Medicare/Physical Therapy/Medical 2016
By – Sheri de Grom
The Centers for Medicare and Medicaid Services passed a law that’s good for the patient and not the establishment.
The settlement agreement means that there have been changes to the manual that Medicare contractors use to process claims. These claims will no longer be evaluated based on potential for improvement but on the need for skilled care. Skilled care will qualify for Medicare even if the medical record reflects that the patient continues to deteriorate or maintains their current condition.
Facilities are rating an increasing number of patients as needing the highest level of therapy. This level requires 120 minutes of intense therapy daily and documenting this amount for high payment. The reality is that most patients cannot endure the scheduled therapy prescribed to meet those high standards of payment.
Medicare classifies nursing home residents into one of 66 groups depending on the patient’s needs. More than one-third of the groups are for patients who require physical, occupational or speech therapy. Medicare pays more for patients who need the most therapy.
The New York Times reported Oct. 5, 2015 that nursing homes and rehabilitative units bill Medicare for more therapy than patients need.
One of the best kept secrets in nursing homes and rehabilitative care units is that they operate at a profit.
‘Profit’ used in conjunction with nursing homes and rehabilitative units is something we don’t hear about. This segment of health care is not eager to open their accounting books for anyone to examine.
The facilities receive more in Medicare payments than it costs the provider to give the patient care, exploiting the billing system while they are attempting more therapy than the patient needs, or can tolerate.
Common sense [obvious to those in the medical profession, caregivers and families of patients everywhere] is that chronically ill patients often require skilled care before returning home from the hospital. These people are too ill to withstand any type of rigorous physical therapy. Physical therapy adds unwarranted pain for this frail population.
DO NOT ALLOW YOUR LOVED ONE TO BE DISCHARGED AS SOON AS THEY STOP SHOWING IMPROVEMENT IN PHYSICAL THERAPY. THIS IS NO LONGER LAWFUL!
The changes I’ve described above apply to the traditional Medicare program and to private Medicare Advantage plans. They apply to people 65 and older, as well as to people under 65 who qualify for Medicare because of disabilities.
Medicare’s new law, now in place, should circumvent the nightmares families face across the nation. Patients upon discharge from the hospital and too ill to go home no longer must meet the rigorous demands of physical therapy, as in days gone by. They may go to skilled care for recovery [unless your medications are too expensive or you have a mental illness diagnosis]. I’ll be discussing these problems in a separate blog.
Thank you for spending time with me. I sincerely hope the changes in Medicare will enhance your life and the lives of those you love.