The Centers for Medicare and Medicaid Services (CMS) Challenged at Capitol Hill Press Briefing for Promoting Compromised Quality of Patient Care

Representatives From Coalition to Preserve Patient Access to Physical Medicine and Rehabilitation Services Urge Congress to Overturn Revised In-Office Therapy Rule for Medicare Patients

WASHINGTON, DC, Nov. 16 -- Representatives from the Coalition to Preserve Patient Access to Physical Medicine and Rehabilitation Services hosted a press briefing today in the Rayburn Building on Capitol Hill to encourage Congress to overturn, or rewrite, legislation regarding in-office therapy for Medicare patients. Comprised of 23 health care organizations, the Coalition includes the National Athletic Trainers’ Association (NATA), Lymphedema Stakeholders PAC, the American Kinesiotherapy Association (AKTA) and the National Vision Rehabilitation Association (NVRA). The policy in dispute is one the Centers for Medicare & Medicaid Services (CMS) revised without Congressional approval and began enforcing in June 2005. It 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 qualified, certified and usually state licensed health care personnel under the supervision of a physician while in his or her office. In issuing this ruling, CMS representatives maintain this change was mandated by the Medicare law adopted in 1997 as part of the Balanced Budget Act. The Coalition rejects this interpretation of the Congressional statute and believes it is inconsistent with the way CMS interpreted it for the past six years. “Prior to the sudden CMS rule change, physicians had the freedom to choose any qualified health care professional authorized by state law or regulatory guidelines to perform therapy services in their office or at a clinic,” said NATA Vice President Marjorie J. Albohm, MS, ATC, who moderated the press briefing. “The new rule adversely affects patients’ access to quality therapy services and restricts Coalition members’ ability to practice. It has also exacerbated the already growing shortage of U.S. therapy and other health care providers. This is happening at the same time the population of Medicare patients is increasing dramatically,” she said. According to the American College of Physicians, that number will jump from a projected 40 million in 2010 to 68 million in 2030. According to Coalition representatives, the new CMS policy is having an adverse trickle down effect with commercial insurance providers. “Using Medicare as a justification, some commercial insurers are quickly moving to restrict who can provide therapy services in the physician’s office,” said Cheri Hoskins, president, Lymphedema Stakeholders PAC. During the 9:00-10:00 a.m. press briefing, Albohm pointed out that the aging American population is creating demand for medical services faster than American schools are graduating allied health care professionals. “Hospitals and medical facilities throughout the country are experiencing a critical shortage,” she said. At the briefing, spokespeople discussed the patient, provider and physician implications on the CMS ruling, known as “therapy-incident to.” They included the Lymphedema Stakeholders PAC, a non-profit organization formed to protect the rights of lymphedema patients; the National Vision Rehabilitation Association (NVRA), created to advance independence and quality of life for people who are blind or partially sighted; the American Kinesiotherapy Association (AKTA), whose members are rehabilitation specialists skilled in the application of exercise-based therapy to restore function and mobility; and the National Athletic Trainers’ Association (NATA), which supports the 30,000 health care providers who specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. Lymphedema Stakeholders Political Action Committee (PAC) Presenters included:

  • Wade P. Farrow, MD, CWS, FCCWS, medical director of the Texas Wound and Lymphedema Center in Bryan, Texas.
  • Katherine C. Erlichman, DO, a lymphedema patient and osteopathic physician who founded the Pennwood Ophthalmic Associates, P.C., in Everett, Pa. and is medical director and founder of the Lymphedema Foundation at the University of Pittsburgh Medical Center in Bedford, Pa., -- the first treatment center of its kind in the surrounding four counties.
  • Denise “Missy” Baylor, RMT, EMT, CLT-LANA, a nationally certified lymphedema specialist based at the Memorial Hermann Hospital Lymphedema Center in Houston, Texas.
  • Helen Eror, an 85-year-old lymphedema patient, based in Cumberland, Md.

Farrow discussed the specialized treatment lymphedema therapists provide patients who experience a chronic swelling of the body, most often as a result of cancer treatment. He claimed the revised CMS ruling reduces the number of trained therapists that he may now use by more than a third, and reimburses people who do not have the advanced training necessary to adequately treat lymphedema patients. Erlichman focused on the need for certifying all health care workers who care for lymphedema patients in a sensible fashion. Baylor stressed the ruling has restricted treatment to patients by eliminating half of those qualified to provide manual lymph drainage (MLD). Eror described her dependence on the specialists she visits and concern that if Medicare continues to restrict reimbursement, it will affect the quality of her care. National Vision Rehabilitation Association (NVRA) Presenters included:

  • Bruce A. Kater, OD, an optometrist and medical director of the Envision Rehabilitation Center in Wichita, Kan.
  • Sharon Schwalm, MS, CVRT, rehabilitation teaching manager, Association for the Blind & Visually Impaired (ABVI), Goodwill Industries of Greater Rochester, Inc., in Rochester, N.Y.
  • Barbara Milleville, recipient of vision therapy services. Vienna, Va.

Kater expressed concern that the recent ruling will have a significant and detrimental impact on the delivery of quality multidisciplinary vision rehabilitation services. Schwalm discussed the importance of specialized care and the specific training required of a vision therapist. Milleville discussed the challenges she faces as a low vision therapy recipient and her concern with potential compromised quality of care. American Kinesiotherapy Association (AKTA) Presenters included:

  • James “J.T.” Magee, Jr., RKT, president-elect, AKTA, and staff kinesiotherapist at Hunter Holmes McGuire VA Medical Center in Richmond, Va.
  • Lori V. Shuart, RKT, first vice president, AKTA, and staff kinesiotherapist at Hunter Holmes VA Medical Center in Richmond, Va.

Magee provided an overview of kinesiotherapy and the role of kinesiotherapists (KTs) in the hospital and clinic setting. He also addressed the rigorous academic training and certification required to practice. Shuart discussed the implications of the ruling for KTs and reinforced the importance of specialized care. National Athletic Trainers’ Association (NATA) Presenters included:

  • Thomas D. Kohl, MD, founding partner and medical director of the Comprehensive Athletic Treatment Center, Division of Berkshire Family Medicine, P.C., in Wyomissing, Pa.
  • Terry Ventresca, ATC, director of sports medicine at the Comprehensive Athletic Treatment Center, Division of Berkshire Family Medicine, P.C., in Wyomissing, Pa.
  • Bernice Kauffman, RN, a Reading, Pa.-based patient with musculoskeletal conditions

Kohl criticized the new ruling for removing the decision making out of the hands of the physician who knows best for the patient. Ventresca described how 40 percent of his work load had once been Medicare patients, and that now his former patients are unable to see him for new problems. Kauffman relayed how she had been effectively treated by an athletic trainer, who is no longer available to her, due to the new ruling. She now sees therapists whom she doesn’t believe have the same credentials and experience to adequately provide the treatment she requires. Albohm concluded the press briefing by urging attendees to contact legislators and decision makers who can fix the problem. “Our goal,” she said, “is to provide the Medicare patient with the quality of care he or she rightfully deserves.” For more information about the Coalition, please visit www.coalitiontopreservepatientaccess.org.


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About the Lymphedema Stakeholders Political Action Committee (PAC) The Lymphedema Stakeholders Political Action Committee (PAC) is a non-profit organization (501C4) formed to protect the rights of all lymphedema patients. The mission of the Lymphedema Stakeholders PAC is to advance the quality of care for lymphedema patients, and to protect patients' rights to comprehensive lymphedema therapy from providers who meet standards established by the Lymphology Association of North America (LANA). www.legislation4lymphedema.org. About the National Vision Rehabilitation Association (NVRA) The National Vision Rehabilitation Association (NVRA) is the national association representing the interests of the vision rehabilitation profession, including vision rehabilitation agencies, providers and the patients they serve. NVRA's mission is to expand access to high quality vision rehabilitation services provided according to a physician's prescription. www.medicarenow.org. About the American Kinesiotherapy Association (AKTA) The mission of the American Kinesiotherapy Association, Inc. (AKTA) is to serve the interest of its registered practitioners and represent the profession of kinesiotherapy to the public. Registered kinesiotherapists (RKTs) are healthcare professionals skilled in the application of scientifically-based exercise principles adapted for rehabilitation. www.akta.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.

 
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