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Medicare Therapy Cap

From left, Briar Cliff physical therapy student Kirsten Townley and physical therapy professor Sue Klappa work at Briar Cliff University's pro bono physical therapy clinic at the Mayfair Center in Sioux City.

SIOUX CITY -- An advocacy campaign that Briar Cliff University physical therapy students participated in played a role in getting Congress to eliminate the hard cap on physical therapy services for Medicare patients earlier this month.

On Feb. 9, President Donald Trump signed into law a budget bill that included a permanent repeal of the arbitrary limit annually placed on outpatient therapy services. Congress previously tried 16 times to prevent implementation of the cap, which had reset every calendar year since 1997. The Medicare therapy cap limits for 2018 were $2,010 for physical therapy and speech-language pathology services combined and $2,010 for occupational therapy services.

Students enrolled in Briar Cliff's doctor of physical therapy program, which is currently in candidacy status, offer physical therapy services to patients with a variety of conditions from stroke to low back pain to multiple sclerosis under the direction of faculty members at the Sioux City college's pro bono clinic. The clinic, which was largely created because of the Medicare therapy cap, is located in the Mayfair Center.

The physical therapy students took action against the cap last fall by speaking with patients and their family members about the cap and writing letters to legislators urging them to support the Medicare Access to Rehabilitation Services Act, which sought to repeal the cap and ensure that Medicare patients continue to have access to medically necessary physical, occupational and speech-language pathology therapy services.

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Medicare Therapy Cap

Heidi Nelson, director of clinical education for the doctor of physical therapy program at Briar Cliff University, said physical therapists will likely have another battle on their hands in a couple of years, as the budget bill makes changes to home health payments in 2020 and reduces payments for occupational therapy assistant services beginning in 2022.

Heidi Nelson, director of clinical education for Briar Cliff's doctor of physical therapy program, said the students' efforts were featured on the American Physical Therapy Association's website and twitter feed, which she said not only gave the college's program recognition, but "added fuel to fire" to repeal the cap.

"I was so surprised to hear that it was repealed. I had hoped, given the efforts of universities, especially our students, and the advocacy of the American Physical Therapy Association," she said. "It was the students' idea. They ran with it and they put our university and our small PT program on the map."

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Medicare Therapy Cap

Brandon Whitten, a physical therapy student at Briar Cliff University, said patients were very excited about his classmates' efforts to repeal the Medicare therapy cap.

Brandon Whitten, a second-year physical therapy student from Nebraska City, Nebraska, said patients were happy to support student-advocacy efforts made on their behalf. The petitions they signed seemed to have had an effect on lawmakers.

"It was very exciting," Whitten said of hearing that the therapy cap had been repealed. "This is probably the first big change that I've seen as far as policies go. Knowing now that we can extend our services a little bit further does really mean a lot to us."

In the wake of the repeal, Nelson said she expects the pro bono clinic to see a decrease in patient referrals. She said one of the clinic's patients has already asked to return to his previous therapy services provider because he wants to give his spot to someone who doesn't have insurance or is underinsured. 

"When Donald Trump signed the legislation it was to repeal it effective immediately, so for the rest of 2018 there is no set therapy cap," Nelson said of the hard cap. "There's a soft $3,000 limit. After a patient reaches $3,000, Medicare may review that patient's progress, but that's really where it stops. Most current clinicians out there expect that only 8 percent of individuals who reach that $3,000 limit will be reviewed."

Although repealing the therapy cap was a big win for physical therapists, as well as patients and their families, Nelson said the battle continues. The budget bill included provisions that make changes to home health payments in 2020 and reduce payments for occupational therapy assistant services beginning in 2022.

"In a couple of years, we're going to potentially see a decrease in reimbursement from Medicare. (Congress's) end budget is the same, so they had to figure out how they were going to counteract that," she said. "That could potentially be the next battle for physical therapists across the country."

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Health and Lifestyles reporter

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