up for an opportunity to permanently take the therapy cap off the books."

    For its part, the House subcommittee is reportedly supportive of repeal, with subcommittee Chair Michael Burgess (R-TX) saying he hopes to avoid enacting another therapy cap exceptions process. "Much like the sustainable growth rate formula, we have a policy inherent to the therapy cap that no one supports," Burgess told the subcommittee.

    The efforts of individual APTA members boost the odds of ending the therapy cap. One way to make a difference: take part in APTA's social media blitz to Congress beginning on July 24. Watch your Facebook and Twitter feeds for messaging and instructions on letting your legislators know how they can improve patient care through putting an end to the cap. And then keep the momentum going by downloading the APTA action app, visiting the association's Legislative Action Center, and learning about other advocacy involvement opportunities.






    • I am a Speech Pathologist. We work closely with PT's and OT's as well and I am very concerned about the possible repeal of the therapy cap. Our patients are generally elderly and need as much therapy as is reasonable, skilled and medically necessary to prevent further decline or exacerbation and possible hospital stays. Further decline can lead to further costs which the government is so desperately needing to curtail. I am calling for a repeal of the therapy caps to benefit are honored seniors. Thank you, Shelly Klosterman, M.S.CCC-SLP

      Posted by SHELLY KLOSTERMAN on 7/24/2017 8:58 PM

    • As a physical therapist for 44 years, I fought with others to get decent therapy coverage for medicare patients. It was destroyed with the balanced budget amendment under the Clinton administration. The idea is to get coverage for those who are on medicare and it is an alternative to staying in the hospital which is expensive. Home health care and LTC/SNF care is a way to provide they folks with needs rehabilitation that will help keep them functioning and at home where they can live independent lives. It helps their families care for them with less effort. In the end if we are keeping the elderly alive longer it is good for them and everyone tho have them functioning at a higher level of independence. Thomas Herman, LPT

      Posted by Thomas Herman on 7/26/2017 3:55 PM

    • I am a retired physical therapist, and have lived through this 20-year process, and sincerely hope that it finally gets resolved. What I don't think the legislators are considering is that a large number of seniors never see a physical therapist, my parents, both of whom passed away at age 89, being prime examples. I think it might be valuable for the legislators who are holding out for a cap to know what percentage of Medicare beneficiaries do or do not see a physical therapist in their lifetime.

      Posted by Marilyn Doud on 7/26/2017 4:14 PM

    • Physical Therapists (and/or the prescribing Physicians) are obligated to assess the medical necessity of treatment for each of their patients in order to justify ongoing care. It is, however, more often the case with Seniors, that PT is forced to discontinue even if a medical necessity still exists because of the current caps on therapy. I urge our Legislators to repeal the cap on Physical Therapy since the cost burden to society is typically so much greater when Seniors are unable to receive necessary care. Increased incidence of hip fractures in Seniors who do not exercise regularly is one typical example of the increased morbidity & often mortality that can occur as a result of discontinuing Physical Therapy. I appreciate the opportunity to testify. Karen Frangos, PT, ND

      Posted by Karen Frangos, PT, ND on 7/26/2017 4:26 PM

    • Thank you for testifying about this! Caps on PT, OT, and ST have been a travesty for many years!

      Posted by Marion Klein on 7/26/2017 4:52 PM

    • This is a perfect example of why APTA dues and PT-PAC are worth every penny. Thank you for supporting and advancing our profession!

      Posted by Luke Wachewicz on 7/28/2017 9:42 AM

    • Physical Therapists are obligated to assess the medical necessity of treatment for each of their patients in order to justify ongoing care. It is, however, more often the case with Seniors, that PT is forced to discontinue even if a medical necessity still exists because of the current caps on therapy. This premature ending of Rx increases risk of secondary issues associated with the geriatric community including falls and decreased function. Please give PT's the freedom to use their expertise in appropriately assessing and treating this population.

      Posted by Mitchell Johnson -> ?GUb<L on 7/28/2017 4:24 PM

    • As a Physical therapist for 30 years , I too would like to see the caps removed. It is disheartening to have to counsel my medicare patients everyday on how PT and Speech benefits are combined. The caps forces us therapist to make the choice as too what therapy is most critical, does the patient need to learn to swallow or walk more. Luckily I work for an organization that tries to put patient first. Please repeal the caps and work together in bipartisan manner , like Senator John McCain said. Honor our seniors and Senator McCain and do he right thing. Do the right thing for all Americans and healthcare bill. Sarah Kacic

      Posted by Sarah Kacic on 7/29/2017 6:07 PM

    • I have been a PT for about 20 years. My biggest concern about therapy caps are the complexity of monitoring them (dollar amount vs # of visits) and having PT and ST lumped together. Having a permanent solution to the caps would be great but at a bare minimum, please give PT and ST their own $1980 with the continued exception process. Also rather than the $1980 threshold, how about a number of visits (such as 20-25? This would be much easier for patients and clinics to track.

      Posted by John Kowalski on 8/2/2017 8:03 AM

    • I would advise everyone to contact their reps in the House to put this bill on their radar. This is something that could easily get overlooked with the current chaos in DC. I agree that even as an inpatient PT, this directly impacts all clinicians. If the push is to fight the opioid crisis, treat or maintain the health of the community, repealing this bill will help on all fronts. Thank you for representing us well!

      Posted by Alisa Curry PT DPT GTC GCS on 8/4/2017 3:25 PM

    • The cap on Medicare payment to privately practicing physical therapists has been an issue since Medicare came into existence. I rarely exceed the cap for my patients, but in the cases when we do need to exceed the cap, I do not think it should be so difficult to do so. I think all outpatient physical therapy providers should have the same rules/regulations apply, regardless of their setting. My hope is that someday our profession proves and insurers recognize the preventative health benefit our profession provides.

      Posted by Cynthia on 8/4/2017 3:50 PM

    • Please repeal the cap. There are many medicare patients that cannot even transfer independently and need help, but cannot receive it due to the cap.

      Posted by Brett Reuter on 8/31/2017 11:58 AM

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