Caps on Physical Therapy Sessions Detrimental to Business Growth
This year has been a year of many changes to the medical system. While some of these changes have been beneficiary, a few have been detrimental to professions such as physical therapy. Many physical therapists are facing tough times today. The market is saturated with physical therapists but not enough patients. Laid off physical therapist Jessica Summers explains why.
A few years ago, patients had a cap on how many sessions were covered by their insurance. Medicare made exceptions for patients that suffered from physical ailments such as osteoporosis, Parkinson’s disease and stroke victims and granted them extensions because they were more likely to need more physical therapy sessions. However, as of October 2012, this is no longer the case.
On October 1, 2012, The Middle Class Tax Relief and Job Creation Act of 2012 (H.R. 3630) amendment was passed which states:
In applying this paragraph with respect to a request for an exception with respect to expenses that would be incurred for outpatient therapy services (including services described in sub- section (a)(8)(B)) that would exceed the threshold described in clause (ii) for a year, the request for such an exception, for services furnished on or after October 1, 2012, shall be subject to a manual medical review process that is similar to the manual medical review process used for certain exceptions under this paragraph in 2006. Middle Class Tax Relief and Job Creation Act of 2012
Because of this new amendment, patients that previously had extensions on their therapy sessions were cancelled and their insurance would no longer cover it. Additionally, patients who had exceeded their session limit had to be denied treatment because they could not afford the care.
According to Summers, patients can file an appeal to extend their coverage but because filing the claim and getting it through takes so long, most have been denied. Additionally, there is a typo in the law that makes Speech Therapy and Physical Therapy share a budget. This places a lot of physical therapists and patients in a tough situation. Summers posed the example of a stroke victim who can have multiple issues such as swallowing, walking and speech deficits. Because of the limit, she has to restrict which therapies she can provide and would have to decide which of these would be priority. Based on the previous example a patient would receive treatment for swallowing problem, but the walking and talking deficits would have to wait for another year.
Fortunately, the amendment which enforced the cap is up for vote in January. Jessica, along with many others in the medical profession are hoping for an extension. This would help bring more patients in and create a bigger demand and more jobs for physical therapists.
