Each year CMS creates changes to the rules of Medicare. Part of these rules involves the physician fee schedule. Unfortunately that is an extremely poor choice of names. There are multiple non physician healthcare disciplines that are reimbursed for payment based on that list.
Care for our elderly
Medicare is the main healthcare insurance policy for our older generation. Starting at 65 years old we as Americans automatically qualify for Medicare A coverage and are responsible for paying the insurance premiums for Medicare B as well as the remaining options of Medicare.
Proliferation of Medicare Advantage plans
Over the years we have allowed traditional insurance companies to establish Medicare Advantage plans that have proliferated thanks to smart marketing and salespeople.
While at times these plans can be beneficial to some populations that are healthy or have certain needs, there are some that can have some significant difficulties with these plans.
Frequently these people do not understand that they are transferring their Medicare benefits over to a managed care plan. They don’t truely understand what they are signing up for and are sold by salespeople.
Serious changes need to be made
So if someone says to you that they have a great buisness proposal for you to take care of some extremely important people, would you be willing to do it?
Now let’s continue the sales pitch of “I will reimburse you for your services if you follow the guidelines I give you.”
Next as the years progress we will adjust the payment model every year.
So it sounds good, right?
Now let’s look at the reality of the situation. Every year as the progression of inflation of normal years as well as the cost of living changes year over year, without taking into account a pandemic or record high inflation, let’s take a pay cut every year.
Would you still take me up on that great buisness idea?
The reality of Healthcare
For therapy providers we have been the recipient of yearly cuts to reimbursement. Not only to the physician fee schedule but other more meaningful and sinister cuts you would never see in any other type of service industry.
So if you took your car for an oil change, would the shop charge you less for the tire rotation or the windshield wiper replacement since you were already there for service? I think not. But somehow that is the world of therapy. Depending on the activity used to improve the functional movement Medicare will reimburse fully for one activity but then only pay a percentage of another on the same visit. Does that make any logical sense when we are doing the exact same thing but it’s worth different if we do something else in the same treatment session?
So if you were having your HVAC worked on does it matter if it was the apprentice or the Owner of the buisness doing the work? You will pay the same amount for the job to be completed as long as the job is done correctly. Well looking at the world of therapy, we now have a payment reduction for services provided by a licensed physical therapy assistant or certified occupational therapy assistant versus a Physical therapist or Occupaional therapist. That also does not matter if the assistant has significant more experience than the therapist. This is all while performing the same activity and education of the resident.
All it really does is hurt access for our most vulnerable
All these cuts and deductions have one direct effect. It severely limits access to therapy services for our elderly. This is much more pronounced in rural nursing facilities. It is continuing to be more difficult with staffing as therapists realize they can make a better living working in other settings or completely leaving healthcare in general. This phenomenon also impacts caregiver burnout. When you feel like you are working harder and harder every year and your reward is a pay cut. Or your vacation does not happen because you can’t find anyone to work for you. Something needs to be done and the biggest voice is everyone. Be an advocate for your loved ones. You never know when one of your family members, or even yourself need the services we provide and hopefully we will still be there.
