I originally wrote this piece on the 31st of December 2012 but unfortunately was unable to finish it until now. It is the fourth of January, and the both Houses of the US Congress has finally set a deal a couple days ago preventing the much feared US fiscal cliff from happening.
The US fiscal cliff is an economic apocalyptic event of drastic spending cuts and dramatic tax hikes to reduce the US budget deficit. With spending cuts, jobs will be lost resulting in decreased consumer spending. Decreased consumer spending means companies, for example Walmart or McDonalds, will not be hiring more people when they don't have a lot of costumers to cater to. Otherwise, they might also start laying people off. Imposing tax hikes means less money for every family to spend and presents the same effects regarding decreased consumer spending. This will send the fragile US economy back into recession and will pull the world down with it. Which leads me to my next point, what does it have to do with healthcare workers, in particular physical therapists? Let me explain.
Medicare alone accounts for almost $600 billion in 2010 and is expected to rise to more than a trillion bucks in 2022, when most of the baby boomer generation would require more health services. All physical therapists based in the US, in one way or the other, are dependent on Medicare reimbursements for their services may it be in out-patient clinics, home health services, skilled nursing facilities, nursing facilities or acute care rehab. If this fiscal cliff happened, and the s--t hit the fan, cuts to Medicare will seriously affect delivery of care to patients and may result in loss of employment or underemployment for therapists. For foreign trained PTs, like us from the Philippines, it may be harder to get working visas when there are no jobs available to start with. There is always talk of increased demand for therapists as the baby boomer generation enters their twilight years and would need more help to increase mobility, improve function and quality of life but the lingering question is who is gonna pay for their therapy when Medicare cuts are implemented here and there? Most won't be able to pay out of pocket. Our skilled services are expensive so to speak as new PTs here spend an average of seven years to be a DPT. However, I personally think it is justified how much we are compensated for our services.
I work in a nursing home with a few skilled beds so I cannot really speak in behalf of other PT specialties but let me explain this one too. As a PT, my job is not only to evaluate and make a program for every patient I have, short-term care or long-term care patient it doesn't matter. It is also part of my job to constantly assess the patient and be in constant communication with other therapists (OT and speech) as well as nursing (which basically encompasses a broad base of unit nurses, restorative nurses, Medicare nurses, unit managers and nursing assistants/aides) with regards to the overall health of the patient. Everyday that I work with the patient, therefore, I am evaluating him if he is making progress, if this program is working for him, if he is at baseline and most especially, if something is off with him. I don't have to diagnose what is wrong with him as that is not part of my job but it is my job to let everyone involved in his care know that something isn't right and has to be put into observation or noted. There are times when a patient is making good progress and then gradually declines for no obvious reasons. Having reported it to nursing, nursing may reveal that his medications may have been changed and when they found out that the patient is not doing so well with the new meds may contact the physician. To make the long story short, a therapist is involved in a large part of patient care and as we play a central figure in restoring patient function and overall quality of life, it is only right that we are paid decently for our clinical judgment and responsibilities.
With a deal reached in Congress, the 27% pay cut to doctors (and by extension to us, therapists) will not happen, or perhaps more accurately, at least not now. However, Medicare reform will soon be an area of great interests to the politicians as they try to rein in the cost of healthcare. According to Wikipedia, only less than 5% of all Medicare claims are evaluated, which means that 95% or more of claims get refunded without adequate verification of appropriateness of reimbursement. Having said this, many firms, both bogus and legal, have turned Medicare into their cashcow, essentially draining the system of much needed funds faster than these seniors can go into full retirement.
In New York alone, Medicare must be losing hundreds of millions on fly-by-night physical therapy clinics that are essentially hot-packs-TENS-factories that change names every two years to avoid detection from government agencies for fraud. These clinics, employ unlicensed PTs to treat dozens of patients a day and are in cahoots with a licensed therapist who comes in only once a week to sign documents to make the operation appear legal. I know this for certain as I have a couple friends verify this.
Insurance fraud such as this adds up to the bankruptcy that is facing the Medicare system in the face. Many reforms have been introduced and as recently as October of last year, they introduced Manual Medicare Review (MMR), towards which they hired (I assume) non-healthcare professionals to assess, evaluate and approve or disapprove request for more therapy for patients who have reached their caps for the year. A cap is the maximum amount of money that Medicare can pay for each patient receiving skilled therapy for the year. If the patient goes beyond cap, theoretically he has to pay out of pocket. Before the MMR, even if the patient reaches the cap, a therapist can write justification explaining why the patient would need more therapy despite having used up his money for the year. With MMR, you are only allowed an evaluation once the patient reaches cap. Then all the necessary documents pertaining to the patient will be sent out to the agency performing the MMR, on which the agency will have ten business days to decide and approve or deny the evaluation and need for therapy. Their response will be sent out via snail mail back to you.
I will say it up front. The whole MMR process is a mess! A big, and utter mess! For starters, ten business days is two weeks from evaluation. Add the days for completion of documents and the days for snail mail and you are looking at at least three weeks (or in my experience even two months!) before you get to know if you can start treating a long term care patient. How in the fucking world can you expect the patient to stay at the same level, set the same goals for the patient after evaluating him a month ago? How in the world do you expect the patient not to have declined in that span? For example, I have a patient evaluated for a fall and I sent the patient's paperwork out for MMR. The evaluators took their damn sweet time processing the papers and I received a reply more than a month later approving twenty treatments for the patient. By that time, the patient has had fallen two more times and has now progressively weakened from the pain and the fear of falling again. How in the world do they expect me to fix him now? I'm pretty sure I need to re-evaluate him as his needs, level of function have changed. But I can't! Because if I do, I would have to wait for God knows how long again before I get their reply. By then I'm not even sure if the patient would still be alive.
The inefficiency of those doing the MMR was so blatantly upsetting, that by the end of the year, three months after the MMR was introduced, I was left with only two patients to see. Two patients mean I can only stay for work for a very short time thus leaving me broke by the new year. Many other therapists who work in nursing homes also reflect the same sentiments. And all the papers I sent out are just there awaiting nothing, no response from MMR whatsoever. I have sent out at least ten patient evaluations and no response from them. It was very frustrating and my fear is that this Manual Medicare Review might go on as the future of Medicare reform. This does not bode well for the future of the healthcare practice and professionals. But most of all, it does not bode well for the quality of life of patients.
It becomes a big irony when they tell you the need for PTs will continue to rise in the future as more and more baby boomers get older and need therapy but at the same time the politicians are looking at choking the lifeline of these same health care professionals and eventually driving them off the workforce. We can only pray that they would know better and make better recommendations at health care reform. Before we all drive ourselves and jump over a real cliff.
With a deal reached in Congress, the 27% pay cut to doctors (and by extension to us, therapists) will not happen, or perhaps more accurately, at least not now. However, Medicare reform will soon be an area of great interests to the politicians as they try to rein in the cost of healthcare. According to Wikipedia, only less than 5% of all Medicare claims are evaluated, which means that 95% or more of claims get refunded without adequate verification of appropriateness of reimbursement. Having said this, many firms, both bogus and legal, have turned Medicare into their cashcow, essentially draining the system of much needed funds faster than these seniors can go into full retirement.
In New York alone, Medicare must be losing hundreds of millions on fly-by-night physical therapy clinics that are essentially hot-packs-TENS-factories that change names every two years to avoid detection from government agencies for fraud. These clinics, employ unlicensed PTs to treat dozens of patients a day and are in cahoots with a licensed therapist who comes in only once a week to sign documents to make the operation appear legal. I know this for certain as I have a couple friends verify this.
Insurance fraud such as this adds up to the bankruptcy that is facing the Medicare system in the face. Many reforms have been introduced and as recently as October of last year, they introduced Manual Medicare Review (MMR), towards which they hired (I assume) non-healthcare professionals to assess, evaluate and approve or disapprove request for more therapy for patients who have reached their caps for the year. A cap is the maximum amount of money that Medicare can pay for each patient receiving skilled therapy for the year. If the patient goes beyond cap, theoretically he has to pay out of pocket. Before the MMR, even if the patient reaches the cap, a therapist can write justification explaining why the patient would need more therapy despite having used up his money for the year. With MMR, you are only allowed an evaluation once the patient reaches cap. Then all the necessary documents pertaining to the patient will be sent out to the agency performing the MMR, on which the agency will have ten business days to decide and approve or deny the evaluation and need for therapy. Their response will be sent out via snail mail back to you.
I will say it up front. The whole MMR process is a mess! A big, and utter mess! For starters, ten business days is two weeks from evaluation. Add the days for completion of documents and the days for snail mail and you are looking at at least three weeks (or in my experience even two months!) before you get to know if you can start treating a long term care patient. How in the fucking world can you expect the patient to stay at the same level, set the same goals for the patient after evaluating him a month ago? How in the world do you expect the patient not to have declined in that span? For example, I have a patient evaluated for a fall and I sent the patient's paperwork out for MMR. The evaluators took their damn sweet time processing the papers and I received a reply more than a month later approving twenty treatments for the patient. By that time, the patient has had fallen two more times and has now progressively weakened from the pain and the fear of falling again. How in the world do they expect me to fix him now? I'm pretty sure I need to re-evaluate him as his needs, level of function have changed. But I can't! Because if I do, I would have to wait for God knows how long again before I get their reply. By then I'm not even sure if the patient would still be alive.
The inefficiency of those doing the MMR was so blatantly upsetting, that by the end of the year, three months after the MMR was introduced, I was left with only two patients to see. Two patients mean I can only stay for work for a very short time thus leaving me broke by the new year. Many other therapists who work in nursing homes also reflect the same sentiments. And all the papers I sent out are just there awaiting nothing, no response from MMR whatsoever. I have sent out at least ten patient evaluations and no response from them. It was very frustrating and my fear is that this Manual Medicare Review might go on as the future of Medicare reform. This does not bode well for the future of the healthcare practice and professionals. But most of all, it does not bode well for the quality of life of patients.
It becomes a big irony when they tell you the need for PTs will continue to rise in the future as more and more baby boomers get older and need therapy but at the same time the politicians are looking at choking the lifeline of these same health care professionals and eventually driving them off the workforce. We can only pray that they would know better and make better recommendations at health care reform. Before we all drive ourselves and jump over a real cliff.
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