What Ails You: Senate to consider important Medicare therapy services bill

Way back in 2006, I wrote to tell you about the Medicare cap on physical therapy services. Many of you contacted me and even more of you took action contacting our senators to tell them how you felt about having your access to care arbitrarily limited.

Your calls and letters were heard and Congress established an exceptions process by which those needing more care could receive extended services. It was an imperfect solution to a complicated problem, but it was better than nothing. Now, as Congress is getting ready to recess for the summer, we find ourselves back where we started.

Also at stake, is a 10.6 percent reduction in payments under the Medicare fee schedule. Medicare already significantly discounts the services you, the Medicare recipient, receive from your medical professionals. Now, when rising prices affect everyone, Medicare intends to cut our pay by another significant margin. Imagine how you would feel if your monthly check was reduced by that much?

Although the House of Representatives passed HR 6331 (MIPPA; a Medicare Improvement Act) by an astounding margin (355-59), the Senate failed by one vote to pass the bill before adjourning for the July 4 recess. Congress will reconvene Monday, July 7 when we can, one final time, try to convince them that action must be taken to avert the proposed cuts.

For those who pay attention to such things, all Democrats except Sen. Edward Kennedy (well wishes to him), were present and voted for the motion. Sen. John McCain was absent so did not vote. Other Republicans voting for the motion were Susan Collins, Maine, Olympia Snowe, Maine, Gordon Smith, Oregon, George Voinovich, Ohio, Elizabeth Dole, North Carolina, Norm Coleman, Minnesota, Pat Roberts, Kansas, Lisa Murkowski, Alaska and Ted Stevens, Alaska.

Let’s talk about what the Medicare cap means to you. The dollar value for the cap is an arbitrary number. There is no rhyme or reason to it. It’s not as if Congress commissioned some study to determine the average cost per year for Medicare members nor did they consider the average cost for therapy services per diagnosis. Congress did not endeavor any rational formula when creating the cap. They simply picked a number and said “That sounds about right.”

As of July 1, 2008, the Medicare Cap is restored at $1,810 per year per patient for physical therapy and speech therapy services combined. If you are currently in physical therapy, it is imperative that you check with your provider to determine how much of that cap has been spent already. There will be some confusion within the system. If you have not already met the cap, then we simply figure from where you are at. If you have already exceeded the cap, in all likelihood, expenses incurred prior to the restoration of the cap will be covered according to current guidelines. Exceeding the cap after July 1 increases the likelihood that you will become responsible for paying for services rendered.

A vast majority of Medicare beneficiaries covered by Part B would never exceed the therapy cap. This arbitrary cap has a disproportionate impact on those Medicare beneficiaries who need therapy the most — the oldest and the sickest. Congress is denying medical care to the old and frail, our most vulnerable population. This cap would force many senior citizens or disabled Medicare recipients to choose between forgoing necessary care or paying 100 percent of the cost out-of-pocket over the Medicare cap. Your Medicare supplement, normally, will not cover fees over the cap. There are some exceptions so check directly with your supplemental carrier.

Let’s say your average physical therapy visit costs $60 (cost can actually vary quite widely depending on the services your condition requires). The cap would allow you approximately 30 visits per year. In January, you have your knee replaced. A knee replacement is a good surgery and many people make fabulous recoveries, but still you can expect to need therapy for about two months. Your knee will use up 24 of your 30 visits. That takes us up to March. What happens in July when you’re working in the garden and suffer a rotator cuff injury? Or worse, what happens if you have a stroke and require prolonged therapy?

Congress has already recognized the shortfall of the cap on therapy services and three times has imposed a moratorium to keep the cap on therapy services from limiting coverage. A bi-partisan majority of the members of Congress in both chambers supported legislation to establish an exceptions process to the cap in 2003, 2004 and 2006.

HR 6331 will ensure that you have access to necessary physical therapy services. It will prevent a 10.6 percent payment cut to your medical professionals. It is imperative that you lend your voice and demand that your representatives in Washington support this important legislation.
It is important that you send a strong message to your representatives to request that they become cosponsors to repeal the therapy cap once and for all. You do not have to be a Medicare recipient nor do you have to be ailing to understand the impact limitations to coverage like this might have on your less fortunate family, friends and neighbors.

Because time is short, I recommend that you either fax your letter to your senator or bypass the letter writing process altogether and make a phone call expressing your concerns. If you don’t have access to a fax machine, bring your letter to me and I will fax it for you. (Only the letters we’re talking about here, folks. Don’t bring me your summer round-up letter to Aunt Peg.) Please get involved. We have gone long past the point when we can sit comfortably back and trust our government will take care of us. Speak out in your own interest and let your representatives know what you expect of them.

If you do not know what to write, stop by your physical therapist’s office. I will ask your therapist to make available to you pattern letters you can follow or to which you can add your own comments.

Send your letter to or call:

Senator Dianne Feinstein, SH-331, Washington, DC 20510-0504 Phone: (202) 224-3841 Fax: (202) 228-3954 TTY/TDD: (202) 224-2501 and Senator Barbara Boxer, SH-112, Washington, DC 20510-0505 Phone: (202) 224-3553 Fax: (916) 448-2563

If you prefer, you may contact your representatives through the Legislative Action Center on the American Physical Therapy Association Web site at: www.apta.org. You will see a link for you on the front page of that Web site.

ABOUT THE WRITER:
Jackie Randa is a physical therapist who owns Back on Track in Barstow. She can be contacted at jranda@aol.com