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.