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PT and the Greater Good

Dramatic Change in Medicare Coverage

Published October 23, 2012 9:15 AM by Dean Metz

Just yesterday the New York Times reported that Medicare will now provide coverage for chronic conditions, particularly for home care and therapy services. This will have a huge impact on physical therapists. Those cases we would have to discharge due to a lack of progress can now continue to receive care in certain circumstances.

There is concern this will lead to an increase in costs to the already beleaguered system. It will add some costs; that is true. If one looks at the managed long-term care (MLTC) models employed by Medicaid though, the increase in costs for preventive measures are dwarfed by the savings in prevention of hospital admissions, exacerbations of conditions and overutilization of inpatient services. My current position is in a company that works in exactly this way.

A personal story: I worked with a woman who had very advanced COPD about seven years ago. She didn't have the endurance to make herself a meal and when we met, she had 12 exacerbations resulting in inpatient admissions in the previous 12 months. I worked with her Medicare care manager and we devised a plan of chest PT every two weeks to assess her lungs, combined with coaching to family and friends who carried out percussion and vibration three times daily. We also provided an aide three days a week to ensure she had a bath and meals prepared. We kept her out of hospital for 13 months. When she finally wound up in the hospital again, it was for the last time.

Her care manager told me that the last year of her life cost the insurance company more than $65,000 but the year prior cost more than $1 million!

Prevention and care management works! Physical therapists have an opportunity to be part of this wave but they will need to alter their vision to include education, prevention, maintenance and interdisciplinary cooperation. Let's not let this opportunity slip us by and be taken up by other professions alone.


Karen, this quote from the article seems to say that the changes are definitely coming:

Federal officials agreed to rewrite the Medicare manual to make clear that Medicare coverage of nursing and therapy services “does not turn on the presence or absence of an individual’s potential for improvement,” but is based on the beneficiary’s need for skilled care.

Dean Metz October 26, 2012 12:51 PM

I saw this article online.  Is it a sure thing already?  I thought it was just a proposal.  I agree that we cannot let this slip by!!  

Karen Schiff October 25, 2012 3:27 PM

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About this Blog

    Dean Metz
    Occupation: Staff Development Specialist
    Setting: New York, NY – Newcastle Upon Tyne, Great Britain
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