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  • APTA to Congress: Arbitrary Cap Stops Therapy Services Regardless of Medical Necessity

    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.

    Ways and Means - Moore - 9/22/11
    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. 

    Ways and Means - Pascrell - 9/22/11
    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

    • Congratulations for the persistence of the APTA, Mike Matlack and Justin Moore on this issue. These folks are the true representatives of persons who seek but, are prevented access to Medicare rehabilative services designed to increase function and independence. Mr. Greenberg must be independently wealthy and may not understand the therapy "cap" issue.

      Posted by Tom Romeo on 9/23/2011 10:17 PM

    • I applaud the APTA efforts in repealling the arbitray cap on PT services! Thank you to Mike and Justin for your fine efforts - keep up the good work! We offer balance and vestibular services in our clinic - often patients do not maximize their progress within the alloted financial contraints. These folks are also often on fixed incomes - in rural areas financially they (and we) are disadvantaged. PTs with integrity treat according to the rules and regs developed by our legislators, CMS, etc. In cases that are medically complicated (multiple diagnoses and medical conditions) the caps hamper regaining full function and independence. Working in the interest of patients and holding onto our morals - depsite health care reform issues - is always the best policy!

      Posted by Rob Burger on 9/24/2011 9:44 AM

    • Physical therapists who abuse the Kx system are only making it more difficult for the rest of us and expose our profession to future cuts due to overutilizatiion. Medicare should remove them as providers and or put them under a reduced reimbursement for 2-3 years. Thank you APTA for testifying to congress. Maybe they will actually understand the implications or their votes.

      Posted by Walt Abbey on 9/25/2011 10:38 AM

    • Can anyone explain why hospital-owned outpatient physical therapy doesn't have a cap and privately-owned outpatient physical therapy does. It seems to me a double standard.

      Posted by Chris on 9/25/2011 12:51 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

    • With these ongoing RAC reviews the KX modifier which I would think most support, puts the fear of continuing PT care beyond our cap. In our state of FL. which is a high Medicare benficiary state therapists are being reviewed that have not even reached the cap. The results are patients not reaching potential but the government saving money and PT's losing on all grounds. Whether its rehab for balance,RTC repairs or Joint replacements not everyone heals at the same pace thats what makes us human. May be a study in histology is in order. Just my opinion.

      Posted by stan on 9/29/2011 2:59 PM

    • In response to Chris, congress established out patient therapy departments of hospitals as the "safety net" for those that would otherwise be excluded by the therapy cap. I for one am very pleased to see APTA getting a seat at this table as this is one way our association is "relevant" to the membership. Nice going Justin Moore and our government and payment advocacy staff! Matt Mesibov

      Posted by Matthew Mesibov -> =FPc? on 10/1/2011 12:52 PM

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