George Bush supports Physical Therapy payments

President George Bush vetoed H.R. 6331, which maintains Medicare payments to medical providers yesterday, including physical therapists, on fiscal and ideological grounds.

In his message to the House of Representatives, Mr. Bush states the following:

"This bill is objectionable, and I am vetoing it because:

It would harm beneficiaries by taking private health plan options away from them; already more than 9.6 million beneficiaries, many of whom are considered lower-income, have chosen to join a Medicare Advantage (MA) plan, and it is estimated that this bill would decrease MA enrollment by about 2.3 million individuals in 2013 relative to the program's current baseline.

It would undermine the Medicare prescription drug program, which today is effectively providing coverage to 32 million beneficiaries directly through competitive private plans or through Medicare-subsidized retirement plans.

It is fiscally irresponsible, and it would imperil the long-term fiscal soundness of Medicare by using short-term budget gimmicks that do not solve the problem; the result would be a steep and unrealistic payment cut for physicians -- roughly 20 percent in 2010 -- likely leading to yet another expensive temporary fix; and the bill would also perpetuate wasteful overpayments to medical equipment suppliers."

After the veto H.R. 6331 was sent back to Congress...

"The House passed this legislation by a 383-41 vote and by a 70-26 Senate vote. A two-thirds vote was needed by the House and the Senate to override the Presidential veto. Once the Senate voted to approve HR 6331, it now becomes law immediately. (LA Times)"

Private practice physical therapists are obviously happy.

My practice would have seen a dramatic decline in cash flow from Medicare.

We staff our office with physical therapists and physical therapist assistants specifically because Medicare patients need that level of expertise (most Medicare patients are elderly).

I might have had to lay off staff.

Nevertheless, the president is right when he says the following:

"...it would imperil the long-term fiscal soundness of Medicare by using short-term budget gimmicks that do not solve the problem; the result would be a steep and unrealistic payment cut for physicians -- roughly 20 percent in 2010 -- likely leading to yet another expensive temporary fix..."

I posted my solution on July 1.

Let's hear from you.

Can we help fix (at least) physical therapy in the health care system?

Post your comments.

20% Medicare Physical Therapy cuts in 2009

The US Senate, on July 9, 2008, overwhelmingly passed their version of HR 6331, designed to prevent the 10.6% cut in the Physicans' Fee Schedule and reinstate the Automatic Exceptions Process to the Physical Therapy $1,810 benefits cap.

The physical therapy benefits caps arbitrarily imposes the cap once outpatient physical therapy charges reach $1,810. Thus, those patients who need physical therapy care the most are harmed the most.

One of my patients, an elderly grandmother had her left knee replaced on June 1. For four weeks she had to use a walker to get from her bed to her bathroom and caused her right elbow to hurt.

June 20th she saw her orthopedic surgeon who said she now has developed osteoarthritis in her left shoulder and needs the shoulder replaced.

On June 29th the "regularly-scheduled hostage crisis" in the US Senate had Americans and their health care providers anxiously waiting to see which way the budget ax would fall.

So far the ax hasn't fallen on my elderly grandmother - she has been able to get her physical therapy at the hospital. Hospital outpatient physical therapy departments are exempt from the cap.

Ironically, the passage of HR 6331 sets the stage for a 20% Medicare cut in December 2009.

Pete Sepp of the Shreveport Times says the following:

"The outcome of this drama depends on whether politicians enact modest reforms sooner to avoid catastrophe later."

As I posted before the Senate vote I recommended an annual 2% cut to the Physicians' (and physical therapists') Fee Schedule.

The American Medical Association (and the APTA)would be unable to register sufficient voter and constituent indignation to counter the cut.

I don't want a 2% to my practice revenues but I, just like all Americans, can see the writing on the wall.

We've made the diagnosis.

Diagnosis is necessary for prognosis.

Now is time for some bitter medicine, before it' too late.

Cut Medicare to Increase Physical Therapy Value Proposition?

American Physical Therapy Association applauds Senator Max Baucus for standing up against efforts to abolish the Automatic Exceptions Process to the Medicare Physical Therapy Cap.

The Automatic Exceptions Process is an essential mechanism to assure that physical therapy services are accessible by the people who need it most.

A recent study ordered by the Centers for Medicare and Medicaid Services (CMS) found that, due to the cap, for the first time since 1999 the cost and the growth in physical therapy expenditures declined during 2006.

The... "study reveals that from CY 2004-2006, although the total number of therapy users continued to increase by 3.5% the overall expenditures actually decreased 4.7%.

This represents the first observed negative growth in payments per beneficiary since the implementation of the therapy caps during CY 1999."

Further, the intended effects of the Medicare cap appeared to be met since the number of beneficiaries accessing physical therapy services actually increased in 2006 by 3.5%.

The mean payment per physical therapy user declined 8% in 2006.

The Medicare cap, first implemented in 1999, is the attempt by Medicare to limit the growth in federal physical therapy expenditures.


The Value Proposition


Medicare would like to measure the value for its health care dollar.

In 2006, Medicare spent $3.05 billion dollars on physical therapy.

From 2002-2004, the growth rate in expenditures was 26%.

The Medicare value proposition is Value = Quality / Cost.

Cost is easy to measure (see above).

Quality, however, is not.

Current projects, like Pay for Performance (P4P), are Medicare's attempt to measure quality.

Too many physical therapists dismiss attempts to measure quality.

What are we afraid of?

Al Amato, PT, MBA replies to a statement by made on August 12, 2007 by Larry Benz, PT that "P4P ...is a fad":

"The momentum is moving toward P4P. I think it imprudent that this trend be ignored. At the least, consider collecting outcomes to be able to compare your care to a national average."

Congratulations to Senator Max Baucus. He is taking a tough stance in the short run - standing up for physical therapy.

In the long run, however, Senator Baucus understands that physical therapy provides value to Medicare.

And to Americans.

Find other ways to measure the value of physical therapy.

See How to make a Physical Therapy Diagnosis

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Destroy Healthcare in order to save it

Medicare wants to save healthcare providers by changing the system.

Ironically, Medicare and Congress are trying to save Medicare by making adjustments that threaten to destroy the health care system.

In order to give congress more time to act to prevent the 10.6% cut in the Physicians' Fee Schedule, the Centers for Medicare and Medicaid Services (CMS) will pinch the cash-flow pipeline until at least July 15th.

Cash flow is the lifeblood of any business and represents the majority of payments to medical practices in retirement areas, such as Florida.

Kevin Schweers, a spokesman for the Department of Health and Human Services, said Monday the Centers for Medicare and Medicaid Services will hold doctors' Medicare claims for services delivered on or after July 1. Claims for services received on before June 30 will be processed as usual, he said. By holding claims for health care services that are delivered on or after July 1, CMS will not be making any payments on the 10.6 percent reduction until July 15 at the earliest," Schweers said.

The CMS action seems reminiscent of a statement attributed to an American major during the Vietnam war...

"After the village of Ben Tre was virtually destroyed, an American Major said to journalist Peter Arnett (who would become famous for his work on CNN during the Gulf War),

"It became necessary to destroy the village in order to save it."

The CMS freeze is designed to prevent providers' accounting workload from going up since retroactive changes to the fee schedule necessitate billing small amounts that increase billing volume without increasing provider revenues proportionally.

Local groups across the nation, such as the Manatee Medical Society, are mobilizing support to encourage the Senate to get behind HR 6331 the Medicare Improvements for Patients and Providers Act of 2008.

When the Senate re-convenes on July 7th the Senators will have another chance to vote to prevent the 10.6% cut to the Physicans' Fee Schedule.

Everyone knows the direction Medicare and social security must go down in order to supply the Baby Boomers with pension and health care services and funds.

Why not a 2% cut every year, scheduled and anticipated, rather than a draconian 10% that prompts a PAC funding and lobbying bonanza every six months?

As a physical therapist, I make a physical therapy diagnosis on every patient I treat.

A healthcare policymaker would diagnose the financing of the Medicare system as broken.

Physical Therapy's Unholy Alliance

This post well-summarizes the recent House and Senate vote on the Medicare Physician's Fee Schedule.

My response to the post recommends ending or reducing not only the bi-annual Medicare lobbying bonanza and PAC funding spree but also the "unholy alliance between providers, payers and patients" (I'm quoting myself).

Here is the response from the American Medical Association to Friday's Senate vote:

***

Statement Attributable to:
Nancy H. Nielsen, M.D.
President, American Medical Association

"The physicians of America are outraged that a group of Republican senators followed the direction of the Bush Administration and voted to protect health insurance companies at the expense of America’s seniors, disabled and military families.

"These senators leave for their 4th of July picnics knowing that the most vulnerable Americans are at risk ...

"...Today, thanks to some senators, we stand at the brink of a Medicare meltdown. On July 1 – just four days from now – the government will slash Medicare physician payments by 10.6 percent, forcing many physicians to make the difficult choice to limit the number of Medicare patients in their practices.

"The Senate must return from their recess and make seniors’ health care their top priority. For doctors, this is not a partisan issue - it's a patient access issue."

***

(here I respond to her original post)

While I agree with the facts of your post I wonder if the rhetoric of the AMA well serves the American public (especially the 46 million uninsured, mainly women and kids).

Instead of bi-annual(we went through this in December 2007 - remember?) 10% Medicare cuts why not a 2% annual reduction in the Medicare Physician's Fee Schedule?

Everyone knows the direction federally funded healthcare reimbursement has to go.

Large cuts inevitably trigger PAC funding and large-scale lobbying to reduce or reverse the cuts.

More money is not the answer.

One solution to the healthcare "crisis" is to dissolve the unholy alliance of providers, payers and patients.

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Can patients afford healthcare without heavy regulation and government intervention?

That is, would there be a healthcare system without insurance companies and Medicare?

Many economists don't think so.

Nevertheless, physical therapy is well-suited to provide services to patients in gyms, schools, industry workplaces and to private-pay, 'cash practices' that would avoid the need for the third party arrangement that dominates healthcare today.

Physical therapists provide value with every intervention.

See how to provide valuable, audit-proof physical therapy for Medicare patients in outpatient physical therapy clinics.

Virginia Chiropractors can't make a Physical Therapy Diagnosis

You can read this discussion about Virginia chiropractors practicing physical therapy that was 'born' on the Physical Therapist Manager Yahoo Groups and can be read here . You will need to sign in to Yahoo Groups to contribute to the discussion.

It's too bad 'physical therapy privileges' can be awarded to
chiropractors who probably can't do a physical therapy evaluation on a
patient prior to performing treatment.

This letter from the acting Virginia Attorney General states that chiropractors can 'practice physical therapy' when performing techniques and modalities.

Here is last paragraph of letter posted on site:

“Based on the above, I am of the opinion that the statutory changes enacted
by the General Assembly in 2000 were not intended to change, and did nothing
to change, the scope of practice of chiropractors, and I am further of the
opinion that chiropractors may lawfully provide physical therapy modalities
as part of a treatment program for patients and, therefore, practice
physical therapy.

With kindest regards, I am
Very truly yours,

Randolph A. Beales

Acting Attorney General”

I wonder if the Virginia state practice act required a 'physical therapy
diagnosis' prior to any profession administering physical therapy
treatments if that would slow the chiropractors down.

The 'physical therapy diagnosis' would require specific measurement of
impairments in ROM, strength and other physical patient
characteristics and also measurement of functional limitations
(perhaps with the OPTIMAL).

The physical therapist would then hypothesize the 'physical therapy
diagnosis' - the link between the impairments and the functional
limitations.

The physical therapist would then treat the patient using any
combination of techniques - exercise, manipulation, education,
whatever it takes.

The physical therapist would then re-measure the patient
characteristics (ROM, strength, OPTIMAL) to see if any improvement
occurred.

If improvement did occur, the physical therapist could attribute the
benefit to the treatment and render a 'discharge physical therapy
diagnosis'.

I've developed a decision-making process called SIMPLE Physical Therapy Diagnosis with 'how-to' videos, data-collection templates and extensive references at www.SimpleScore.com .

If most physical therapists followed this decision-making process I
bet most chiropractors would hesitate mightily before advertising
their services as anything akin to physical therapy.

The problem is that most physical therapists don't follow this
decision-making process prior to administering physical therapy on a
patient and most chiropractors know this.

If chiropractors thought that physical therapy diagnosis was 'over
their heads' then we would be safe from professional infringement.

Physical Therapy Diagnosis is the only sustainable competitive position that physical therapists have in the rehabilitative marketplace.

The only way to protect that position is by practicing Physical Therapy Diagnosis.

Legislative solutions wont work because economic forces drive legislation. Deeper pockets will prevail.

Physical therapists can beat chiropractors not with better laws but by being better physical therapists.