Changes because of the caps

[Guest guest]

How about we all keep writing to our congressmen and women so that the cap

doesn't go into effect! Have patients write to their congressmen and women as

well. Go to www.apta.org to find out what else we can all do to keep this

arbitrary and useless cap from going into effect.

J. Boyle PT, MS, CSCS

Physical Therapist/ Co-owner

Gaston Rehab Associates, Inc.

1361-B East Garrison Blvd.

Gastonia, NC 28054

Phone:

Fax:

www.gastonrehabassociates.com

[Guest guest]

How about we all keep writing to our congressmen and women so that the cap

doesn't go into effect! Have patients write to their congressmen and women as

well. Go to www.apta.org to find out what else we can all do to keep this

arbitrary and useless cap from going into effect.

J. Boyle PT, MS, CSCS

Physical Therapist/ Co-owner

Gaston Rehab Associates, Inc.

1361-B East Garrison Blvd.

Gastonia, NC 28054

Phone:

Fax:

www.gastonrehabassociates.com

[Guest guest]

How about we all keep writing to our congressmen and women so that the cap

doesn't go into effect! Have patients write to their congressmen and women as

well. Go to www.apta.org to find out what else we can all do to keep this

arbitrary and useless cap from going into effect.

J. Boyle PT, MS, CSCS

Physical Therapist/ Co-owner

Gaston Rehab Associates, Inc.

1361-B East Garrison Blvd.

Gastonia, NC 28054

Phone:

Fax:

www.gastonrehabassociates.com

[Guest guest]

Hello:

What are outpatient providers going to do different, if anything,

because of the impending therapy caps?

Ron

[Guest guest]

We make sure and have the patient sign a disclaimer regarding the cap. The

patient must inform you if he/she has already used any of their alotment

because Medicare will not give you that information. We bill Medicare fee

schedule

so we can track the cap and check all secondary insurance to see if they will

pick up as primary when Medicare has been exhausted.

[Guest guest]

We make sure and have the patient sign a disclaimer regarding the cap. The

patient must inform you if he/she has already used any of their alotment

because Medicare will not give you that information. We bill Medicare fee

schedule

so we can track the cap and check all secondary insurance to see if they will

pick up as primary when Medicare has been exhausted.

[Guest guest]

www.cms.hhs.gov/medlearn/therapy

Information on this site states that Hospital bases OP departments are

exempt from cap. ???

Kathi Lee

Carson City Michigan

[Guest guest]

www.cms.hhs.gov/medlearn/therapy

Information on this site states that Hospital bases OP departments are

exempt from cap. ???

Kathi Lee

Carson City Michigan

[Guest guest]

Folks,

What we should be complaining about is the extra time and resources

that it's going to take to explain the cap to patients, and the extra

time and resources that it's going to take to track data associated

with the cap. Let's call the cap what it really is, and fight it on

that basis:

Cost shifting of administrative tracking of resource utilization from

the government to the professional.

NO ONE thinks that's a good idea. Not an MD, not a DO, not a DC. My

suggestion is simply to open the debate and discussion into one that

impacts more than just PT's, OT's, and SLP's. We may happen to be

the first group the government tries this with, but we will not be

the last. Why not use that reality to get a bit more support from

our traditional allies (e.g. AMA), and traditional non-supporters

(e.g. ACA) in the here and now.

Dr. M. Ball, PT, DPT, PhD

[Guest guest]

Folks,

What we should be complaining about is the extra time and resources

that it's going to take to explain the cap to patients, and the extra

time and resources that it's going to take to track data associated

with the cap. Let's call the cap what it really is, and fight it on

that basis:

Cost shifting of administrative tracking of resource utilization from

the government to the professional.

NO ONE thinks that's a good idea. Not an MD, not a DO, not a DC. My

suggestion is simply to open the debate and discussion into one that

impacts more than just PT's, OT's, and SLP's. We may happen to be

the first group the government tries this with, but we will not be

the last. Why not use that reality to get a bit more support from

our traditional allies (e.g. AMA), and traditional non-supporters

(e.g. ACA) in the here and now.

Dr. M. Ball, PT, DPT, PhD

[Guest guest]

Folks,

What we should be complaining about is the extra time and resources

that it's going to take to explain the cap to patients, and the extra

time and resources that it's going to take to track data associated

with the cap. Let's call the cap what it really is, and fight it on

that basis:

Cost shifting of administrative tracking of resource utilization from

the government to the professional.

NO ONE thinks that's a good idea. Not an MD, not a DO, not a DC. My

suggestion is simply to open the debate and discussion into one that

impacts more than just PT's, OT's, and SLP's. We may happen to be

the first group the government tries this with, but we will not be

the last. Why not use that reality to get a bit more support from

our traditional allies (e.g. AMA), and traditional non-supporters

(e.g. ACA) in the here and now.

Dr. M. Ball, PT, DPT, PhD

[Guest guest]

Just to clarify a few points regarding the cap:

-All Medicare OP billing is based on the Medicare Physician Fee Schedule.

-Medicare reimburses 80% of the MPFS once the deductible is met, with the

beneficiary being responsible for the remaining 20%.

-Under the cap, the " financial limitation " on OP PT/ST & OT would be $1750.

-Medicare is responsible for 80% of the $1750 ($1400) with the remaining

$350 due from the beneficiary.

Ken Mailly, PT

Mailly & Inglett Consulting, LLC

Tel. 973 692-0033

Fax 973 633-9557

68 Seneca Trail

Wayne, NJ, 07470

www.NJPTAid.biz

Bridging the Gap!

Re: Changes because of the caps

I too am not in favor of the caps, I too worry about a slippery

slope, but let's be honest, we're not really debating this argument

on the facts. It's not really a discussion of what's best for our

patients is it? I suggest we fight the caps, but drop the pretense!

I KNOW that I'm not going to make many friends with the following,

and I KNOW that not all non-hospital outpatient centers treat

patients in the following way, but for 20 years or so, a few bad

apples have dictated the reputation of the group --- and our failure

to properly police ourselves as true professionals should, has

brought us to this impasse. In a way, it's simply time to pay up for

borrowed time, and we have really only ourselves as a profession to

blame.

We've all been around enough corporate PT offices to know that when

patients with multiple disabilities go to a private outpatient

practice, that they too often end up being seen in " group " (although

they are often charged 1:1) or, at best, for 15-20 minutes 1:1 along

with 2 other patients in the same hour. Grouping or " clustering "

or " dovetailing " three patients with menisectomies or ACL repairs or

with RTC repairs is one thing . . . but when it gets into clustering

these kinds of patients with those more medically complex who have

had, for example, an old stroke and a joint replacement, things get a

bit less appropriate for the more medically complex patient.

Hospital outpatient therapy centers don't tend to dovetail patients

quite like that. I'm not saying that these medically complex

patients should NEVER see the outpatient PT mills, but a therapy cap

of $1750 before having to refer to a hosptial outpatient center DOES

tend to carve the more medically complex patients out of the

outpatient PT mill --- either at the outset, or after all other

resources have been exhausted. It's not like these patients won't

get care after $1750, it's just that they'll have to be refered to a

hospital outpatient center where they likely would have gotten better

care and attention in the first place.

If you're a private outpatient therapist and you can't (or don't

usually) get your Medicare patients better in less than $1750, ask

yourself why. Are you using too many extras or too many visits for

that patient status-post A & A? (Remember it's $1750 of what's paid,

not what's billed). Or (as is the case with a massive RTC) is it

simply a rehab process that takes a long time for healing regardless

of how good or bad the post surgical PT happens to be? This, for

example, is where the cap is a problem.

My point is that we should focus upon the patient situations that are

going to be an issue with respect to the cap, not simply spout " Cap

Bad, No cap good " like some inarticulate non-professional. ly,

I see very few situations where the cap will come into play, and when

it does, it usually serves as a clinical safety net for the patient.

There are a few " layups " to be sure, but in a way, this simply

balances out the angry and irritated patients that aren't going to

understand why they had to be refered from one therapist to another.

Dr. M. Ball, PT, DPT, PhD

Looking to start and own 100% of your own Practice?

Visit www.InHomeRehab.com.

PTManager encourages participation in your professional association. Join

and participate now!

[Guest guest]

Just to clarify a few points regarding the cap:

-All Medicare OP billing is based on the Medicare Physician Fee Schedule.

-Medicare reimburses 80% of the MPFS once the deductible is met, with the

beneficiary being responsible for the remaining 20%.

-Under the cap, the " financial limitation " on OP PT/ST & OT would be $1750.

-Medicare is responsible for 80% of the $1750 ($1400) with the remaining

$350 due from the beneficiary.

Ken Mailly, PT

Mailly & Inglett Consulting, LLC

Tel. 973 692-0033

Fax 973 633-9557

68 Seneca Trail

Wayne, NJ, 07470

www.NJPTAid.biz

Bridging the Gap!

Re: Changes because of the caps

I too am not in favor of the caps, I too worry about a slippery

slope, but let's be honest, we're not really debating this argument

on the facts. It's not really a discussion of what's best for our

patients is it? I suggest we fight the caps, but drop the pretense!

I KNOW that I'm not going to make many friends with the following,

and I KNOW that not all non-hospital outpatient centers treat

patients in the following way, but for 20 years or so, a few bad

apples have dictated the reputation of the group --- and our failure

to properly police ourselves as true professionals should, has

brought us to this impasse. In a way, it's simply time to pay up for

borrowed time, and we have really only ourselves as a profession to

blame.

We've all been around enough corporate PT offices to know that when

patients with multiple disabilities go to a private outpatient

practice, that they too often end up being seen in " group " (although

they are often charged 1:1) or, at best, for 15-20 minutes 1:1 along

with 2 other patients in the same hour. Grouping or " clustering "

or " dovetailing " three patients with menisectomies or ACL repairs or

with RTC repairs is one thing . . . but when it gets into clustering

these kinds of patients with those more medically complex who have

had, for example, an old stroke and a joint replacement, things get a

bit less appropriate for the more medically complex patient.

Hospital outpatient therapy centers don't tend to dovetail patients

quite like that. I'm not saying that these medically complex

patients should NEVER see the outpatient PT mills, but a therapy cap

of $1750 before having to refer to a hosptial outpatient center DOES

tend to carve the more medically complex patients out of the

outpatient PT mill --- either at the outset, or after all other

resources have been exhausted. It's not like these patients won't

get care after $1750, it's just that they'll have to be refered to a

hospital outpatient center where they likely would have gotten better

care and attention in the first place.

If you're a private outpatient therapist and you can't (or don't

usually) get your Medicare patients better in less than $1750, ask

yourself why. Are you using too many extras or too many visits for

that patient status-post A & A? (Remember it's $1750 of what's paid,

not what's billed). Or (as is the case with a massive RTC) is it

simply a rehab process that takes a long time for healing regardless

of how good or bad the post surgical PT happens to be? This, for

example, is where the cap is a problem.

My point is that we should focus upon the patient situations that are

going to be an issue with respect to the cap, not simply spout " Cap

Bad, No cap good " like some inarticulate non-professional. ly,

I see very few situations where the cap will come into play, and when

it does, it usually serves as a clinical safety net for the patient.

There are a few " layups " to be sure, but in a way, this simply

balances out the angry and irritated patients that aren't going to

understand why they had to be refered from one therapist to another.

Dr. M. Ball, PT, DPT, PhD

Looking to start and own 100% of your own Practice?

Visit www.InHomeRehab.com.

PTManager encourages participation in your professional association. Join

and participate now!

[Guest guest]

Just to clarify a few points regarding the cap:

-All Medicare OP billing is based on the Medicare Physician Fee Schedule.

-Medicare reimburses 80% of the MPFS once the deductible is met, with the

beneficiary being responsible for the remaining 20%.

-Under the cap, the " financial limitation " on OP PT/ST & OT would be $1750.

-Medicare is responsible for 80% of the $1750 ($1400) with the remaining

$350 due from the beneficiary.

Ken Mailly, PT

Mailly & Inglett Consulting, LLC

Tel. 973 692-0033

Fax 973 633-9557

68 Seneca Trail

Wayne, NJ, 07470

www.NJPTAid.biz

Bridging the Gap!

Re: Changes because of the caps

I too am not in favor of the caps, I too worry about a slippery

slope, but let's be honest, we're not really debating this argument

on the facts. It's not really a discussion of what's best for our

patients is it? I suggest we fight the caps, but drop the pretense!

I KNOW that I'm not going to make many friends with the following,

and I KNOW that not all non-hospital outpatient centers treat

patients in the following way, but for 20 years or so, a few bad

apples have dictated the reputation of the group --- and our failure

to properly police ourselves as true professionals should, has

brought us to this impasse. In a way, it's simply time to pay up for

borrowed time, and we have really only ourselves as a profession to

blame.

We've all been around enough corporate PT offices to know that when

patients with multiple disabilities go to a private outpatient

practice, that they too often end up being seen in " group " (although

they are often charged 1:1) or, at best, for 15-20 minutes 1:1 along

with 2 other patients in the same hour. Grouping or " clustering "

or " dovetailing " three patients with menisectomies or ACL repairs or

with RTC repairs is one thing . . . but when it gets into clustering

these kinds of patients with those more medically complex who have

had, for example, an old stroke and a joint replacement, things get a

bit less appropriate for the more medically complex patient.

Hospital outpatient therapy centers don't tend to dovetail patients

quite like that. I'm not saying that these medically complex

patients should NEVER see the outpatient PT mills, but a therapy cap

of $1750 before having to refer to a hosptial outpatient center DOES

tend to carve the more medically complex patients out of the

outpatient PT mill --- either at the outset, or after all other

resources have been exhausted. It's not like these patients won't

get care after $1750, it's just that they'll have to be refered to a

hospital outpatient center where they likely would have gotten better

care and attention in the first place.

If you're a private outpatient therapist and you can't (or don't

usually) get your Medicare patients better in less than $1750, ask

yourself why. Are you using too many extras or too many visits for

that patient status-post A & A? (Remember it's $1750 of what's paid,

not what's billed). Or (as is the case with a massive RTC) is it

simply a rehab process that takes a long time for healing regardless

of how good or bad the post surgical PT happens to be? This, for

example, is where the cap is a problem.

My point is that we should focus upon the patient situations that are

going to be an issue with respect to the cap, not simply spout " Cap

Bad, No cap good " like some inarticulate non-professional. ly,

I see very few situations where the cap will come into play, and when

it does, it usually serves as a clinical safety net for the patient.

There are a few " layups " to be sure, but in a way, this simply

balances out the angry and irritated patients that aren't going to

understand why they had to be refered from one therapist to another.

Dr. M. Ball, PT, DPT, PhD

Looking to start and own 100% of your own Practice?

Visit www.InHomeRehab.com.

PTManager encourages participation in your professional association. Join

and participate now!

[Guest guest]

,

If YOU were offended, then I must have simply miscommunicated badly.

You've not been one to miss my meaning. Let me try again . . .

I KNOW that not all private-practices operate in a " conveyor belt "

manner. I also am quite aware that we disagree as to where the

lesser quality of care is likely to occur. I KNOW that over the

course of my 10 year career, that I've worked short stents for some

less than ethical employers/bosses, and that because they tended to

be either corporates or non-PT owners of private practices, that I'm

a bit jaded.

Either way you're missing my point.

Inproprieties, or at least the appearence thereof, DO exist, and the

public perception is that they are far more common in private

practices than hospital outpatient clinics. This is because of the

assumption that the hosptial outpatient clinics has greater resources

and don't need to do anything questionable to attact patients. Fact

or not, truth or not, that is, I believe, public perception.

It is perceptions and extreme statements that is, or at least should

be, at the heart of the discussion. I am not pro-cap, nor do I think

that hospital therapy centers always provide better can than

outpatient clinics --- so why are we discussing this situation in

terms of the cap having COMPLETELY negative impact. The fact of the

matter is that the cap won't impact nearly as many patients as we'd

as PT's against the cap might have the public believe, and GENERALLY

SPEAKING (I know there are a few exceptions) the ones that it does

impact are more likely to need more comprehensive care and broader

resources that (in my experience anyway) the hospital is more likely

to have.

My point, again, and maybe I've simply communicated it wrong, is

almost exactly what yours seems to be --- that we should not only

focus upon how it's inappropriate and professionally offensive to

impose a cap on one clinical doctoring profession and not all (can

you IMAGINE a Medicare Medical Services cap? A Podiatry Cap? A

Chiropractic Cap?) --- but also suggest that we focus our discussion

upon those situations where a patient might be affected. To do so

presents a far more professional argument than " the Cap is completely

bad and has no positive elements, " which is, in my opinion, a

dangerous game that we're playing. Otherwise, I fear we're going to

end up sounding a little less professional and a little less educated

than I believe our profession to be.

Dr. M. Ball, PT, DPT, PhD

[Guest guest]

,

If YOU were offended, then I must have simply miscommunicated badly.

You've not been one to miss my meaning. Let me try again . . .

I KNOW that not all private-practices operate in a " conveyor belt "

manner. I also am quite aware that we disagree as to where the

lesser quality of care is likely to occur. I KNOW that over the

course of my 10 year career, that I've worked short stents for some

less than ethical employers/bosses, and that because they tended to

be either corporates or non-PT owners of private practices, that I'm

a bit jaded.

Either way you're missing my point.

Inproprieties, or at least the appearence thereof, DO exist, and the

public perception is that they are far more common in private

practices than hospital outpatient clinics. This is because of the

assumption that the hosptial outpatient clinics has greater resources

and don't need to do anything questionable to attact patients. Fact

or not, truth or not, that is, I believe, public perception.

It is perceptions and extreme statements that is, or at least should

be, at the heart of the discussion. I am not pro-cap, nor do I think

that hospital therapy centers always provide better can than

outpatient clinics --- so why are we discussing this situation in

terms of the cap having COMPLETELY negative impact. The fact of the

matter is that the cap won't impact nearly as many patients as we'd

as PT's against the cap might have the public believe, and GENERALLY

SPEAKING (I know there are a few exceptions) the ones that it does

impact are more likely to need more comprehensive care and broader

resources that (in my experience anyway) the hospital is more likely

to have.

My point, again, and maybe I've simply communicated it wrong, is

almost exactly what yours seems to be --- that we should not only

focus upon how it's inappropriate and professionally offensive to

impose a cap on one clinical doctoring profession and not all (can

you IMAGINE a Medicare Medical Services cap? A Podiatry Cap? A

Chiropractic Cap?) --- but also suggest that we focus our discussion

upon those situations where a patient might be affected. To do so

presents a far more professional argument than " the Cap is completely

bad and has no positive elements, " which is, in my opinion, a

dangerous game that we're playing. Otherwise, I fear we're going to

end up sounding a little less professional and a little less educated

than I believe our profession to be.

Dr. M. Ball, PT, DPT, PhD

[Guest guest]

,

If YOU were offended, then I must have simply miscommunicated badly.

You've not been one to miss my meaning. Let me try again . . .

I KNOW that not all private-practices operate in a " conveyor belt "

manner. I also am quite aware that we disagree as to where the

lesser quality of care is likely to occur. I KNOW that over the

course of my 10 year career, that I've worked short stents for some

less than ethical employers/bosses, and that because they tended to

be either corporates or non-PT owners of private practices, that I'm

a bit jaded.

Either way you're missing my point.

Inproprieties, or at least the appearence thereof, DO exist, and the

public perception is that they are far more common in private

practices than hospital outpatient clinics. This is because of the

assumption that the hosptial outpatient clinics has greater resources

and don't need to do anything questionable to attact patients. Fact

or not, truth or not, that is, I believe, public perception.

It is perceptions and extreme statements that is, or at least should

be, at the heart of the discussion. I am not pro-cap, nor do I think

that hospital therapy centers always provide better can than

outpatient clinics --- so why are we discussing this situation in

terms of the cap having COMPLETELY negative impact. The fact of the

matter is that the cap won't impact nearly as many patients as we'd

as PT's against the cap might have the public believe, and GENERALLY

SPEAKING (I know there are a few exceptions) the ones that it does

impact are more likely to need more comprehensive care and broader

resources that (in my experience anyway) the hospital is more likely

to have.

My point, again, and maybe I've simply communicated it wrong, is

almost exactly what yours seems to be --- that we should not only

focus upon how it's inappropriate and professionally offensive to

impose a cap on one clinical doctoring profession and not all (can

you IMAGINE a Medicare Medical Services cap? A Podiatry Cap? A

Chiropractic Cap?) --- but also suggest that we focus our discussion

upon those situations where a patient might be affected. To do so

presents a far more professional argument than " the Cap is completely

bad and has no positive elements, " which is, in my opinion, a

dangerous game that we're playing. Otherwise, I fear we're going to

end up sounding a little less professional and a little less educated

than I believe our profession to be.

Dr. M. Ball, PT, DPT, PhD

[Guest guest]

,

Okay, so we disagree on how many people this is going to impact. You

did, however, steal my thunder about my greatest concerns about the

cap --- that there will be vast geographical differences in impact.

From very little, to pockets of complete entropy.

" Suggesting that the hospital " safety net " . . . even

exists in some communities is simply not true. "

I've suggested no such thing, in fact, that's where I've been heading

all along.

Are we arguing on that point of lack-of-backup as a profession? Are

we asking what is to happen to those patients who hit their cap and

then have to drive an excessive amount of miles to reach a hosptial

outpatient center? I agree that these are just one of the kinds of

people that are going to say to themselves, " forget it, it's not

worth the hassle. " The government's argument will, of course, be

that if these patients REALLY needed care, they'd find a way to get

it. I agree that it's setting the stage for the government to one

day claim the services of a (D)PT to be non-essential and therefore

non-reimbursable.

Come on , you're one of the people that I learned the value of

contingency planning from! In that vein, what are we doing as a

profession to ensure that IF the cap goes into effect, and IF a

patient exhausts their funds, and IF a patient has NO ACCESS to a

hosptial " safety net, " or IF for whatever reason, that safety net

does not serve the patient's needs --- what, if anything, are we as a

profession doing to ensure a crack in the armor? Have we raised the

issue of a waiver? Of an appeal process? I admit I've been out of

the loop for a while, but I've not heard of one.

We've got a little more than 40 days by my count. Were we 6 months

out, I'd have a different position. I KNOW it may compromise

political capital to do the following, but I personally fear that the

cap may be more likely to go into effect and stay in effect than ever

before. What's wrong with pressing hard against the cap, but also

pusing for clear and well defined back-up waiver and appeals

processes should the cap be enacted?

Dr. M. Ball, PT, DPT, PhD, MBA

[Guest guest]

,

Okay, so we disagree on how many people this is going to impact. You

did, however, steal my thunder about my greatest concerns about the

cap --- that there will be vast geographical differences in impact.

From very little, to pockets of complete entropy.

" Suggesting that the hospital " safety net " . . . even

exists in some communities is simply not true. "

I've suggested no such thing, in fact, that's where I've been heading

all along.

Are we arguing on that point of lack-of-backup as a profession? Are

we asking what is to happen to those patients who hit their cap and

then have to drive an excessive amount of miles to reach a hosptial

outpatient center? I agree that these are just one of the kinds of

people that are going to say to themselves, " forget it, it's not

worth the hassle. " The government's argument will, of course, be

that if these patients REALLY needed care, they'd find a way to get

it. I agree that it's setting the stage for the government to one

day claim the services of a (D)PT to be non-essential and therefore

non-reimbursable.

Come on , you're one of the people that I learned the value of

contingency planning from! In that vein, what are we doing as a

profession to ensure that IF the cap goes into effect, and IF a

patient exhausts their funds, and IF a patient has NO ACCESS to a

hosptial " safety net, " or IF for whatever reason, that safety net

does not serve the patient's needs --- what, if anything, are we as a

profession doing to ensure a crack in the armor? Have we raised the

issue of a waiver? Of an appeal process? I admit I've been out of

the loop for a while, but I've not heard of one.

We've got a little more than 40 days by my count. Were we 6 months

out, I'd have a different position. I KNOW it may compromise

political capital to do the following, but I personally fear that the

cap may be more likely to go into effect and stay in effect than ever

before. What's wrong with pressing hard against the cap, but also

pusing for clear and well defined back-up waiver and appeals

processes should the cap be enacted?

Dr. M. Ball, PT, DPT, PhD, MBA

[Guest guest]

Just a reminder that the cap is also on Part B patients in long term care

facilities. Rural or urban, they are rarely in any position to be transported

to or from the hospital for care - especially when it is available right

there in the facility. These patients are typically the ones with chronic

issues

that will utilize the cap quickly and will often need speech and PT services

(combined cap $). That has little to do with quality of care and much to do

with need.

Lynn Janssen, Ed.D. SLP

President/CEO

Premier Health Associates, Inc.

West Des Moines IA 50266

In a message dated 11/20/2005 2:52:37 P.M. Central Standard Time,

DrDrewpt@... writes:

,

Okay, so we disagree on how many people this is going to impact. You

did, however, steal my thunder about my greatest concerns about the

cap --- that there will be vast geographical differences in impact.

From very little, to pockets of complete entropy.

" Suggesting that the hospital " safety net " . . . even

exists in some communities is simply not true. "

I've suggested no such thing, in fact, that's where I've been heading

all along.

Are we arguing on that point of lack-of-backup as a profession? Are

we asking what is to happen to those patients who hit their cap and

then have to drive an excessive amount of miles to reach a hosptial

outpatient center? I agree that these are just one of the kinds of

people that are going to say to themselves, " forget it, it's not

worth the hassle. " The government's argument will, of course, be

that if these patients REALLY needed care, they'd find a way to get

it. I agree that it's setting the stage for the government to one

day claim the services of a (D)PT to be non-essential and therefore

non-reimbursable.

Come on , you're one of the people that I learned the value of

contingency planning from! In that vein, what are we doing as a

profession to ensure that IF the cap goes into effect, and IF a

patient exhausts their funds, and IF a patient has NO ACCESS to a

hosptial " safety net, " or IF for whatever reason, that safety net

does not serve the patient's needs --- what, if anything, are we as a

profession doing to ensure a crack in the armor? Have we raised the

issue of a waiver? Of an appeal process? I admit I've been out of

the loop for a while, but I've not heard of one.

We've got a little more than 40 days by my count. Were we 6 months

out, I'd have a different position. I KNOW it may compromise

political capital to do the following, but I personally fear that the

cap may be more likely to go into effect and stay in effect than ever

before. What's wrong with pressing hard against the cap, but also

pusing for clear and well defined back-up waiver and appeals

processes should the cap be enacted?

Dr. M. Ball, PT, DPT, PhD, MBA

Looking to start and own 100% of your own Practice?

Visit www.InHomeRehab.com.

PTManager encourages participation in your professional association. Join

and participate now!

[Guest guest]

Just a reminder that the cap is also on Part B patients in long term care

facilities. Rural or urban, they are rarely in any position to be transported

to or from the hospital for care - especially when it is available right

there in the facility. These patients are typically the ones with chronic

issues

that will utilize the cap quickly and will often need speech and PT services

(combined cap $). That has little to do with quality of care and much to do

with need.

Lynn Janssen, Ed.D. SLP

President/CEO

Premier Health Associates, Inc.

West Des Moines IA 50266

In a message dated 11/20/2005 2:52:37 P.M. Central Standard Time,

DrDrewpt@... writes:

,

Okay, so we disagree on how many people this is going to impact. You

did, however, steal my thunder about my greatest concerns about the

cap --- that there will be vast geographical differences in impact.

From very little, to pockets of complete entropy.

" Suggesting that the hospital " safety net " . . . even

exists in some communities is simply not true. "

I've suggested no such thing, in fact, that's where I've been heading

all along.

Are we arguing on that point of lack-of-backup as a profession? Are

we asking what is to happen to those patients who hit their cap and

then have to drive an excessive amount of miles to reach a hosptial

outpatient center? I agree that these are just one of the kinds of

people that are going to say to themselves, " forget it, it's not

worth the hassle. " The government's argument will, of course, be

that if these patients REALLY needed care, they'd find a way to get

it. I agree that it's setting the stage for the government to one

day claim the services of a (D)PT to be non-essential and therefore

non-reimbursable.

Come on , you're one of the people that I learned the value of

contingency planning from! In that vein, what are we doing as a

profession to ensure that IF the cap goes into effect, and IF a

patient exhausts their funds, and IF a patient has NO ACCESS to a

hosptial " safety net, " or IF for whatever reason, that safety net

does not serve the patient's needs --- what, if anything, are we as a

profession doing to ensure a crack in the armor? Have we raised the

issue of a waiver? Of an appeal process? I admit I've been out of

the loop for a while, but I've not heard of one.

We've got a little more than 40 days by my count. Were we 6 months

out, I'd have a different position. I KNOW it may compromise

political capital to do the following, but I personally fear that the

cap may be more likely to go into effect and stay in effect than ever

before. What's wrong with pressing hard against the cap, but also

pusing for clear and well defined back-up waiver and appeals

processes should the cap be enacted?

Dr. M. Ball, PT, DPT, PhD, MBA

Looking to start and own 100% of your own Practice?

Visit www.InHomeRehab.com.

PTManager encourages participation in your professional association. Join

and participate now!

[Guest guest]

Just a reminder that the cap is also on Part B patients in long term care

facilities. Rural or urban, they are rarely in any position to be transported

to or from the hospital for care - especially when it is available right

there in the facility. These patients are typically the ones with chronic

issues

that will utilize the cap quickly and will often need speech and PT services

(combined cap $). That has little to do with quality of care and much to do

with need.

Lynn Janssen, Ed.D. SLP

President/CEO

Premier Health Associates, Inc.

West Des Moines IA 50266

In a message dated 11/20/2005 2:52:37 P.M. Central Standard Time,

DrDrewpt@... writes:

,

Okay, so we disagree on how many people this is going to impact. You

did, however, steal my thunder about my greatest concerns about the

cap --- that there will be vast geographical differences in impact.

From very little, to pockets of complete entropy.

" Suggesting that the hospital " safety net " . . . even

exists in some communities is simply not true. "

I've suggested no such thing, in fact, that's where I've been heading

all along.

Are we arguing on that point of lack-of-backup as a profession? Are

we asking what is to happen to those patients who hit their cap and

then have to drive an excessive amount of miles to reach a hosptial

outpatient center? I agree that these are just one of the kinds of

people that are going to say to themselves, " forget it, it's not

worth the hassle. " The government's argument will, of course, be

that if these patients REALLY needed care, they'd find a way to get

it. I agree that it's setting the stage for the government to one

day claim the services of a (D)PT to be non-essential and therefore

non-reimbursable.

Come on , you're one of the people that I learned the value of

contingency planning from! In that vein, what are we doing as a

profession to ensure that IF the cap goes into effect, and IF a

patient exhausts their funds, and IF a patient has NO ACCESS to a

hosptial " safety net, " or IF for whatever reason, that safety net

does not serve the patient's needs --- what, if anything, are we as a

profession doing to ensure a crack in the armor? Have we raised the

issue of a waiver? Of an appeal process? I admit I've been out of

the loop for a while, but I've not heard of one.

We've got a little more than 40 days by my count. Were we 6 months

out, I'd have a different position. I KNOW it may compromise

political capital to do the following, but I personally fear that the

cap may be more likely to go into effect and stay in effect than ever

before. What's wrong with pressing hard against the cap, but also

pusing for clear and well defined back-up waiver and appeals

processes should the cap be enacted?

Dr. M. Ball, PT, DPT, PhD, MBA

Looking to start and own 100% of your own Practice?

Visit www.InHomeRehab.com.

PTManager encourages participation in your professional association. Join

and participate now!

[Guest guest]

If it were fiscally feasible, I'd say we should all follow the Mayo Clinic

example and decide not to be medicare providers...maybe that would wake up

everyone to the benefits of good care...maybe not...but I think Mayo is still up

and running just fine without the confines and hassles of medicare. Obviously a

different animal than us, but still it's nice to see that it's possible not to

rely on the government so much. The true test if the cap does take effect, is

how long it will take the patients to get loud about the cap. Maybe after a

senators mother has a stroke and can't get the services she needs, congress will

pay more attention. Maybe AARP and others will be squeaky wheels to make a

change... or maybe this is the beginning of the government backing away from

many of the programs that cost a lot. Think about the amount of medicare the

huge influx of baby boomers will use...then think about what will be there for

the person who is now 3 years old....the way the nation looks at health care is

changing whether we like it or not...and the only people who can steer it are

the patients....that's all of us. I don't know the anwers,,,but do see some

strange times coming. Sorry for butting in.

Amy

Re: Changes because of the caps

,

Okay, so we disagree on how many people this is going to impact. You

did, however, steal my thunder about my greatest concerns about the

cap --- that there will be vast geographical differences in impact.

From very little, to pockets of complete entropy.

" Suggesting that the hospital " safety net " . . . even

exists in some communities is simply not true. "

I've suggested no such thing, in fact, that's where I've been heading

all along.

Are we arguing on that point of lack-of-backup as a profession? Are

we asking what is to happen to those patients who hit their cap and

then have to drive an excessive amount of miles to reach a hosptial

outpatient center? I agree that these are just one of the kinds of

people that are going to say to themselves, " forget it, it's not

worth the hassle. " The government's argument will, of course, be

that if these patients REALLY needed care, they'd find a way to get

it. I agree that it's setting the stage for the government to one

day claim the services of a (D)PT to be non-essential and therefore

non-reimbursable.

Come on , you're one of the people that I learned the value of

contingency planning from! In that vein, what are we doing as a

profession to ensure that IF the cap goes into effect, and IF a

patient exhausts their funds, and IF a patient has NO ACCESS to a

hosptial " safety net, " or IF for whatever reason, that safety net

does not serve the patient's needs --- what, if anything, are we as a

profession doing to ensure a crack in the armor? Have we raised the

issue of a waiver? Of an appeal process? I admit I've been out of

the loop for a while, but I've not heard of one.

We've got a little more than 40 days by my count. Were we 6 months

out, I'd have a different position. I KNOW it may compromise

political capital to do the following, but I personally fear that the

cap may be more likely to go into effect and stay in effect than ever

before. What's wrong with pressing hard against the cap, but also

pusing for clear and well defined back-up waiver and appeals

processes should the cap be enacted?

Dr. M. Ball, PT, DPT, PhD, MBA

Looking to start and own 100% of your own Practice?

Visit www.InHomeRehab.com.

PTManager encourages participation in your professional association. Join and

participate now!

[Guest guest]

If it were fiscally feasible, I'd say we should all follow the Mayo Clinic

example and decide not to be medicare providers...maybe that would wake up

everyone to the benefits of good care...maybe not...but I think Mayo is still up

and running just fine without the confines and hassles of medicare. Obviously a

different animal than us, but still it's nice to see that it's possible not to

rely on the government so much. The true test if the cap does take effect, is

how long it will take the patients to get loud about the cap. Maybe after a

senators mother has a stroke and can't get the services she needs, congress will

pay more attention. Maybe AARP and others will be squeaky wheels to make a

change... or maybe this is the beginning of the government backing away from

many of the programs that cost a lot. Think about the amount of medicare the

huge influx of baby boomers will use...then think about what will be there for

the person who is now 3 years old....the way the nation looks at health care is

changing whether we like it or not...and the only people who can steer it are

the patients....that's all of us. I don't know the anwers,,,but do see some

strange times coming. Sorry for butting in.

Amy

Re: Changes because of the caps

,

Okay, so we disagree on how many people this is going to impact. You

did, however, steal my thunder about my greatest concerns about the

cap --- that there will be vast geographical differences in impact.

From very little, to pockets of complete entropy.

" Suggesting that the hospital " safety net " . . . even

exists in some communities is simply not true. "

I've suggested no such thing, in fact, that's where I've been heading

all along.

Are we arguing on that point of lack-of-backup as a profession? Are

we asking what is to happen to those patients who hit their cap and

then have to drive an excessive amount of miles to reach a hosptial

outpatient center? I agree that these are just one of the kinds of

people that are going to say to themselves, " forget it, it's not

worth the hassle. " The government's argument will, of course, be

that if these patients REALLY needed care, they'd find a way to get

it. I agree that it's setting the stage for the government to one

day claim the services of a (D)PT to be non-essential and therefore

non-reimbursable.

Come on , you're one of the people that I learned the value of

contingency planning from! In that vein, what are we doing as a

profession to ensure that IF the cap goes into effect, and IF a

patient exhausts their funds, and IF a patient has NO ACCESS to a

hosptial " safety net, " or IF for whatever reason, that safety net

does not serve the patient's needs --- what, if anything, are we as a

profession doing to ensure a crack in the armor? Have we raised the

issue of a waiver? Of an appeal process? I admit I've been out of

the loop for a while, but I've not heard of one.

We've got a little more than 40 days by my count. Were we 6 months

out, I'd have a different position. I KNOW it may compromise

political capital to do the following, but I personally fear that the

cap may be more likely to go into effect and stay in effect than ever

before. What's wrong with pressing hard against the cap, but also

pusing for clear and well defined back-up waiver and appeals

processes should the cap be enacted?

Dr. M. Ball, PT, DPT, PhD, MBA

Looking to start and own 100% of your own Practice?

Visit www.InHomeRehab.com.

PTManager encourages participation in your professional association. Join and

participate now!

[Guest guest]

If it were fiscally feasible, I'd say we should all follow the Mayo Clinic

example and decide not to be medicare providers...maybe that would wake up

everyone to the benefits of good care...maybe not...but I think Mayo is still up

and running just fine without the confines and hassles of medicare. Obviously a

different animal than us, but still it's nice to see that it's possible not to

rely on the government so much. The true test if the cap does take effect, is

how long it will take the patients to get loud about the cap. Maybe after a

senators mother has a stroke and can't get the services she needs, congress will

pay more attention. Maybe AARP and others will be squeaky wheels to make a

change... or maybe this is the beginning of the government backing away from

many of the programs that cost a lot. Think about the amount of medicare the

huge influx of baby boomers will use...then think about what will be there for

the person who is now 3 years old....the way the nation looks at health care is

changing whether we like it or not...and the only people who can steer it are

the patients....that's all of us. I don't know the anwers,,,but do see some

strange times coming. Sorry for butting in.

Amy

Re: Changes because of the caps

,

Okay, so we disagree on how many people this is going to impact. You

did, however, steal my thunder about my greatest concerns about the

cap --- that there will be vast geographical differences in impact.

From very little, to pockets of complete entropy.

" Suggesting that the hospital " safety net " . . . even

exists in some communities is simply not true. "

I've suggested no such thing, in fact, that's where I've been heading

all along.

Are we arguing on that point of lack-of-backup as a profession? Are

we asking what is to happen to those patients who hit their cap and

then have to drive an excessive amount of miles to reach a hosptial

outpatient center? I agree that these are just one of the kinds of

people that are going to say to themselves, " forget it, it's not

worth the hassle. " The government's argument will, of course, be

that if these patients REALLY needed care, they'd find a way to get

it. I agree that it's setting the stage for the government to one

day claim the services of a (D)PT to be non-essential and therefore

non-reimbursable.

Come on , you're one of the people that I learned the value of

contingency planning from! In that vein, what are we doing as a

profession to ensure that IF the cap goes into effect, and IF a

patient exhausts their funds, and IF a patient has NO ACCESS to a

hosptial " safety net, " or IF for whatever reason, that safety net

does not serve the patient's needs --- what, if anything, are we as a

profession doing to ensure a crack in the armor? Have we raised the

issue of a waiver? Of an appeal process? I admit I've been out of

the loop for a while, but I've not heard of one.

We've got a little more than 40 days by my count. Were we 6 months

out, I'd have a different position. I KNOW it may compromise

political capital to do the following, but I personally fear that the

cap may be more likely to go into effect and stay in effect than ever

before. What's wrong with pressing hard against the cap, but also

pusing for clear and well defined back-up waiver and appeals

processes should the cap be enacted?

Dr. M. Ball, PT, DPT, PhD, MBA

Looking to start and own 100% of your own Practice?

Visit www.InHomeRehab.com.

PTManager encourages participation in your professional association. Join and

participate now!