With no promise of therapy caps fix, real pain hitting home

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James M. Berklan
James M. Berklan

Long-term care providers who supply therapy weren't invited to the big party Thursday, but they're hoping they'll still have reason to celebrate soon anyway.

The “party” was a national press conference hosted by AARP and a handful of therapy-professionals associations to bring attention to the Medicare Part B outpatient therapy caps. Yes, those therapy caps. 

Although the call served more as a primer for consumer-focused media outlets and their audiences, the mere fact that the groups were engaged might be the news of the day. With the expansive AARP behind the awareness campaign, there is no way lawmakers or policy managers can claim unfamiliarity with the problems. 

And there are definitely problems. We're now on Day 33 with the caps in place and patients are already starting to be hurt by them, speaker after speaker reminded Thursday. It's a “very real” problem already for some nursing home residents, one source assured me Thursday. 

After less than two weeks of rehab a stroke patient could hit cap limits ($2,010 for speech and physical therapy combined; and $2,010 for occupational therapy alone). 

Already, association execs say, they are seeing patients starting to slow down appointments and stretch out therapy allotments as long as they can before hitting a cap. Less therapy will lead to more disabilities and rehospitalizations, just another reason to get a fix in place. 

So providers and beneficiaries (an estimated 1 million would be hurt by caps in a year) are intent on getting a full repeal. 

They can almost taste success. That's because the lawmakers are already on board — sort of. A bipartisan, bicameral congressional committee agreed on a plan months ago, and a vast coalition of providers has given it the thumbs-up. 

However, now the hunt is on for a vehicle to get it passed. The next best hope lies with Feb. 8 (Thursday). That's when the current Continuing Resolution ends. But with so many high-pressure national topics, such as immigration policies, clouding the picture, providers are unsure of what could come next. 

Then there's also the funding or “pay-for” aspect of eliminating the caps. Every therapy provider organization I've spoken with rushes to tell the harm from the caps, but none can offer ideas on how such a $6.5 billion move would be paid for. Odds are cuts to other parts of provider budgets would occur. That is just one of the elephants in the room. 

They are darn certain, however, that they can't see the can kicked down the road another month or two. Patients are already getting hurt. 

And it's no time to be complacent that an eventual fix would repair everything retroactively. Based on history, provider payments probably would be covered. 

But what about the missed therapy? Every day with caps on, thousands of seniors become less functional. Some are missing treatment windows of opportunity that will leave them scarred or disabled forever. 

The drumbeat to pass a Medicare extender bill with a therapy caps repeal provision — or pass a caps repeal on its own — will only get louder in the coming days. As well it should. 

In this unprecedented era of partisan politics and runaway policy making, however, no one can say for sure what will happen. This administration has shrugged off convention repeatedly and faces more hostility from its ideological counterparts than ever before. 

But something needs to happen, and soon. 

“These patients can't wait for Congress to not take action next week, and then wait until maybe March for the next chance,” Cynthia Morton, executive vice president of the National Association for the Support of Long Term Care, reminded me this week.

Perhaps the consumer-awareness campaign that received a big boost Thursday will be the nudge that finally gets things done. 

Follow Editor James M. Berklan @JimBerklan.

Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.

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