Today, APTA testified before the United States House of Representatives Committee on Ways and Means Subcommittee on Health on the detrimental effect the therapy cap can have on Medicare beneficiaries. The hearing, which was held to examine various Medicare provider payment provisions that will expire this year, also included witnesses from the American Hospital Association, American Ambulance Association, and American Medical Association.
In his testimony, Justin Moore, PT, DPT, APTA vice president, Government and Payment Advocacy, provided background on the cap, described the types of patients who are most affected by the cap, and explained the association's work on a reformed payment system for outpatient physical therapy services that would ensure access to services and improve payment accuracy for therapy services under Medicare Part B. "Congress has long known that allowing the therapy caps to go into effect would have a profound impact on patient care," said Moore. "The pattern of yearly extensions without an exit plan is not in the best interest of patients, physical therapists, or the Medicare program."
The association also highlighted several cost saving proposals to address the therapy cap and payment reform under Medicare Part B. "We commend the committee for this hearing of expiring Medicare payment policies and encourage an extension of the therapy cap exceptions process, movement toward a reformed payment system, and refinements to the therapy benefit," Moore said in his closing remarks.
Update 9/22/11: The video of the hearing, previously linked in this story, has been removed from the Ways and Means Web site. If video is made available later, we will add the link back to this story.
Justin Moore, PT, DPT, APTA vice president of government and payment advocacy, testifies before the House Ways and Means Subcommittee on Health about Medicare therapy caps.
Rep Bill Pascrell (D-NJ) addresses Justin Moore, PT, DPT, about the impact of the therapy caps on patients with traumatic brain injuries.
I am in support of extensions to the Medicare cap. However, I have seen so much abuse by therapists who allow treatment year round and simply keep "KX" ing these clients. I am in a seasonal resort area and by the time the clients come North for a P.T. problem that is new, they have been simultaneously extended for what essentially is maintenance. Also, clients try to continue what essentially is maintenance care here in the summer saying "my therapist says I need to continue" , coming with a MD Rx but essentially are functionally indep., status quo pain wise, but like someone supervising their exercise programs. I refuse them on Medicare and we need to crack down on those who don't but keep fudging them along. Thank you.
Posted by Larry Greenberg
on 9/23/2011 4:46 PM
I have been a PT for 20 years,both in Canada and the USA. I completely understand a check and balance system, but many medicare patients suffer daily with multiple diagnoses. Although the kx modifier is great-it continues to limit the ability of therapy to do what it is designed to do. It is not possible to race a body to the finish line-nor is it ethical/humane. Sometimes "maintenance" can be defined as "still able to function independently". Ultimately, PT is still much more cost effective than surgery,HHA,or nursing home care. Hospital vs Private owned PT limits??- I am also confused by this.
Posted by M Stoski
on 9/28/2011 7:05 PM