MEDICARE CUTS: Therapy Specialties Feel the Pain

      In addition to tough payment negotiations with HMOs, physical, occupational and speech therapists have encountered major reimbursement setbacks under Medicare therapy restrictions established in January. Since the cutbacks took effect, the Pittsburgh Post-Gazette reports that therapists have seen their hours reduced, their salaries decreased and some have had their positions eliminated. According to Anthony Delitto, chair of the department of physical therapy at the University of Pittsburgh, "There is no question that it has had a huge impact. Right now, jobs are very difficult to come by." The regulations, stemming from the 1997 Balanced Budget Act, set Medicare limits on outpatient therapy at $1,500 yearly for combined physical and speech therapy and $1,500 annually for occupational therapy. In addition to "depressing the job market for therapists who work with the elderly," rehabilitation services for "some of the nation's most chronically ill patients" have been compromised. According to Jim Potter, spokesperson for the American Speech-Hearing-Language Association, "Even greater than the economic impact, is the fact that many patients covered by Medicare may not be able to receive the treatment they need to recuperate." He notes that $1,500 a year will not cover the necessary speech and physical therapy for a stroke victim, adding that "[p]atients have to choose between walking and talking." Therapist training has also been affected by the restrictions, since Medicare no longer pays for students who work with patients through internship programs. Delitto argues that "It will be difficult to get students the proper training. In turn, you will have less capable technicians." Despite the cuts, the Bureau of Labor Statistics still calls physical therapy "a career with very good job opportunities," while U.S. News and World Report calls it a "hot job." But American Physical Therapy Association Spokesperson Jennifer Hunt says, "We are no longer calling it the hot career that it once was ... We are predicting a glut in the market by 2005." All three therapy specialties are working to "repeal the caps" and "[s]everal pieces of legislation have been introduced" that call for limit exemptions in some cases (Ackerman, 8/15).