Archive for Saturday, December 10, 2005

Therapy cap puts seniors at risk

Congress may pass legislation that limits outpatient services

December 10, 2005


Q: I really enjoyed your recent column about how the pending budget cuts in Washington would impact Medicaid and the effects these cuts will have on poor, disabled and elderly Americans. If it wasn't for your column, our newspaper would not have even mentioned these attacks on needy and chronically ill Americans.

I would suggest you also point out to your readers a Medicare travesty: the upcoming expiration of the moratorium on the Medicare Therapy Cap that will become effective Jan. 1.

Unless Congress acts between now and Dec. 31, all Medicare patients will face a coverage limit of $1,750 per year for outpatient physical therapy and speech therapy combined, and $1,750 per year for occupational therapy. I believe that arbitrarily capping these benefits will be most detrimental to those frail elderly persons who have multiple medical problems to overcome and need therapy.

A: Thank you for your timely suggestion, and we totally agree with you about yet another Washington absurdity about which the public is kept in the dark.

Today, these types of outpatient therapies are covered 80 percent by Medicare B and 20 percent by the patient's gap insurance without a cap; however, unknown to most, Congress established little-known, arbitrary therapy caps in the Balanced Budget Act of 1997 (we have yet to understand how anyone can call these budgets "balanced"). Ever since, Congress has delayed implementation of the caps by passing legislation in 1999, 2001 and 2003, which hold the caps in abeyance.

Should Congress not repeal the caps or enact another moratorium before year's end, you or your parents would be limited to about 18 outpatient therapy visits under each cap. This means that elderly folks who suffer strokes, for example, and are discharged home from a nursing facility to receive physical, speech and/or occupational therapy so they can live independently will not receive enough therapy to reach maximum improvement. This translates to many being deprived of higher quality of life by Congress and finding themselves back in hospitals and nursing homes at higher costs than the therapy would have cost

Once again, in the name of "saving money" - rather than considering the patient's medical needs as dictated by medical professionals - Congress has chosen to pick on the frail elderly and disabled members of our population who have no lobbying voice, while continuing to squander funds elsewhere.

Although there are more intelligent ways in which to save money, Congress generally chooses the path of least political resistance and chooses to pass life sentences of misery on the disabled and sickly while spending like drunken sailors on nonessentials. For example, when a proposed $450 million project to build "two bridges to nowhere" in Alaska came under heat recently, the U.S. Senate refused to specifically fund the bridges, but gave the same amount of money to Alaska as part of a transportation spending bill, saying Alaskan officials could decide how and where to spend the money.

How much therapy would $450 million buy? What's more important, funding pork for friends and colleagues or taking care of the disabled and chronically ill? Congress should stop wasting their time and our money ordering study after study when we all know the facts: 1) The oldest and most debilitated Americans will be affected by arbitrary caps on therapy; 2) Many with chronic health issues will be deprived by the arbitrary caps of a good quality of life that can go with spending their last years at home; and 3) The cost of nursing home care exceeds therapy at home many times.

Call your senator and representative and tell them that they should repeal this misguided provision and eliminate the therapy cap. Tell them there is a midterm election next year, and you will remember their vote on this issue when you go to the ballot box. As an aside, ask them if their health coverage limits outpatient therapy for them and their families. For more information, visit our Web site at where you can link to the American Physical Therapy Assn.'s Web site.

- Jan Warner is a member of the National Academy of Elder Law Attorneys and has been practicing law for more than 30 years. Jan Collins is editor of the Business and Economic Review published by the University of South Carolina and a special correspondent for The Economist.


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