Therapy cuts hurt seniors

Caps in Medicare coverage that limit how much can be spent on speech and physical therapy and similar services have skilled nursing facilities crying Uncle since the caps went into effect Jan. 1. Now they're turning to Nevada's congressional delegation for relief.

The cap of $1,500 per year for rehabilitative care costs just doesn't stretch far enough, representatives of the Nevada Health Care Association said. Considering that a typical session costs $40 and intensive therapy often calls for two sessions a day, the cap is easily reached inside a month, they said Wednesday at a news conference at the Las Vegas Senior Citizens Center.

The cap has caused major hardships for ailing seniors, officials of the group said as they called on Sens. Harry Reid and Richard Bryan, both D-Nev., to sponsor Senate Bill 1500, a bill by Sen. Orrin Hatch, R-Utah. Hatch's bill would relax the caps on services like physical and speech therapy that are provided by skilled nursing care facilities.

Reid has already introduced his own bill, Senate Bill 473, calling for a change in the caps that were imposed by the Balanced Budget Act of 1997 and took effect Jan. 1. The $1,500 cap includes occupational therapy.

"Medicare cuts resulting from the Balanced Budget Act -- and the way they are being implemented -- have clearly hurt the ability to ensure access to vital nursing home services for our most vulnerable seniors," Michael Clark, the group's executive director, said.

"The Medicare cuts to skilled nursing facilities will soon reach $2 billion per year -- almost double the $1.3 billion originally intended by Congress."

Nevada lawmakers already have initiated action on the issue. Reid's bill, the Medicare Rehabilitation Benefit Improvement Act of 1999, is in a Senate committee. A similar House measure, HR 1837, is sponsored by both Reps. Shelley Berkley, D-Nev., and Jim Gibbons, R-Nev.

Reid's bill calls for a payment system that reflects Medicare beneficiaries' needs based on their condition and not on an arbitrary monetary amount. His legislation allows the secretary of Health and Human Services to exempt people from the cap when their provider shows that they have medical needs costing more than $1,500.

But Reid also expressed support for Hatch's bill.

"When Congress reconvenes in September, I will co-sponsor S. 1500, which is a companion bill to my legislation to address the impact of the Balanced Budget Act on nursing homes throughout Nevada and the country," he said Wednesday.

Although Bryan says he is open to reviewing the cutbacks, he is not ready to co-sponsor either Reid's or Hatch's measures.

"The reductions we made extended solvency of Medicare from 2008 to 2015, and since then every major medical provider has come to us saying they cannot make it," Bryan said. "I will say that the therapy group (skilled nursing care) makes a good case, and we probably cut them back too far.

"Our job is to determine which ones (cutbacks) are legitimate. I am committed to review -- to take a look at each of them."

The Balanced Budget Act was designed to save the Medicare program, which is expected to be financially burdened by the first wave of 77 million baby boomers retiring in 2010. As a result of the caps and other measures in the act, Congress will reduce Medicare spending by an estimated $115 billion over the next five years.

Bryan said that because so little time has passed, the full benefit of the cutbacks on Medicare is not yet realized. To simply do away with cutbacks approved just two years ago could leave Medicare back in a jam by 2008, he said.

Proponents for nixing the caps say the skilled nursing care industry already is in a fix.

"By February, six of our patients had reached their caps," said Tammy McDermott, president of the Nevada Health Care Association who also runs the 118-bed Silver Hills Health Care Center in northwest Las Vegas, one of about 20 skilled nursing care facilities in Southern Nevada.

"We are seeing patients being cut off from physical therapy. This is wrong and this must stop."

McDermott said patients require different amounts of therapy based on the severity of their ailments. She noted that patients are charged $40 per 30 minutes of speech therapy, usually with two half-hour sessions per day. At that rate, it could take just a few weeks of intensive therapy for a patient to reach the cap.

Among those most affected by the caps are patients suffering from stroke, Parkinson's disease, diabetes, coronary disease, pneumonia, cancer, fractures and amputations. Those who exceed their limits must pay out of their pockets for additional care, rely on Medicare supplements to pick up the additional costs or forgo the care altogether.

"The Balanced Budget Act was a well-intentioned bill because Medicare was getting too expensive," McDermott said. "But while our industry was ready to absorb $1.3 billion in losses, $2 billion is just way too much."

An independent study by Washington D.C.-based Muse & Associates in June found that Medicare payments to skilled nursing facilities have decreased by 24 percent.

Reid earlier this year pointed to another study that showed that during the first month of the caps one in four beneficiaries who received therapy in skilled nursing facilities and in rehabilitative agencies had used up half of their benefits.

The House bill, which has 90 co-sponsors, would provide exemptions for those who qualify under certain conditions. Among them are patients who suffer injuries or ailments to different parts of the body during the same year and patients who suffer injuries or ailments to the same body part in different incidents during the same year.

Also under the House bill, a patient would be allowed to petition the Health and Human Services secretary for an exemption to the cap.

Hatch's bill, also called the Medicare Beneficiary Access to Quality Nursing Care Home Act of 1999, notes that senior Medicare patients are "experiencing decreased access to skilled nursing facility services (because of) inadequate reimbursement under the prospective payment system.

"Some inadequate reimbursement may force skilled nursing homes to file for bankruptcy and close their doors, resulting in reduced access to skilled nursing facility services for Medicare beneficiaries," the bill says.

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