"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Sunday, April 3, 2011

"Immense Benefits" of Maintenance Physical Therapy

Maintenance therapy is going the way of the dinosaur, the dodo bird and the compact disc...

New, judicial interpretations of the skilled physical therapy and skilled nursing Medicare benefit have found that "improvement" is not necessary for coverage by Medicare and that maintenance therapy may be appropriate for some patients.

I have been a physical therapist since 1992 and, for my entire career, I have had it drilled into my head that we are not allowed to do maintenance therapy on Medicare patients.

It turns out now that isn't true.

Judith Stein, Executive Director/Attorney of the Center for Medicare Advocacy (seen in the above video) says the "illegal" Medicare Improvement Standard is being challenged in a lawsuit filed January 18th, 2011.

The lawsuit, Jimmo vs. Sebelius, may provide relief to patients needing physical therapy services and to physical therapists who want to treat these people.

Listen to this audio webcast announcing the lawsuit against Secretary of Health and Human Services (HHS), Kathleen Sebelius and Medicare (CMS).

According to Stein...
"This is a real problem that is affecting real people every day... some of our plaintiffs have passed away... (waiting for changes to the Improvement Standard)...and are no longer with us."
What about Outpatient Therapy?

Unfortunately, many patients in outpatient physical therapy do not get denials from Medicare when they hit the $1,870 Medicare PT "cap". Therefore, we may not be included in the class action.

Physical therapists have been "educated" to stop physical therapy and discharge patients when we see a plateau and no further improvement.

We have been told these "facts" by our managers and administrators and by Medicare "experts" for at least 25 years, according to the Center for Medicare Advocacy.

Yet, the patients who plateau may be at the greatest risk of a functional decline when we discharge them from therapy.

As a physical therapist manager, I admit, I have told my staff some of these very same things.

We all have plenty of these stories. If you or one of your patients have an advocacy story you may be able to contribute to the lawsuit against Medicare.


  1. I can see the case for this woman who is paralyzed and it is cheaper to stay at home than being in a nursing home. The problem that I have is where do we draw the line? For all my medicare patient's with some type of "failed back syndrome" who will never get better because of the multilevel fusions (as evidence has confirmed time and time again), is it fair to bill and drain medicare with maintenance treatments that a health and fitness center can also provide with independent exercises? If these changes are allowed, you will see more and more conditions being challenged as needing "maintenance." As a profession, we need to be careful in that we are providing "skilled care" and that we are not functioning as personal trainers. These are the questions we need to ask as we choose sides on this issue.

    Eric, PT

  2. Eric, Great point. I often have "failed back syndrome" patients which I justify using an Oswestry scale to show current disablement. I'll also use a variety of performance measures like stair stepping, 10' gait Velocity or kneeling test.

    I may also use a few impairment-level measures, like hip internal rotation or prone plank time.

    These all demonstrate medical necessity.

    Skilled therapy demands safety. To answer this I try to document future risk - does the patient shown increased future falls risk, are there cardiac risk factors like elevated BP?

    Fear-avoidance behaviors predict future disablement and may need skilled intervention (cognitive behavioral therapy). Many of these people do not want to go to a gym and will segue to your PT clinic-based maintenance program after you are through treating them.

    Hopefully, we don't have to choose sides. Every one of these people has a Medicare PT benefit that belongs to them the same as their house or their car. I'd like to see PTs fight harder to get patients theri PT benefits - not take them away.

    Thank you for your comment.


  3. Maintenance pricing is a percentage of the SRP of the product for which maintenance is being purchased for the first twelve months typically around 20.Maintenance ProgramsMaintenance will always be quoted as a percentage of SRP rather than of netor purchase price. Purchasing twenty-four months of maintenance and support is a better option from a pricing standpoint,if you would like the longer term coverage. Pricing for maintenance terms beyond twenty-four months will be provided upon request.

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Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

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