FOR IMMEDIATE RELEASE Contact: LaFayette Physical Therapy
February 11, 2010 706-638-5983

MEDICARE BENEFICIARIES ALREADY NEARING 2010 LIMIT
ON OUTPATIENT REHAB SERVICES

LaFayette, Georgia, February 11, 2010 — Just 6 weeks into the new year, a growing number of Medicare beneficiaries—especially those in LaFayette, Georgia—are nearing their yearly financial limit (also known as therapy caps) on outpatient rehabilitation services provided by physical therapists and other health care providers, says local physical therapist Dr. LaTefa Terry, PT, DPT.
Imposed by the Balanced Budget Act of 1997, the therapy caps end Medicare's coverage of outpatient physical therapy, occupational therapy, and speech-language pathology services (hospital outpatient departments are exempt) billed under Medicare Part B once a beneficiary has received $1,860 of services in a calendar year. Congress has responded 6 times in the past to prevent Medicare beneficiaries from being negatively impacted by the therapy cap policy by delaying the enforcement of the caps and implementing an exceptions process that allowed services above the financial cap based on diagnosis, clinician evaluation, and judgment. However, the exceptions process expired December 31, 2009.
"With Medicare beneficiaries approaching the $1,860 cap, we need Congress to act now to ensure coverage for necessary services," said Dr. LaTefa Terry. "Senior citizens and people with disabilities who have chronic conditions or multiple comorbidities, or who experience stroke or hip fracture, may soon be negatively affected by the therapy caps."
While both the House and Senate versions of health care reform legislation addressed the therapy cap by extending the exceptions process temporarily, failure to enact reform has put beneficiaries who require rehabilitation after an illness or injury at considerable risk.
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Dr. LaTefa Terry, PT, DPT practices at LaFayette Physical Therapy. The facility provides physical therapy services for patients with Neurologic, Orthopedic, Balance/ Gait Impairments,
Arthritic pain and many others.

What You Can Do
v Call your Members of Congress TODAY. To reach your Member of Congress, contact the Capitol Switchboard at 202-224-3121. Ask the operator to direct you to your Member of Congress.
v Send an email, fax or letter to your Member of Congress TODAY.

Honorable Nathan Deal Honorable Saxby Chambliss Honorable Johnny Isakson
U.S. House of Representatives U.S. Senate U.S. Senate
2133 Rayburn House Off. Bldg. 416 Russell Senate Off. Bldg. 416 Russell Senate Off.Bldg
Washington, D.C. 20510 Washington, D.C. 20515-1005 Washington, D.C.20510-1006


For sample letters, please contact LaFayette Physical Therapy, 120 West Villanow St.,
LaFayette, GA 30728 by email at lafayettept@gmail.com (subject: Medicare cap)
or by phone at 706-638-5983.

NEW YEAR 2010
Let's Start the New Year off Right!!!

Regular exercise helps achieve and maintain weight loss, enhances mood, lowers blood pressure, improves sleep, improves bone density increases longevity, and reduces discomfort from arthritis. Setting reasonable goals and staying focused are the two most important factors in maintaning a regular excercise program. Here are a few tips to help keep you on track:

• Set a definite date to begin. Mark your calendar for a certain date for each goal that you want to achieve.
• Meet mini-goals: Make small changes every week and they will add up with time. Here are some examples of weekly changes you could incorporate into mini goals: Week One: Drink 8- 10 glasses of water a day. Week Two: Take the steps at work instead of the elevator
• Friends for ever: Tell your friends and family what you want to accomplish and tell them how to help you. Two heads are always better than one, especially when it comes to staying motivated.
• By creating goals, you can evaluate your progress better and know you've reached them. Having a realistic plan and being accountable to it are the keys to your success.
• Reward yourself when you have completed your goals.

START OUT on the RIGHT FOOT

Be sure to WARM-UP 5-7 minutes before exercising. Stretching and flexibility exercises keep muscles supple, increases range of motion of joints, enhances flexibility, improves coordination, increases heart rate, increases blood flow to muscles and prevents injuries. The right way to STRETCH is slow, sustained and relaxed. Stretch to the point of mild tension and hold. Back off if it feels painful. DO NOT BOUNCE. This can actually cause you to pull the muscle you are trying to stretch. HOLD the stretch for a minimum of 15 seconds each. BREATHE slowly and naturally. COOL DOWNS are performed after exercise for 5- 7 minutes. The purpose of cool down is togradually return your heart rate and blood pressure to resting or pre- exercising levels.

BE AWARE!

For all of those patients whose physicians refer to physical therapy, please

BE AWARE!!

Once a physician informs a patient that Physical Therapy is being prescribed for them, a person has a right to choose where they desire to go for Physical Therapy services. Several people have not encountered Physical Therapy in the past and may ask their physician where should I go for therapy? This is an appropriate question for the patient to ask the physician. The physician at that point can make suggestions. However, physicians are NOT to insist that a patient go to a specific practice for Physical Therapy services. This is inappropriate and violates your rights as a patient.

“Section 1877 of the Social Security Act (the Act), also referred to as the physician self-referral law (Stark II) prohibits a physician from making referrals for certain designated health care services (including physical therapy services) to an entity in which the physician (or an immediate family member of the physician) has a financial relationship (ownership or compensation interest), unless an exception applies.” (APTA website; Advocacy & Government Affairs)

In fact, when a physician or group of physicians has ownership in the providers of rehabilitation services, that information is to be disclosed to the patient or added to their prescription. Patients should BE AWARE that they have a right to go to any physical therapy clinic of their choice without feeling like their doctor would be displeased with them for their decision.

“A financial relationship can be either an ownership interest or a compensation arrangement, and can be direct or indirect.” (APTA website; Advocacy& Government Affairs)
“The law also prohibits an entity from billing for services provided as a result of the prohibited referral”. (APTA website; Advocacy & Government Affairs)

Several factors play into deciding where one may choose to go to physical therapy. Those factors include: location, cost, type of services provided, reputation, acceptance of different insurance policies, or personal preference.

Once a person has made a decision on a provider of rehabilitation services and is in compliance with the physicians orders; there should not be a problem. The therapist and the physician should have good rapport to communicate what is necessary in the overall wellbeing and progress of the patient.

The only time it is dictated where one MUST go for physical therapy services is when Worker’s Compensation is the payor source for their care. However, at that point it’s still NOT the decision of the physician on which facility to attend.

In conclusion, BE AWARE OF YOUR RIGHTS

you have a choice when Medicare or commercial insurance are the carriers.