Access to Physical Medicine and Rehabilitation Services Improvement Act of 2006 Introduced on Senate floor
917-301-1350 (week of 6/12)
Ellen Satlof, NATA
ACCESS TO PHYSICAL MEDICINE AND REHABILITATION SERVICES
DALLAS, TX – September 29, 2006 – The National Athletic Trainers’ Association (NATA) announced today its support for the Access to Physical Medicine and Rehabilitation Services Improvement Act of 2006 (S. 3963). Introduced by Sen. Craig Thomas (R-Wyo.), the passage of the Act will ensure that Medicare beneficiaries have better access to quality health care provided by state licensed or certified health care professionals.
“This crucial piece of legislation ensures that the maximum number of qualified therapy professionals are available to provide Medicare beneficiaries with the quality care they need and deserve,” said Chuck Kimmel, ATC, president of NATA. “NATA estimates that 600,000 medically necessary physical medicine and rehabilitation sessions provided annually by athletic trainers to Medicare patients are going unmet as a result of a restrictive rule put in place by the Centers for Medicare and Medicaid Services (CMS). We believe that physicians are best qualified to determine the type of therapy treatments prescribed and to choose the best qualified professionals to deliver those services.”
“Sen. Thomas has strongly demonstrated his leadership and commitment to ensuring that the health care needs of Medicare patients are met with this Act,” said Kimmel. “He recognizes that it is important for patients to receive physical medicine and rehabilitation services quickly in order to prevent further injury and promote cost savings to Medicare.”
The CMS “therapy-incident to” rule, which was implemented in July 2005, is inconsistent with existing law, and the Act will correct that inconsistency. The existing rule prohibits Medicare reimbursement for therapy services provided “incident to a physician’s services” by anyone other than a physical therapist, occupational therapist or speech and language pathologist. Such “incident to” therapy services are those services provided by educationally qualified state licensed or certified health care professionals who work under the supervision of a physician while in his or her office. The Coalition to Preserve Patient Access to Physical Medicine and Rehabilitation Services, comprising organizations whose members are affected by the current policy, supports changing the CMS’s “incident to” rule.
The Access to Physical Medicine and Rehabilitation Services Improvement Act of 2006’s goals are threefold:
- Improve patient access to quality health care by ensuring that Medicare patients have access to the medically appropriate health care professionals, and that the physicians’ practices will receive payment for covered services delivered under the supervision of a physician.
- Allow physicians to decide which state-authorized or certified health care professionals have the requisite education and training to provide quality, cost-effective physical medicine and rehabilitation services to their patients. The physicians are the most knowledgeable and qualified people to decide who is best able to provide services to Medicare patients.
- Reduce expenses to the Medicare system by providing services in the most cost-effective methods.
A 2005 Medicare Payment Advisory Commission (MedPAC) report noted that, based on 2002 payment data, the physician’s office was the most cost-effective place for Medicare beneficiaries to obtain physical medicine and rehabilitation services. By comparison, the MedPAC report found that average per-beneficiary costs for a set of comparable therapy sessions ranged from a low of $405 for services provided in a physician’s office to a high of $868 for treatment at a skilled nursing facility. Treatment by a physical therapist in private practice was $653. The General Accounting Office (GAO) concluded in another, more focused study that the cost differences at different health care settings could not be explained by patient characteristics such as diagnosis, age, sex, disability and prior hospitalization. In other words, the only significant difference was where -- the actual locations -- the services were provided.
The shortage of therapy providers, some of whom are very specialized, creates long waits and sometimes even denies access to many Medicare patients needing therapy. With the passage of the Act, athletic trainers, lymphedema therapists, low vision therapists, kinesiotherapists and others will again be able to provide services to Medicare patients. These health care professionals were suddenly prohibited from providing Medicare-covered therapy services despite decades of successful outcomes. The Act will ensure that physicians can again hire therapy professionals who are best qualified for the work and receive payment from Medicare for their services. In addition, athletic trainers and lymphedema therapists working under physician supervision can provide Medicare-covered therapy services in locations outside of physicians’ offices.
Athletic trainers and lymphedema therapists are covered providers in the bill because they represent the greatest opportunity for cost savings to the Medicare program. Athletic trainers have a demonstrated ability to accelerate rehabilitation and return patients to pre-injury levels of activity. Additionally, breast cancer survivors suffering from lymphedema have lost access to more than one-third of these specially trained therapists because of the 2005 CMS rule. There is a crucial and urgent need to have these health care professionals recognized by the Medicare program.
“Breast cancer survivors who develop lymphedema as a result of the removal of the lymph nodes can develop more serious complications that can lead to long hospitalizations and even death,” said Cheri Hoskins, president of Lymphedema Stakeholders Political Action Committee (PAC), a non-profit organization formed to protect the rights of all lymphedema patients and a member of the coalition. “But with lymphedema therapy, the complications are reduced and the cost to Medicare is significantly reduced. Most lymphedema therapy was given in physician offices prior to the CMS rule. Now survivors simply have no place to go because the physicians can’t get reimbursement for these medically necessary services and the physician is left out of the plan of care.”
“Passage of this legislation will result in better, more cost-effective care for Medicare patients, because of the particular skills we bring to the table,” said Marjorie Albohm, MS, ATC, NATA board member. “Athletic trainers offer unique skills that allow patients to benefit from their ability to safely accelerate rehabilitation and provide ongoing care under the physician’s supervision. For more information, please visit www.NATA.org. For more information on the coalition, please visit www.coalitiontopreservepatientacess.org.
About the National Athletic Trainers’ Association (NATA)
Certified athletic trainers are unique health care providers who specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. The National Athletic Trainers' Association represents and supports the 30,000 members of the athletic training profession through education and research. www.NATA.org.