Re: NOW on PTManager: Medicare: Lawsuit challenges controversial policy http://post.ly/1VLZI

[Guest guest]

It is a pity that the lawsuit does not include persons with chronic pain

conditions. As a physical therapist specialized in the physical therapy

management of persons with chronic pain conditions, many of my patients do not

necessarily always demonstrate functional progress and improvement, yet, without

PT they quickly get worse and lose basic functional abilities.

Jan Dommerholt, PT, DPT, MPS, DAAPM

Bethesda Physiocare®, Inc.

7830 Old town Road, Suite C-15

Bethesda, MD 20814-2440

United States

+ (voice)

+ (fax)

dommerholt@...

www.bethesdaphysiocare.com

[Guest guest]

It is a pity that the lawsuit does not include persons with chronic pain

conditions. As a physical therapist specialized in the physical therapy

management of persons with chronic pain conditions, many of my patients do not

necessarily always demonstrate functional progress and improvement, yet, without

PT they quickly get worse and lose basic functional abilities.

Jan Dommerholt, PT, DPT, MPS, DAAPM

Bethesda Physiocare®, Inc.

7830 Old town Road, Suite C-15

Bethesda, MD 20814-2440

United States

+ (voice)

+ (fax)

dommerholt@...

www.bethesdaphysiocare.com

[Guest guest]

It is a pity that the lawsuit does not include persons with chronic pain

conditions. As a physical therapist specialized in the physical therapy

management of persons with chronic pain conditions, many of my patients do not

necessarily always demonstrate functional progress and improvement, yet, without

PT they quickly get worse and lose basic functional abilities.

Jan Dommerholt, PT, DPT, MPS, DAAPM

Bethesda Physiocare®, Inc.

7830 Old town Road, Suite C-15

Bethesda, MD 20814-2440

United States

+ (voice)

+ (fax)

dommerholt@...

www.bethesdaphysiocare.com

[Guest guest]

Physical Therapists can contribute to this legal action by submitting stories of

patients who have been adversely affected by Medicare's illegal " Improvement

Standard " .

An example from the outpatient setting may illustrate the need for your stories.

For the last four years I have had to tell some of my patients that I cannot

append the -kx modifier when they near $1,840 in billed charges if I cannot show

meaningful progress using validated measures of function.

About 20% of Medicare patients have 5 or more chronic conditions. The most

common are COPD, eye disorders, CAD, AODM and hyperlipidemia. Many have more

severe conditions such as neurological deficits, lumbar spinal stenosis or CVA.

Many of these people will have difficulty achieving certain goals (eg: gait

velocity better than 3 sec. over 10', ABC test scores better than 68%, Berg

scores better than 45/56 or Functional Reach to 25 inches. Many have a previous

fall and take 4+ medications prescribed by their doctors.

If you have treated any of these people over the long term you may have

distressing stories of, what one of my patients humorously described as the

" Medicare Kabookie Dance " , - endless referrals, re-certifications, discharges

and future evaluations after a " sufficient " amount of time and a decline in

function.

Medicare beneficiaries DO NOT have to wait for a decline in function to receive

physical therapy. That's like the police who say they cannot arrest a crazy

stalker until AFTER a crime has been committed. Physical therapists can PREDICT

future adverse events using validated tools that most physicians have never even

heard of.

Maintenance therapy IS allowed to prevent a future adverse event: a fall, a

re-occurrence of chronic pain or an increase in disablement.

Various Medicare " experts " will tell you that maintenance therapy is not

allowed. They appear to be incorrect. This is an " urban legend " promoted by

compliance " gurus " at the expense of Americans who need our care the most.

We need your story...

Call the Center for Medicare Advocacy or go to their web page if you can share

your story with them:

http://www.medicareadvocacy.org/Projects/Improvement/ImprovementMain.htm

Tim , PT

www.PhysicalTherapyDiagnosis.com

>

> Now on PTManager <http://www.PTManager.Posterous.com>

>

> Medicare: Lawsuit challenges controversial policy

> Medicare's policy on therapy comes under attack Lawsuit charges government

> with illegally denying care to thousands of chronically ill recipients

>

<http://www.facebook.com/sharer.php?u=http%3A%2F%2Fwww.chicagotribune.com%2Fheal\

th%2Fct-met-medicare-lawsuit-20110118%2C0%2C7699963.story & t=Medicare%3A%20Lawsui\

t%20challenges%20controversial%20policy%20-%20chicagotribune.com & src=sp>

> By

> Judith Graham, Tribune Newspapers

>

>

> 6:21 p.m. CST, January 18, 2011

>

>

>

> The federal government is illegally denying thousands of chronically ill

> Americans needed therapies and medical services, five national organizations

> charged Tuesday in a lawsuit filed in U.S. District Court in

>

Vermont<http://www.chicagotribune.com/health/ct-met-medicare-lawsuit-20110118,0,\

7699963.story#>

> .

>

> The class action lawsuit is the first to mount a broad challenge to a

> controversial

Medicare<http://www.chicagotribune.com/health/ct-met-medicare-lawsuit-20110118,0\

,7699963.story#>policy

> requiring that patients achieve demonstrable improvements in

> functioning in order to qualify for physical, speech and occupational

> therapy and skilled

>

nursing<http://www.chicagotribune.com/health/ct-met-medicare-lawsuit-20110118,0,\

7699963.story#>care.

> More at http://post.ly/1VLZI

>

>

> Kovacek, PT, MSA, DPT

> PKovacek@...

> Cell (313) 492-4293

> Personal Fax

>

> Twitter.com/PKovacek

> Facebook.com/.Kovacek

>

>

>