Medicare fee cuts could devastate rehabilitation services

May 8 2008

Pending cuts to the Medicare physician fee schedule could severely hamper the ability of physical therapists to serve the rehabilitation needs of seniors and people with disabilities -- driving up overall costs while decreasing quality of care, according to the American Physical Therapy Association (APTA) and its Private Practice Section.

In testimony May 8 before a hearing of the U.S. House Committee on Small Business, Tom DiAngelis, PT, vice president of APTA's Private Practice Section, commented that a scheduled 10.6 percent cut in Medicare physician payments could have an especially devastating impact on PTs in private practice, who are faced with not only the rising costs of running a small business, but also decreases in revenue due to a variety of government payment and policy challenges. The hearing on "Medicare Physician Fee Cuts: Can Small Practices Survive?" provided an opportunity for the committee to examine the potential impact of fee cuts on the practices of physicians and other allied health professionals. Unless Congress intervenes, the cuts will go into effect July 1, 2008, and could also have significant ramifications on the services offered to Medicare patients, according to APTA.

"These Medicare beneficiaries are individuals who have suffered from stroke, had joint replacements or chronic diseases that impair their ability to move, walk and perform their daily tasks," DiAngelis testified. "Physical therapist small businesses address these beneficiaries' health care needs throughout the United States and contribute to the health status of our country, including its economic health."

Physical therapists, in particular, are being hit especially hard, according to DiAngelis. Not only will they experience the overall 10.6 percent reduction in payment under the fee schedule, they also will be subject to an arbitrary annual cap of $1,810 per beneficiary on outpatient services beginning July 1.

"This cap will not save the Medicare program money," added DiAngelis. "It would only shift the cost of care away from outpatient facilities and small business to more costly and less efficient inpatient facilities. Small businesses in physical therapy will be impacted as the therapy cap policy includes an exemption for hospital outpatient departments. This exemption will do nothing more than encourage patients to seek services in the hospital setting to avoid having to change providers over the course of their physical therapy treatment when they reach the cap." APTA is advocating for a repeal of the therapy caps or an extension of the current exceptions process that maintains access to clinically appropriate physical therapy services under Medicare.

In addition to the problems posed by the pending payment cuts and therapy caps, physical therapists in private practice have significant limitations on how patients may access their services and the marketplace, DiAngelis explained. Currently, Medicare requires that patients obtain physician referrals to receive physical therapy, despite laws in 44 states and the District of Columbia providing direct patient access to physical therapists. "If the payment cuts go into effect and physicians stop taking Medicare patients or limit the accessibility or availability of physician services, then access to physical therapy services will be impacted as a ripple effect," DiAngelis added. APTA is lobbying for passage of the Medicare Patient Access to Physical Therapist Act (HR 1552) as one strategy to provide relief to physical therapist small businesses.

"The health care delivery system needs physical therapist small businesses to meet patients' rehabilitation needs," testified DiAngelis. "If those needs are unmet, then health care costs will be transferred to more intensive, costly environments, compounding the existing crisis in health care spending. Physical therapist small businesses are a cost-effective, efficient delivery model for physical therapy services, and efforts to maintain and enhance this setting are essential."

To read DiAngelis' full testimony, visit: http://www.apta.org/media.

APTA is asking its members and consumers to contact members of Congress and urge them to prevent the implementation of policies that would severely impact rehabilitation coverage for Medicare beneficiaries. For more information on these and other APTA advocacy efforts, visit APTA's Patient Action Center.

Physical therapists are health care professionals who diagnose and manage individuals of all ages, from newborns to elders, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. Physical therapists examine each individual and develop a plan of care using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. Physical therapists also work with individuals to prevent the loss of mobility by developing fitness- and wellness-oriented programs for healthier and more active lifestyles.

The Private Practice Section of APTA represents 4,200 practitioners who are the owners or operators of physical therapy private practices.

The American Physical Therapy Association (http://www.apta.org/) is a national organization representing physical therapists, physical therapist assistants, and students nationwide. Its goal is to foster advancements in physical therapist education, practice, and research. Consumers can visit http://www.findapt.us/ to find a physical therapist in their area, as well as http://www.apta.org/consumer for physical therapy news and information.