How does the therapy cap affect physical therapy in general?



When we hear the term “therapy cap”, how many of us immediately think about outpatient services? If you are one of these people you are probably not alone. With the impending March 31st deadline for a full repeal of the Medicare therapy cap and a permanent policy fix to the flawed sustainable growth rate, I think it is extremely important to realize the broad impact this cap has on the entire physical therapy profession.

Currently, the cap places a $1,900 limit on occupational therapy services and $1,900 on physical and speech therapy services combined. Once patients reach the cap they must either utilize secondary insurance or pay out of pocket for continued and often-necessary services. To put this into perspective lets use an example. A 65 y/o patient is admitted to an acute care hospital with a primary diagnosis of a left CVA. Discussion with the rehab team reveals an episode of outpatient therapy three months prior for a left rotator cuff repair. The patients Medicare coverage only covers 6 days in acute care and the patient does not have secondary insurance. When the social worker explains the situation to the family, the family states that they are unable to pay out of pocket for medical services. Now what?

​For initial providers, especially those of us in acute care, it is important to look at the entire continuum of care. 1 in 3 patients who suffer from stroke will also suffer secondary complications whether it is orthopedic in nature or further vascular compromise. Patients post stroke require care in the many years following their acute care services whether it be sub-acute, home care or outpatient management post-stroke, counseling, nutrition services, community integration programs, medical counseling, support groups, return to driving training etc. Services that often fall by the wayside, sometimes with dangerous consequences, due to the hard cap on therapy services.

​How does this affect physical therapy in general? Well as physical therapists we are more than just clinicians, we are advocates, advocates for both the integrity of our profession and our patients and ensuring that they receive the skilled care they deserve through the ENTIRE continuum of care. As we look to a more innovative tomorrow we want to be the providers that say “functional” is just not going to cut it. As a united profession we need to look to the bigger picture and shift focus from an outdated mindset of “functional” to “optimal” through a collaborative and comprehensive patient/provider dynamic. Then and only then will we begin to live the vision: “Transforming society by optimizing movement to improve the human experience.”

Take action before March 31st! #StopTheTherapCap

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