James M. Berklan
James M. Berklan

If December’s at our doorstep, that can mean only one thing: anxiety — in all its good and bad forms. 

We’re looking forward to good year-end breaks, but we’re also wondering what shoes might drop before then. And after then too.

Notice how there’s two parts of worry to just one part anticipation? That’s what being around long-term care for so many years will get you, I guess. Either that or being a card-carrying journalist. Talk about a double-whammy.

But we’re going to focus on the positive — or at least potentially positive — here today. Sure, a tax overhaul bill that has a significant segment of providers quivering is picking up steam and should be on the president’s desk soon. (Not that many businesses and providers aren’t going to enjoy some big tax breaks themselves.)

But there’s also other legislation being considered that should have providers acting like tiny tots with their eyes all aglow. Repeal of the Medicare Part B therapy caps could be a nice Christmas present for all providers. (Hey, the president said to use “Christmas” this year … )

As first reported at mcknights.com over a month ago, the nearly unthinkable could be happening: 20 years of worrying about capped therapy payments could become a thing of the past. The same goes for stressing through getting a therapy-cap exception process approved year after year. The exceptions have been a saving grace, but still something to sweat over regularly.

Now, however, congressional aides might have this thing steered in the right direction. Bipartisan staffers from no no fewer than three key committees have been hammering out a good-looking deal. At last check, patients hitting a $3,000 threshold could become eligible for targeted medical review (it’s $3,700 now). Eligible, not mandated. [The caps now sit at $1,980, incidentally, one for occupational therapy and one for speech and physical therapy combined.]

Therapists would still need to deal with the KX modifier but so far there is no prior-authorization stipulation for potentially allowing therapy billings to climb. Yes, getting the caps off the figurative menu would be like a kid getting vegetables taken off his dinner plate.

Close observers say a key was getting the “doc fix” taken care of two years ago. That annual albatross had the potential to ripple havoc throughout the entire healthcare system every year until enough people found the intestinal fortitude to bite their lip and just get it done. That included nursing home operators, who were among those taking a one-time cutback in reimbursements.

And that’s going to be the rub again this time. Who’s going to pay if therapy caps are shown the door? It would not come cheaply, so providers are praying any solution would spread the pain widely.

Leading long-term care lobbyists have been hoping for the best. One of them who is typically known for extremely cautious forecasting gives caps-banishment a “really good probability” of happening. They know that a resolution now — even if there’s a big, short-term price tag — could bring much-needed stability to a fretful field.

So while the tax bill and all of its huffing and puffing fill your screens over the coming days, be aware — be hopeful — that there could be a better present coming before the end of the year. 

The therapy caps exception process expires Jan. 1, meaning that by that time the process either has to be renewed or the caps need to be done away with entirely. Or providers could have to deal with the caps and no exceptions process, which would be the worst scenario of all.

A season for restless anticipation indeed.

Follow Editor James M. Berklan @JimBerklan.