Medicare Physical Therapy Cap

Is A Mistake

To the Editor: 

On September 1, 2003, Medicare imposed a $1,590 cap on its coverage for outpatient physical therapy and speech therapy services in all outpatient settings except hospitals. If a patient recovering from stroke, for example, needs more than $1,590 in physical therapy and speech therapy services, this policy means that he or she may have to pay out of pocket to continue to receive care. If Congress fails to take action to lift this arbitrary cap, it could affect tens of thousands of Medicare recipients. Also, those who experience more than one medical condition could be forced to make a difficult and unfair choice –– to neglect a back problem, for example, in order to have enough Medicare coverage to return function to an arm and leg affected by a stroke.

Some patients will be able to pay “out of pocket” for the remaining rehabilitation they need and some will go to a local hospital to continue their rehabilitation. Others will not be so fortunate. Patients in rural areas, for example, are likely to be left with few treatment options. Limited income and lack of access to hospital centers may force many of these patients to neglect the rehabilitation they need and deserve.

And then there’s the issue of the “crystal ball.” The cap affects the total amount of physical therapy and speech therapy services provided during a calendar year. What happens if a patient “uses” the full $1,590 by early March to rehabilitate from a stroke, but then experiences an unexpected fracture from a fall in July?

As a practicing physical therapist, I know that the rehabilitation needs of Medicare patients can easily exceed what the $1,590 cap allows. Cutting corners on rehab can lead to more expensive complications down the road. By taking action to remove the cap, Congress can allow necessary therapy care to be provided now and avoid the costly consequences of neglect.

Congress has the opportunity to remove the cap. I urge anyone who is a Medicare beneficiary or who has loved ones who are to contact his or her member of Congress immediately. Urge them to take action now to remove this arbitrary $1,590 cap on Medicare therapy benefits and assure that seniors get the rehabilitation they need.

Sincerely,

Robert H. Clark, PT

68 Mile Hill Rd South, Newtown                       September 29, 2003