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Remove the cap on Medicare therapy services — it could save lives

Remove the cap on Medicare therapy services — it could save lives

On Jan. 1 44 million Medicare beneficiaries will wake up to limited Medicare therapy services unless Congress acts now to permanently repeal the Medicare therapy cap.

I am a physical therapist and an assistant professor at Northwestern University, Feinberg School of Medicine. In my 10-year career, Congress has passed multiple short-term extensions of the therapy cap that have enabled my patients to access the physical therapist services they need to live.  

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But without repeal by Dec. 31 millions of Medicare recipients will be left with a health care policy that roughly provides only 16 visits per year. This amount is simply not enough tofully address the complex medical conditions that older adults face.

 

Now is the time to pass the Medicare Access to Rehabilitation Services Act to repeal the annual cap on Medicare rehabilitation services and ensure that we are caring for the most vulnerable and medically complex older adults in our society.

The existing therapy cap is particularly problematic because it restricts access to care regardless of a person’s medical history. Sixty nine percent of older adults manage at least two chronic diseases that are often associated with difficulties walking, moving in and out of a chair, and accessing the community for necessary tasks like grocery shopping and going to the doctor.

Physical therapists are experts in evaluating and treating these issues, yet older adults with these multiple chronic diseases and movement problems reach their therapy cap quickly, limiting their access to necessary care.

Having difficulty completing activities of daily living, tasks like walking, bathing, and moving out of a chair is the strongest predictor of entering a nursing home. At an average cost of$90,500 per year, nursing home care is a substantial financial challenge for individuals and their families, as well as our overall health care system.

A simple solution to prevent nursing home placements and proactively provide the rehabilitation that older adults need is to eliminate restrictions on access to physical therapist care.

One of the reasons that older adults seek a physical therapist is due to age-related progressive conditions like Alzheimer’s or Parkinson’s disease.

Further, certain medical conditions like stroke and frailty occur with greater frequency as one ages. These conditions require multi-disciplinary care encompassing both physical, occupational, and speech therapies.

The current Medicare therapy cap of $1,980 is a combined amount for both physical and speech therapy services. Subsequently, people with complex conditions requiring multiple therapy disciplines end up reaching the therapy cap amount much more quickly than those without complex conditions. Effectively, the Medicare cap punishes the medically complex in our society who most need comprehensive care by restricting their access to services that keep them healthy.

While not only restricting care that keeps people functioning, the therapy cap may also be deadly.

One out of every three older adults fall each year contributing to 27,000 deaths annually. Falls are the number one cause of injuries among older Americans. The solution to prevent and treat falls is physical therapist intervention. The 16 yearly therapy sessions under the cap is often an insufficient amount to fully recover from a fall or prevent deadly falls from occurring.

This also means that if an older person falls in January, they may use up all their therapy benefits for the entire year. If another health conditions arises later in the year, that individual could be left with no coverage for outpatient rehabilitation services.

Eliminating restrictions to therapy services will also allow our health care system to function more proactively. Older adults can have balance problems proactively addressed rather than treating broken bones resulting from a fall. Ultimately, eliminating the therapy cap will show we are a society that values its senior citizens and wants them to lead full and healthy lives.

Some may be concerned that without regulation, therapy costs will skyrocket due to unconstrained spending. Without a therapy cap, the amount of therapy services billed to Medicare will likely increase as older adults are no longer limited to $1,980 per year.

However, increased spending in preventive and comprehensive therapy services is a much better investment that expensive hospital or nursing home care treating the consequences of a fall, injury, or disease.

Physical therapist care has routinely shown to improve health outcomes and decrease health care costs. Eliminating the cap and investing in greater amounts of physical therapist services will put our society on a healthier path to a more cost-effective health care system.

Aging is inevitable and most, if not all people will need a physical therapist at some point in their lives.

Let’s act now to pass the Medicare Access to Rehabilitation Services Act to ensure unrestricted therapy services are available when we need them.

Margaret Danilovich is an assistant professor at Northwestern University Feinberg School of Medicine  Department of Physical Therapy and Hum. You can find her on Twitter at: @margaretdptphd.