You may have read the recent NY Times’ article “A Change in Medicare has Therapists Alarmed.” Or you may have learned of the revised Medicare (Part A) payment policies through personal experience – perhaps a family member spent time in a skilled nursing facility after a hospitalization, or received home health therapy.
As a medical speech pathologist who has spent the last 11 years in our rapidly-evolving healthcare system, I feel it is necessary that all Medicare beneficiaries (and their families!) are made aware of some changes and their implications.
It would be an understatement to say that our system has needed an overhaul for a while. There have been countless reports over the years of financial waste, abuse and fraud around the country, partially a result of the increased reimbursement rates to organizations when they provided higher amounts of therapy for longer periods of time. However, now the pendulum has swung in the extreme opposite direction, and many of us are not yet aware of how impactful these changes will be.
As of October 2019, when Medicare revised its payment system to skilled nursing facilities, reimbursement now steadily declines once a patient has been in rehab for just 15 days. There is less financial incentive to keep this individual as a patient, and a greater likelihood that they may be sent home prematurely, even though they may still be unable to care for themselves.
Home health therapy has also taken a hit with its own Medicare reimbursement changes, which were implemented Jan. 1, 2020. With this new payment model, physical, occupational and speech therapy may now be rationed to a certain number of visits between all three disciplines. Patients with short-term needs will be prioritized, and those with more chronic conditions will have less access to home health therapy.
As we begin to see real effects from these reimbursement changes, it is critical that we stay informed and know how to advocate for ourselves and our loved ones to receive appropriate care. And since Medicare Part B has not yet been affected, we may see a spike in referrals for outpatient therapy.