National Safety Month — keep older adults safe by repealing the medicare therapy cap

One thousand nine hundred and eighty dollars could buy two iPhones or a half months rent in Manhattan. But for older adults, $1,980 is all that one is entitled to for an entire year’s worth of physical therapy and speech-language pathology outpatient services. This amount is roughly less than 1,000 minutes of therapy.

June is National Safety Month with the theme to “Keep Each Other Safe.” To keep older adults safe, we must ensure access to healthcare services by passing the Medicare Access to Rehabilitation Services Act (H.R. 807/S.253) to repeal the annual cap on Medicare rehabilitation services.

{mosads}I am a physical therapist and public health researcher at Northwestern University, Feinberg School of Medicine. In the course of my 10-year career, I have witnessed how the therapy cap limits access to physical therapy service and how this arbitrary dollar amount ends up being more costly to individuals, their families, and our health system long-term.

A fundamental problem of the cap is that it restricts therapy access regardless of a person’s medical history and reasons for needing therapy. 88 percent of older adults have at least one chronic disease and 20 percent of those 85 and older have more than five chronic illnesses. Chronic diseases are associated with difficulties in getting out of a chair, walking and navigating stairs. These are the movement problems that physical therapist treat, but older adults with chronic disease reach their therapy cap amount rapidly, restricting their access to necessary medical care. 

The current Medicare cap disadvantages the most vulnerable, medically complex people in our society.

Older adults often need rehabilitation for age-related progressive conditions like Parkinson’s disease or Alzheimer’s, or complex conditions common in older adults like stroke, arthritis and cancer. Based on conservative estimates, a person will reach the therapy cap around 16 visits. At two visits per week, two months of care is often insufficient to fully recover.

Further, patients with conditions like stroke or Alzheimer’s need multidisciplinary care; physical, occupational, and speech therapies. Because the therapy cap encompasses both physical and speech therapy, patients reach the cap amount quickly, depleting access to on-going care.

Once the annual cap is reached, healthcare providers can request more services through an exception process. However, this undertaking places undue stress on patients, administrative work on staff, and delays necessary and urgent care. 

Without a therapy cap, some fear that Medicare therapy outpatient costs will spiral out of control due to unconstrained spending. That is true as Medicare billing will likely increase as older adults are no longer limited to $1,980 per year.

However, the investment in preventative and proactive outpatient services is a far better investment than treating the consequences of injury and disease. 

By eliminating the cap, we can proactively treat a balance problem rather than treating a broken hip. By eliminating the cap, we can fully help those following stroke regain the ability to walk, talk, and carry out daily tasks. By eliminating the cap, we can be a society that values its elders by providing unrestricted access to critical rehabilitative services that improve physical, mental, and emotional health.

When my older patient took his first steps in therapy recovering from a stroke, he broke down in tears. Therapy had not just given him the ability to move, it gave him freedom; the capacity to return to his community doing the activities he loved.

Care from a physical therapist improves health outcomes and decreases costs to our healthcare system and society. In a time of staggering healthcare costs, an investment in physical therapist care puts us on a path to a more cost-effective healthcare system and healthier society.

We must not let caps on physical therapy services affect the safety of older adults and restrict people’s ability to recover and lead active and engaged lives.

Aging is inevitable and we will all likely need therapy services in the future. We must pass the Medicare Access to Rehabilitation Services Act to ensure that services are available and unrestricted when needed.

Margaret Danilovich is an assistant professor at Northwestern University Feinberg School of Medicine — Department of Physical Therapy and Human Movement Sciences. She is a fellow in The OpEd Project’s Public Voices Fellowship.

The views expressed by contributors are their own and are not the views of The Hill.