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Changes in Medicare For Physical Therapy

Posted Oct 07 2008 7:19pm

As of July 1, 2008 Medicare patients might have a cap on their physical therapy visits.  Right now there is a financial cap but there are diagnoses that are exceptions to the cap.  Medicare also plans to decrease the physical therapy fee schedule by 10.6%.  There is hope if Congress decides to either eliminate the cap or keep the diagnoses exceptions.
It's interesting, physical therapy is cost effective but yet Congress wants to have a financial cap?  Yes the baby boomer generation is approaching quickly, 2011 and there will be more patients.  The typical Medicare patient usually has more than one injury and in most cases the problems are complex. It's not like treating a 35 years old person with shoulder pain.  The Medicare patient will come in with shoulder pain,  a decrease in range of motion, loss of function and neck/back pain.  Now to treat the patient  possibly in 18 visits (average amount of visits to reach the cap) is difficult to say the least.  The person will only receive those 18 visits for the whole year. Now what happens when the Medicare patient finishes their physical therapy treatment and still has pain, decrease range of motion, and unable to perform daily tasks pain free? Well chances are they will visit the orthopedic surgeon who will perform surgery to help the patient regain their function. Yes another problem arises, the Medicare patient needs another round of physical therapy to regain their motion and strength. yes a vicious cycle has emerged.
I understand our government is worry about the financial strain the baby boomers generation will place on the Medicare system and rightly so.  First,  there will be some Medicare Baby Boomers who will be working, which makes them and their spouse not eligibly for Medicare benefits.  Another idea, instead of capping physical and speech therapy at $1,810,  we should cap the daily reimbursement rate. The daily rates would be different in each state due to the expenses of operating a practice. Example the rates could be set between $65.00 - $90.00 and evaluation/re-evaluations will also be paid at a set rate. 
The government can oversee utilization reviews with their very powerful software systems.  The professionals will also oversee their own utilization and use the right judgment for discharging the patient.
We need to look outside the box and not only look at short-term results.  The government seems always to look at the small picture instead of the big picture.  It seems politicians do not have the ability to look beyond today.

I truly believe society is the change maker not the politician. Politicians only react to our needs and the future we will need to make tough and hopefully creative ideas to change our world.

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