Today’s blog post comes from Ann Wendel, PT. Ann is the owner of PranaPT, a member of WebPT, and an active social media participant (@PranaPT). Thanks, Ann!

Grab a cup of coffee (or a stiff drink) because we’re going to talk about Medicare. Currently, there are two issues that we as physical therapists need to be aware of because they affect how we treat patients on a daily basis.

First, it is vital for all therapists to pay attention to what is going on in Congress regarding the Medicare Therapy Cap. On April 14, 2011, sponsor Rep. Jim Gerlach introduced H.R. 1546 (112th): Medicare Access to Rehabilitation Services Act of 2011. As summarized by the Library of Congress, H.R. 1546 amends title XVIII (Medicare) of the Social Security Act to repeal the cap on outpatient physical therapy, speech-language pathology, and occupational therapy services of the type furnished by a physician or as an incident to physicians' services. Unfortunately, as listed on the govtrack.us website, the bill died a quick death and Congress subsequently referred it to the Ways and Means Committee on the same day. And there the act lies, awaiting the committee chair’s decision as to whether it moves past the committee stage.

The members of the Ways and Means Committee are listed here. We need to contact these folks to ask them to support H.R. 1546 (112th): Medicare Access to Rehabilitation Services Act of 2011 to allow Medicare patients to receive the rehabilitative care they need to live a full and functional life. Here is their contact information:

Ways and Means Committee Office
1102 Longworth House Office Building
Washington D.C. 20515
P: 202-225-3625
F: 202-225-2610

Moving onto the second issue we face: As you may know from several posts on the topic in the past year (here, here, and here), physical therapists are prohibited from “opting out” of Medicare. This means that a small PT-owned practice that does not participate in Medicare is forbidden from treating Medicare patients because it is illegal to take cash payment for services that are normally covered by Medicare. 

Over the past two weeks, I have turned away four Medicare patients who called me to schedule evaluations because I choose not to participate in Medicare. The inability to “opt out” takes away a huge patient population—a growing patient population of very active seniors who are living longer; have worked hard all their lives; and have the cash to pay out of pocket for quality services. (You haven’t seen angry until you see an extremely intelligent Medicare patient who CMS won’t allow to pay out of pocket with their hard-earned money to get the best services available in their community!)

But there might be hope. I just found out that on September 20, 2011, the PPS and APTA sent a statement to the Ways and Means Committee that includes a provision for PTs to opt out of Medicare. It states the following:

“PPS/APTA recommends Congress extend to physical therapists the policy allowing these professionals to collect out of pocket from a Medicare beneficiary. Such an amendment would afford beneficiaries the freedom of choice they deserve, without resulting in any greater expenditure, in fact quite likely some modest savings, for the Medicare program.

“PPS/APTA recommends that Section 1802(b) (5) (B) of the Social Security Act be amended as follows:

Inclusion of physical therapists under private contracting authority.
Section 1802(b)(5)(B) (42 U.S.C. 1395a(b)(5)(C)) is amended by striking ‘the term practitioner has the meaning given such term by section 1842(b)(18)(C)’ and inserting ‘In this subparagraph, the term “practitioner” means an individual defines at section 1842(b)(18)(C) or an individual who is qualified as a physical therapist.’”
(The original statement includes the bold and italic treatment.)

Tim Richardson, PT, posted this template letter to the Ways and Means Committee on his blog recently. I urge all physical therapists to contact their representative on this matter. We need to make our voices heard—these two issues affect the ability for PT-owned outpatient clinics to survive. As the population ages, they deserve to seek out the provider of their choice and to continue therapy until the therapist decides that treatment is complete.

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