Permanent may be a temporary state. Speaker of the House, Paul Ryan, is not shy in sharing his thoughts about the direction the Medicare budget should take. (Photo from Speaker Paul Ryan YouTube Channel.)
The end of the therapy cap brought about by the Congressional budget deal February 9 gave therapists the opportunity to celebrate. Not so much, though, for PTAs (and COTAs), for whom Congress included some fine print about their services being paid at 85% of the Medicare physician fee schedule. That payment differential kicks in as of 2022.
Bummer for PTAs. For PTs themselves, however, the permanent repeal approved by Congress should leave a good feeling; sparing them the annual cat-and-mouse game of the exceptions process. Right?
Perhaps not. It looks like rain may be waiting for the therapy cap parade.
Permanent, or not…
One set of dark clouds that could threaten the permanent removal of the therapy cap is the term, “permanent,” itself. What does that even mean in 2018? Consider that the Patient Protection and Affordable Care Act (ACA) became the law of the land in 2010. For the last 2 years, however, the ACA has been openly and enthusiastically targeted for repeal by several political actors in very high office.
The fragility of “permanent” can be seen in the stripping away of the ACA’s individual healthcare insurance mandate which, many assumed, was as permanent as the law itself. That changed when the GOP tax bill passed in December. The individual mandate that one day was the law of the land was gone and forgotten on the next.
Click here to see the president’s proposed fiscal year 2019 budget.
A second set of storm clouds that linger over the permanent removal of the therapy cap is the $266 billion in Medicare cuts included in the president’s proposed budget for 2019. Those cuts would affect older adults as well as individuals living with disabilities. A recent article in Forbes indicates that those cuts would include payments to skilled nursing facilities and physicians.
Logically, those cuts could also appear in Medicare reimbursement for therapy services. Should that occur, those cuts likely would blunt some of the progress made by removal of the therapy cap.
Ryan’s “big thing”
Speaker of the House Paul Ryan offers a train of thought that makes that possibility believable. During a December 2017 radio interview, Ryan plainly expressed his sentiments about future budget cuts, telling show host Ross Kaminsky, “Frankly, it’s the health care entitlements that are the big drivers of our debt, so we spend more time on the health care entitlements — because that’s really where the problem lies, fiscally speaking.”
Ryan subsequently tells Kaminsky he feels he is having an impact on the president’s thinking regarding Medicare reform, and characterizes his longstanding efforts to revamp Medicare as, “my big thing,” and that it is the single greatest entitlement program where reform is needed.
So, while the therapy cap repeal is worth celebrating now, one must wonder how it will stand up against a commitment in Congress to reshape Medicare.
In fact, the permanence of the therapy cap repeal itself may turn out to be little more than a political football that can be thrown, fumbled, or handed off as needed by the makers of healthcare policy.
—Frank Long is Chief Editor of Physical Therapy Products. Contact: [email protected].
