With Physical Therapy Medicare Reimbursement Capped at $1,740, a Challenge to Physical Therapy to Step Up Health Promotion Strategies

Share Article

Catherine Mormile, DPT, owner of Mormile Physical Therapy, Anchorage, Alaska explains that because Congress adjourned December 22 without completing work on a budget reconciliation bill (S. 1932), allowing the current moratorium on the Medicare therapy cap to expire December 31, 2005, beginning January 1, 2006 millions of Medicare recipients will be subject to implementation of a cap limiting physical therapy services to $1,740. As a result Dr. Mormile believes that to ensure proper health care for all Medicare recipients, physical therapy health promotional interventions and strategies must be implemented. She offers several methods to help Medicare patients obtain these goals in the face of shrinking Federal reimbursement dollars.

Congress adjourned December 22 without completing work on a budget reconciliation bill (S. 1932), allowing the current moratorium on the Medicare therapy cap to expire December 31, 2005. Therefore, unbeknownst to most of the millions of Medicare recipients, beginning January 1, 2006, the Centers for Medicare and Medicaid Services (CMS) is expected to proceed with implementation of the $1,740 therapy cap, although Congress is likely to agree to modifications to the cap later in January.

What these means for Seniors and others who depend upon Medicare for primary health care coverage is that unless and until Congress offers exceptions for those most needy, beginning in January, private out-patient physical therapy coverage will be limited to only $1,740 of coverage for this entire year.

Because this is obviously not enough health care coverage to meet the needs of all Medicare recipients, health care providers and patients must turn to health promotional strategies that identify (1) things that negatively impact health, wellness, and well-being (2) activities and behaviors that enhance quality of life while minimizing dependency upon the health care system.

One of the most demanding health influences in our lives today is stress. Stress is an unavoidable part of our lives. As life’s situations demand change, the imperative to adapt is stressful. To some degree, stress can offer an exciting challenge to motivate one on to higher achievement. Or, it can be distressing if life events are overwhelming, especially if the individual possesses physical and mental challenges that prohibit positive adaptations. Patients who solely depend upon Medicare for health care reimbursement are most at risk for feelings of helplessness, and inability to cope in the face of life-challenging events. Stress has been shown to cause or worsen many of the leading health problems in the US today, such as those related to obesity, heart disease, mental well-being, and use of addictive substances.

In The Wellness Book (1993), Herbert Benson, MD and Eileen Stuart, RN, list the many manifestations of stress as: (1) Physical Symptoms: headaches, back pain, tight neck and shoulders, indigestion, restlessness, sleep disturbances, racing heart/shortness of breath, stomach aches, sweaty palms, dizziness, tiredness/fatigue, and ringing in the ears;(2) Behavioral Symptoms: excessive smoking, bossiness, critical, angry, grinding of teeth, compulsive gum chewing, and over use of alcohol; (3) Emotional Symptoms: crying, nervous, anxious, edgy/ready to explode, feeling powerlessness, anger, lonely, unhappy for no reason, and easily upset; and (4) Cognitive Symptoms: trouble thinking clearly, forgetfulness, inability to make decisions, lack of creativity, constant worry, thoughts of running away, and loss of sense of humor. If you feel stressed, you many recognize and have many of these symptoms.

What can be done to assure health and well-being for the Seniors and those dependent upon the Federal government for health care reimbursement. For one, visit your physical therapist so she or he may assess your health indicator risks and design with you an inclusive health promotional program that encompasses the following: (1) physical activity for fitness and (2) stress management strategies. Also, all individuals need to stay educated regarding what they can do to help themselves. The Wellness Book is a good place to start. Dr. Benson and Ms Stuart have written other works on the topic of wellness as well.

Older adults need to be active to promote health. Engage in moderate physical activity for at least 30 minutes most days of the week. An example of a moderate activity is walking 2 miles in 30 minutes. Choose activities that you enjoy and do regularly. These may include activities such as gardening, or daily household chores. If you are already getting 30 minutes of these types of activities, you can get even more health benefits by increasing the time or vigorousness of the activity. For full attainment of physical fitness, choose activities that incorporate aerobic health; ones that improve your heart fitness and breathing, and ones that improve strength and flexibility. Information providing practical health and fitness solutions may be obtained free of charge by logging on to healthypeople.gov. Your physical therapist will be glad to assist you with finding just the right information activities to suit your needs.

Although an enhanced fitness level automatically assists and individual to feel more capable to handle stressful situations, some people find that adding relaxing meditation or selective quiet personal times to a busy schedule is also helpful. There are many self-help remedies available and your physical therapist will help you to find and place into practice the one that works best for you. The most popular and effective stress busting remedies use the principles of personal self-regulation and mindful meditation as the basis of intervention. For patient looking for further and deeper discussions on self-regulation for mindful meditation and relaxation, the works of Jon Kabat-Zinn, PhD are a must read.

These abrupt changes in the Medicare regulations are prone to take many Seniors off guard as they attempt to navigate other Medicare programs such as the newly formed prescription medicine plan. It is important for Seniors to know that in the face of shrinking health care dollars that investment in their health through properly applied health promotional strategies will get them through these times of privation with independence and self-determination. Although the physical therapy cap is small, a visit to your physical therapist can show you how to make it go far. And with this said, happy New Year, and good health to you throughout the year.

# # #

Share article on social media or email:

View article via:

Pdf Print

Contact Author

Dr.Catherine Mormile
Visit website