You may not like following, talking, or even the thought of politics. I know there was a time when the government’s affairs were not interesting to me. Why do I want to waste my time watching people constantly fighting and remaining stubborn about working together and compromising? FACT is: politics affects us all. If we neglect to pay attention, we let others make decisions for us without any of our input. Is that freedom? No.
We have a duty as citizens of America to follow the people that are elected to represent us and the issues that matter the most to us. Legislation on health care has recently become a hot-button issue. I have tried my best to follow the reform debates and legislation that will affect my patients and my practice. The American Physical Therapy Association helps me stay current on issues affecting me and my patients. I also subscribe to email updates from each of my senators and representatives and follow legislation at THOMAS.
Many of my patients have Medicare as a primary insurance. Currently, Medicare has a cap on outpatient physical and speech therapies combined of $1860 per year, which started over on January 1st, 2010. This is the maximum amount of money each beneficiary can spend for PT and OT combined per year. Luckily, my company, HealthReach Rehab is one of the most cost-effective therapy providers in the area and Medicare patients get the most bang and quality for their buck. I encourage Medicare recipients to shop cost and quality when choosing a therapy provider. You can search for physical therapists in your area here.
In previous years, there was an exception to the Medicare therapy cap. If a Medicare beneficiary were to experience a serious injury that requires intense therapies, for example a stroke, or if multiple injuries happened in one year, there was an exceptions process PTs could go through to ensure that necessary treatments would be covered for their patients. However this may not be the case in just a few weeks. If the government does not act, as of March 1,2010, there will be no exceptions process for the Medicare therapy cap AND a 21.29% cut on all benefits for Medicare beneficiaries. This means that if you have exceeded your $1860 for outpatient combined physical and speech therapies, you will be forced to pay for services 100% out-of-pocket or forgo needed treatments.
If you think this doesn’t affect you because Medicare is not your insurance, think again. First, you probably know someone and are close to someone who has Medicare as their primary insurance. Physical therapy helps people move again, overcome the ability to not walk after a stroke, learn how to compensate for losses following a spinal cord injury, maintain mobility to remain independence, and improve strength and balance to prevent falls just to name a few of our treatments’ effects. Second, many insurances use a formula to determine payments for services that is based on Medicare’s reimbursement. If Medicare payments drop, so will other insurance payments. I wouldn’t count on the insurance companies to drop your deductible or monthly payments in response to these cuts. What does this equate to? These insurance companies will see increased profits.
I hope this information makes you want to do something to stop the therapy cap exceptions process removal and 21.29% cut in Medicare benefits from happening, because the only way we will get our legislators to act in our interests is to let them know our opinions. The easiest part of advocating for yourself is contacting your legislators. Don’t know who your legislators are? Easy, just go to the Senate or House websites, put in your zip code and voila! you will be given their contact information. You can write a letter or send a fax. Emails are easy enough and calling is even easier. I called Herb Kohl and Russ Feingold last week and left a message on their voicemail. Don’t worry you won’t have to go through lots of prompts or have to talk to someone in person, it goes straight to voicemail and you can leave your message – took approximately 2 minutes. You can try all of these methods combined. Power in numbers. The APTA has a website for patients, the Patient Legislative Action Center. Here, you can also follow a link to find your elected officials and there are nice summaries of issues that may be important to your physical therapy. They have sample letters you can send to your elected officials. You can also join the APTA’s patient action list, if you want emails updating you about legislation.
When you contact your elected officials, let them know you think the best solution to this problem would be to revoke all therapy caps. Those who need therapy should be able to receive it, and the cost of those not receiving necessary treatments could be more costly. Let them know that although this is the best solution, if legislation is not passed to revoke the caps, in the least there should be an exceptions process, to ensure those who need therapy the most will be able to receive it. Also, let them know that you do not want benefits cut by 21.29%, because that would negatively affect the amount of care covered and possibly access to services.
Make your opinion known today. Together we can make positive changes happen!
Patient Legislative Action Center: http://capwiz.com/amerpta/home/
Senate: http://www.senate.gov/
House: http://www.house.gov/
MoniqueSerpasPT
My name is Monique Serpas, PT, DPT, OCS. I am a physical therapist and board-certified Orthopaedic Clinical Specialist practicing at the Southeast Louisiana Healthcare System in New Orleans, LA. I realize how difficult it can be to overcome an injury or manage a chronic condition and am focused on helping my clients achieve wellness through a physically active lifestyle. I treat orthopaedic, balance, and vestibular disorders and practice using a combination of hands-on manual therapy, therapeutic exercise, and education. This enables my patients to assist in their own recovery and injury prevention. I also have developed fall prevention and golf-related rehab programs in the past. I hold a Doctor of Physical Therapy from Concordia University Wisconsin (2008) and a Bachelor of Science in Kinesiology from Louisiana State University (2004). I am a member of the American Physical Therapy Association (APTA), Louisiana Physical Therapy Association (LPTA), and the Orthopaedic and Neurology sections of the APTA.
If you want to connect beyond the blog, m...@geaux2pt.com or click on the following social network icons:
February 19, 2010
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