Therapy cap extension impacts Southeast patients
wrangell — Patients in local hospitals could face new limitations on how physical therapy can be paid for in Southeast Alaska hospitals.
Annual caps for the amount of physical therapy have, in past years, been restricted only to hospitals that did not receive the critical care designation from the federal government. However, for the first time this year, Medicare will apply reimbursement caps – the limit is $1,920 – to physical therapy patients receiving physical therapy even at critical access facilities, like the Petersburg and Wrangell medical centers.
The caps are expended and renewed on an annual basis, meaning patients with intense physical therapy regimes could now face the possibility of exhausting the Medicare cap after as little as one or two months.
The cap comes with an allowance for cases of medical necessity, so patients in dire need of therapy can extend that amount to $3,700, though exceptions to the $1,920 primary cap are rare, officials said.
The average cost of a physical therapy visit in Petersburg is between $150 and $300, officials said. Though costs vary depending on how much therapy is required.
In Wrangell, the change will affect roughly 70 percent of physical therapy patients, according to physical therapy director Aaron McPherson. Petersburg medical officials aren’t sure how many patients will be affected by the change overall, though physical therapy director Ellie Van Swearingen estimated the percentage of physical therapy patients reliant on medicare at about 50 percent.
The cap is in effect for all patients who receive Medicare reimbursement, which is roughly 30 percent of the total number of patients seen in Petersburg, though it wasn’t immediately clear how many take advantage of physical therapy, officials said.
Petersburg officials said their hospital could discontinue treatment for some patients after only a few months, Van Swearingen said.
“That would be a cap for occupational therapy, and then physical therapy and speech therapy combined go towards that cap,” she said. “Each year, Medicare will only pay that amount for therapies. What that means for patients is that once they reach that cap we can’t continue see them for therapy.”
The cost of physical therapy services varies by patient, Van Swearingen said.
“It depends what we do,” she said. “We charge for 15 minutes, but essentially that cap is easily reached if a patient is being seen two or three times per week.”
Van Swearingen estimated as little eight weeks for some patients to exhaust their annual allowance.
“It’s not good for us, it’s not good for them,” she added.
Critical access hospitals are those in rural areas with less than 25 beds and which receive a special designation from the federal government. For the last few years the practice has been to allow those facilities to conduct physical therapy without a cap, McPherson said.
“Basically, they’re small, rural facilities,” said Petersburg Medical Center CEO Elizabeth Woodyard.
In Wrangell, the change could mean discontinuing therapy for patients who rely solely on Medicare for health costs. However, many patients maintain secondary medical insurance policies, so those policies could step up to continue to fund critical therapies at increased cost to the consumer, according to McPherson.
“What this really means is that for the whole calendar year … we have to keep an eye on how much money they’re accruing with therapy,” he said. “What we want people to be aware of is not that you can’t be seen or that you’re going to be paying out of pocket, it’s just different than how we’ve been able to do business before. We don’t want people to think that the hospital had changed anything, but Medicare is now requiring us to do business just like every other hospital in the country.”
McPherson urged patients to be mindful of how they use physical therapy.
“Most of our therapies that we do, we schedule them for an hour,” he said. “If they came three days a week for two months, that’d probably fill it up, but if they came twice a week for two months and they only came for thirty minutes, you’re looking at probably four months.”
The changes will affect 77,024 people statewide, according to figures provided by the Medicare Information Office, which fields between 8,000 and 10,000 calls a year.
Federal officials made the decision after a public comment period last year, according to Health Program Manager Judith Bendersky.